Prognostic value of the six-minute walk test in heart failure patients undergoing cardiac surgery: a literature review

Development a nomogram prognostic model for survival in heart failure patients based on the HF-ACTION data

BACKGROUND

The risk assessment for survival in heart failure (HF) remains one of the key focuses of research. This study aims to develop a simple and feasible nomogram model for survival in HF based on the Heart Failure-A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) to support clinical decision-making.

METHODS

The HF patients were extracted from the HF-ACTION database and randomly divided into a training cohort and a validation cohort at a ratio of 7:3. Multivariate Cox regression was used to identify and integrate significant prognostic factors to form a nomogram, which was displayed in the form of a static nomogram. Bootstrap resampling (resampling = 1000) and cross-validation was used to internally validate the model. The prognostic performance of the model was measured by the concordance index (C-index), calibration curve, and the decision curve analysis.

RESULTS

There were 1394 patients with HF in the overall analysis. Seven prognostic factors, which included age, body mass index (BMI), sex, diastolic blood pressure (DBP), exercise duration, peak exercise oxygen consumption (peak VO2), and loop diuretic, were identified and applied to the nomogram construction based on the training cohort. The C-index of this model in the training cohort was 0.715 (95% confidence interval (CI): 0.700, 0.766) and 0.662 (95% CI: 0.646, 0.752) in the validation cohort. The area under the ROC curve (AUC) value of 365- and 730-day survival is (0.731, 0.734) and (0.640, 0.693) respectively in the training cohort and validation cohort. The calibration curve showed good consistency between nomogram-predicted survival and actual observed survival. The decision curve analysis (DCA) revealed net benefit is higher than the reference line in a narrow range of cutoff probabilities and the result of cross-validation indicates that the model performance is relatively robust.

CONCLUSIONS

This study created a nomogram prognostic model for survival in HF based on a large American population, which can provide additional decision information for the risk prediction of HF.

Comparison of a Wearable Accelerometer/Gyroscopic, Portable Gait Analysis System (LEGSYS+TM) to the Laboratory Standard of Static Motion Capture Camera Analysis

Examination of gait patterns has been used to determine severity, intervention triage and prognostic measures for many health conditions. Methods that generate detailed gait data for clinical use are typically logistically constrained to a formal gait laboratory setting. This has led to an interest in portable analysis systems for near clinical or community-based assessments. The following study assessed with the wearable accelerometer/gyroscopic, gait analysis system (LEGSYS+^TM) and the standard of static motion capture camera (MOCAP) analysis during a treadmill walk at three different walking speeds in healthy participants (n = 15). To compare each speed, 20 strides were selected from the MOCAP data and compared with the LEGSYS+ strides at the same time point. Both scatter and bland-Altman plots with accompanying linear regression analysis for each of the parameters. Each stride parameter showed minimal or a consistent difference between the LEGSYS+ and MOCAP, with the phase parameters showing inconsistencies between the systems. Overall, LEGSYS+ stride parameters can be used in the clinical setting, with the utility of phase parameters needing to be taken with caution.

Estimation of Functional Aerobic Capacity Using the Sit-to-Stand Test in Older Adults with Heart Failure with Preserved Ejection Fraction

Background: The 6-Min Walking Test (6MWT) has been proposed to assess functional aerobic capacity in patients with heart failure, but many older adults with heart failure cannot complete it. The adequacy of the 5-repetition Sit-To-Stand (5-STS), a simpler test than 6MWT, to assess the functional aerobic capacity in older adults with heart failure has not been evaluated. Objectives: This study aimed to assess the usefulness of 5-STS in estimating maximal oxygen uptake (VO2 peak) in older adults with heart failure with preserved ejection fraction (HFpEF). Methods: A cross-sectional study was carried out. Patients 70 years and older with HFpEF were included. A bivariant Pearson correlation and subsequent multivariate linear regression analysis were used to analyze the correlations between the 5-STS and the estimated VO2 peak. Results: Seventy-six patients (80.74 (5.89) years) were recruited. The 5-STS showed a moderate and inversely correlation with the estimated VO2 peak (r = −0.555, p < 0.001). The 5-STS explained 40.4% of the variance in the estimated VO2 peak, adjusted by age, sex, and BMI. When older adults were stratified by BMI, the 5-STS explained 70% and 31.4% of the variance in the estimated VO2 peak in older adults with normal weight and overweight/obesity, respectively. Conclusions: The 5-STS may be an easy tool to assess functional aerobic capacity in older adults with HFpEF, especially for those with normal weight.

Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis

BACKGROUND

Patients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Moreover, physical functional performance in functional tests has also been related to the prognosis in patients with HF. Thus, it would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65 years old. This systematic review and meta-analysis aims to summarise and synthesise the evidence published about the relationship between physical functional performance and prognosis in patients with HF, as well as assess the risk of bias of included studies and the level of evidence per outcome.

METHODS

Major electronic databases, such as PubMed, AMED, CINAHL, EMBASE, PEDro, Web of Science, were searched from inception to March 2020 for observational longitudinal cohort studies (prospective or retrospective) examining the relationship between physical functional performance and prognosis in patients with HF.

RESULTS

44 observational longitudinal cohort studies with a total of 22,598 patients with HF were included. 26 included studies reported a low risk of bias, and 17 included studies showed a moderate risk of bias. Patients with poor physical functional performance in the Six Minute Walking Test (6MWT), in the Short Physical Performance Battery (SPPB) and in the Gait Speed Test showed worse prognosis in terms of larger risk of hospitalisation or mortality than patients with good physical functional performance. However, there was a lack of homogeneity regarding which cut-off points should be used to stratify patients with poor physical functional performance from patients with good physical functional performance.

CONCLUSION

The review includes a large number of studies which show a strong relationship between physical functional performance and prognosis in patients with HF. Most of the included studies reported a low risk of bias, and GRADE criteria showed a low and a moderate level of evidence per outcome.

Composite Uremic Load and Physical Performance in Hemodialysis Patients: A Cross-Sectional Study

Impaired physical performance is common in patients on hemodialysis (HD) and is associated with poor prognosis. A patient relevant marker of adequacy of dialysis is lacking. Previous studies evaluated uremic toxicity by assessing the impact of different uremic toxins separately. However, such an approach is most likely not reflective of true uremic toxicity. Therefore, this cross-sectional study aimed to examine if the uremic syndrome, estimated as one composite of different uremic toxins (facilitated by ridge regression method) to reflect the kinetic behavior during dialysis, is associated with physical performance in patients on HD. Levels of p-cresyl glucuronide and sulfate, indole-acetic acid, indoxyl sulfate, uric acid, hippuric acid, and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid were assessed and associated by ridge regression to muscle strength, functional exercise capacity, and measures of balance and coordination. 75 HD patients were included (mean age 68 years, 57% male). The composite of different uremic toxins (i.e., uremic load) explained 22% of the variance in handgrip strength. Although there was an association between full body muscle strength and the composite uremic load independent of nutritional status, age and gender, the predictive power of composite uremic load for muscle weakness is limited. Single uremic toxins as well as composite uremic load were not associated with exercise capacity, coordination, and balance, indicating that the degree of uremia does not predict physical performance in patients on HD.

The Importance of the Double Product in the Six-Minute Walk Test to Predict Myocardial Function

Introduction

The Six-Minute Walk Test (6MWT) is a widely used test to measure the physical performance of patients to assess the effectiveness of treatment, to qualify for rehabilitation, and to evaluate its effects..

Aim

This paper focuses on the assessment of the growth of a double product (DP) during the 6MWT and its diagnostic value in the assessment of patients with heart failure.

Material and Methods

The paper has retrospective character. We analyzed medical records of 412 patients hospitalized for cardiac reasons, in whom a 6MWT was performed. The patients were divided into two groups: one with diagnosed heart failure and a control group.

Results

The patients with diagnosed heart failure, compared to the control group, were characterized by a shorter walking distance and greater DP increase at equal walking intervals. After distinguishing the group with the preserved and decreased left ventricle ejection fraction, the value of the DP increase was still higher compared to the control group. The mean DP increase corresponding to one meter of walk was the only one that correlated negatively with the left ventricular ejection fraction.

Conclusion

The assessment of the increase of the DP during the march test seems to be a better parameter reflecting the efficiency of the myocardium from the distance of the march.

Six-Minute Walk Test for Assessing Physical Functional Capacity in Chronic Heart Failure

PURPOSE OF THE REVIEW

The six-minute walk test (6MWT) is a submaximal exercise test for evaluating physical functional capacity. This review aims to report the research on the use of the 6MWT in chronic heart failure (CHF) that has been published in the past 5 years.

RECENT FINDINGS

The 6MWT distance does not accurately reflect peak VO₂. Minimal clinically important difference in the 6MWT distance, and additional measurements, such as heart rate recovery, can assist in the interpretation of the 6MWT distance, so management decisions can be made. Incorporating mobile apps and information technology in measuring the 6MWT distance extends the usefulness of this simple walk test and improve remote monitoring of patients with CHF. The 6MWT is a useful tool in CHF programs. However, interpretation of the 6MWT distance must be with caution. With the advancement in technology, the 6MWT has the potential to facilitate the monitoring of people living in rural and remote areas.

Left atrium in cardiac resynchronization therapy: Active participant or innocent bystander

Background

Cardiac resynchronization therapy (CRT) is an established treatment for patients with advanced heart failure that results in improvement of left ventricle (LV) systolic function and LV reverse remodeling. This may have a positive effect on the size and the function of the left atrium (LA). We assessed the LA function, dimensions, and volumes before and after CRT implantation.

Methods

A total of 37 patients with mean age of 55.3 ± 9.64 years including 11 (29.7%) females, having symptomatic heart failure [ejection fraction (EF) <35%, left bundle branch block >120 ms, with New York Heart Association III or ambulatory class IV] were enrolled, and underwent CRT implantation. M-mode, two-dimensional (2D) echocardiography, tissue Doppler imaging, and 2D strain (ɛ) imaging were done assessing LV volumes, ejection fraction, and diastolic function, LA diameter, area, maximal and minimal volumes, LA EF, and longitudinal strain (ɛ). Patients were reassessed after 3 months. A reduction in LV end-systolic volume of ≥10% was defined as volumetric responders to CRT. Patients with decompensated New York Heart Association class IV, sustained atrial arrhythmias, rheumatic or congenital heart diseases, nonleft bundle branch block, and those who were poorly echogenic, were excluded.

Results

Twenty-four (64.8%) patients were volumetric responders (group A). Both groups were matched regarding demographic, clinical, electrocardiographic, and echocardiographic criteria apart from the LA dimension and volumes which were significantly lower in the responders group prior to CRT. At the end of the follow-up, only the responders group had further significant reduction in LA diameter (41.6 ± 1.67 vs. 43.88 ± 1.82 mm, p < 0.01), maximal volume (62.2 ± 18.3 vs. 73.04 ± 21.78 ml, p < 0.01), minimal volume (32.6 ± 12.3 vs. 41.8 ± 13.97, p < 0.01), together with a significant increase in LA EF (48.3 ± 11.3 vs. 41.99 ± 13.9, p < 0.01), positive longitudinal strain (16.59% ± 5.89 vs. 12.45% ± 6.12, p < 0.01), and negative longitudinal strain (−3.3 ± 1.9 vs. −1.62 ± 1.2, p < 0.01) compared to baseline readings, a finding that was not present in the nonresponders group. In addition, atrial fibrillation was significantly higher in the nonresponders group. Baseline LA diameter and volumes were found to be independent predictors of response to CRT by multivariate analysis.

Conclusions

CRT induces LA anatomic, electrical, and structural reverse remodeling that could be assessed by conventional 2D echocardiography and 2D (ɛ) strain imaging. LA dimension and volumes were independent predictors of response to CRT and can help in selection of candidates for it.

Effect of prophylactic non-invasive mechanical ventilation on functional capacity after heart valve replacement: a clinical trial

OBJECTIVE

During cardiac surgery, several factors contribute to the development of postoperative pulmonary complications. Non-invasive ventilation is a promising therapeutic tool for improving the functionality of this type of patient. The aim of this study is to evaluate the functional capacity and length of stay of patients in a nosocomial intensive care unit who underwent prophylactic non-invasive ventilation after heart valve replacement.

METHOD

The study was a controlled clinical trial, comprising 50 individuals of both sexes who were allocated by randomization into two groups with 25 patients in each group: the control group and experimental group. After surgery, the patients were transferred to the intensive care unit and then participated in standard physical therapy, which was provided to the experimental group after 3 applications of non-invasive ventilation within the first 26 hours after extubation. For non-invasive ventilation, the positive pressure was 10 cm H2O, with a duration of 1 hour. The evaluation was performed on the 7th postoperative day/discharge and included a 6-minute walk test. The intensive care unit and hospitalization times were monitored in both groups. Brazilian Registry of Clinical Trials (REBeC): RBR number 8bxdd3.

RESULTS

Analysis of the 6-minute walk test showed that the control group walked an average distance of 264.34±76 meters and the experimental group walked an average distance of 334.07±71 meters (p=0.002). The intensive care unit and hospitalization times did not differ between the groups.

CONCLUSION

Non-invasive ventilation as a therapeutic resource was effective toward improving functionality; however, non-invasive ventilation did not influence the intensive care unit or hospitalization times of the studied cardiac patients.

Assessment of right ventriclular systolic function prior to cardiac resynchronization therapy: Does it make any difference?

Background

Cardiac resynchronization therapy (CRT) is an effective treatment for patients with advanced heart failure (HF). Nearly 30% of candidates are inadequate responders. The benefit of patients with right sided heart failure from CRT is still a matter of debate. We examined the effect of CRT on right ventricular (RV) dimensions and overall systolic function and whether RV function prior to CRT could have an impact on CRT response.

Methods

94 patients with a mean age of 53.7 ± 14.6 years including 19 (20%) females, with advanced HF (EF < 35%, LBBB > 120 ms, or non-LBBB > 150 ms, with NYHA –III or ambulatory class IV) were enrolled and underwent CRT implantation. Standard two dimensional (2D) echocardiography, tissue Doppler imaging, for assessment of Left ventricular (LV) end-diastolic (LVEDV), and end-systolic volumes (LVESV), ejection fraction, RV maximum basal (RVD basal), maximum mid (RVD mid) transverse, maximum longitudinal (RVD long) diameters, TAPSE, fractional area change (FAC), and tricuspid lateral annular systolic velocity (S′), in addition to RV global longitudinal strain (RVGLS) measured by speckle tracking echocardiography, were done before CRT implantation and at the end of the follow up period (5.9 ± 1.2 months). Patients presenting with reductions of LVESV of >15% were termed volumetric responders for further statistical analysis.

Results

63 (67%) cases were volumetric responders. Both groups were matched regarding demographic, clinical, ECG, and echocardiographic criteria apart from the RV significantly smaller transverse diameters and significantly better systolic function parameters in the responders group prior to CRT compared to non-responders (NR) group. At the end of the follow up, only the responders group had further significant reduction in RV basal, mid and longitudinal diameters (33.6 ± 7.1 vs 40.7 ± 8.6, 21.4 ± 4.9 vs 27 ± 6.1, 68.3 ± 10.8 vs 81.2 ± 15, respectively), p < 0.01, together with significant improvement in RV systolic performance: FAC (47.7 ± 7.3 vs 40.9 ± 6.4), TAPSE (25.2 ± 4.6 vs 22.1 ± 4.9), S′ (15.3 ± 2.3 vs 12.8 ± 2.3), and GLS (26.1 ± 2.1 vs 18.5 ± 1.6), P < 0.01, compared to baseline readings. S' and GLS were the only independent predictors of CRT response by multivariate analysis. S′ >9 cm/s, and GLS >12.45% had 100% sensitivity and 70%, 99.7% specificity, respectively for prediction of response to CRT.

Conclusions

CRT induces RV reverse remodeling and improves RV systolic function particularly in cardiac volumetric responders. RV systolic dysfunction before CRT implantation could identify patients that might not benefit from CRT thus helping proper patient selection and optimizing CRT response.

Prognostic indices among hypertensive heart failure patients in Nigeria: the roles of 24-hour Holter electrocardiography and 6-minute walk test

Background

Hypertensive heart failure (HHF) is associated with a poor prognosis. There is paucity of data in Nigeria on prognosis among HHF patients elucidating the role of 24-hour Holter electrocardiogram (ECG) in concert with other risk factors.

Objective

The aim of this study was to determine the prognostic utility of 24-hour Holter ECG, the 6-minute walk test (6-MWT), echocardiography, clinical and laboratory parameters among HHF patients.

Methods

A total of 113 HHF patients were recruited and followed up for 6 months. Thirteen of these patients were lost to follow-up, and as a result only 100 HHF patients were analyzed. All the patients underwent baseline laboratory tests, echocardiography, 24-hour Holter ECG and the 6-MWT. HHF patients were analyzed as “mortality vs alive” and as “events vs no-events” based on the outcome at the end of 6 months. Events was defined as HHF patients who were rehospitalized for heart failure (HF), had prolonged hospital stay or died. No-events group was defined as HHF patients who did not meet the criteria for the events group.

Results

HHF patients in the mortality group (n = 7) had significantly higher serum urea (5.71 ± 2.07 mmol/L vs 3.93 ± 1.45 mmol/L, p = 0.003) than that in those alive. After logistic regression, high serum urea conferred increased mortality risk (p = 0.035). Significant premature ventricular complexes (PVCs) on 24-hour Holter ECG following logistic regression were also significantly higher (p = 0.015) in the mortality group than in the “alive” group (n = 93) at the end of the 6-month follow-up period. The 6-minute walk distance (6-MWD) was least among the HHF patients who died (167.26 m ± 85.24 m). However, following logistic regression, the 6-MWT was not significant (p = 0.777) for predicting adverse outcomes among HHF patients. Patients in the events group (n = 41) had significantly higher New York Heart Association (NYHA) class (p = 0.001), Holter-detected ventricular tachycardia (VT; p = 0.009), Holter-detected atrial fibrillation (AF; p = 0.028) and PVCs (p = 0.017) following logistic regression than those in the no-events group (n = 59).

Conclusion

High NYHA class, elevated serum urea, Holter ECG-detected AF and ventricular arrhythmias are predictive of a poor outcome among HHF patients. The 6-MWT was not a useful prognostic index in this study.

Using three-dimensional echocardiography to guide left ventricle lead position in cardiac resynchronization therapy: does it make any difference

BACKGROUND

Cardiac resynchronization therapy (CRT) is an effective treatment for patients with advanced heart failure. Nearly 30% of candidates are inadequate responders. Proper patient selection, left ventricle (LV) lead placement optimization, and optimization of the programming of the CRT device are important approaches to improve outcome of CRT. We examined the role of three-dimensional (3D) echocardiography in determining the optimal LV lead position as a method of optimizing CRT response.

METHODS

Forty-seven patients with a mean age of 60.2 ± 11.1 years including five (10.6%) females, all having advanced CHF (EF <35%, LBBB >120 mesc, or non-LBBB >150 msec, with NYHA II-III or ambulatory class IV) were enrolled. Detailed history (NYHA class, Minnesota living with heart failure questionnaire), clinical examination, 6-min walk test, and standard 2D echocardiography were done in all cases. 3D echo detailed analysis of the LV 16 segments was done to determine the latest wall to reach the minimal systolic volume. Multisite pacing was done blind to the 3D echo data achieving a stable LV lead position in mid LV segment. This exact fluoroscopic site was determined (in two orthogonal views) and correlated with 3D most delayed area using a resized 16-segment schema. Patients were classified retrospectively into group A with concordance between the delayed LV area and LV lead position and group B with discordance between both. Patients were followed up after 3-6 (5.1 ± 1.8) months. Patients with reduction of 2D LV end-systolic volume of ≥10% at follow-up were termed volumetric responders. Poorly echogenic patients and those with decompensated NYHA class IV, sustained atrial arrhythmias, and rheumatic or congenital heart diseases were excluded.

RESULTS

LV lead placement was concordant in 22 (46.8%) cases. After the follow-up period, 31 (65.9%) of the study population were considered volumetric responders with no significant difference among both groups (14 (63.3%) in group A vs 17 (68%) in group B, p > 0.05). CRT insertion resulted in significant improvement of NYHA class in 36 (76.5%) cases, 6-min walk test (447.2 ± 127.0 vs 369.6 ± 87.5 m, p < 0.01), MLHFQ (58.1 ± 19.7 vs 69.6 ± 13.5, p < 0.01), QRS duration (131.2 ± 13.8 vs 149.4 ± 16 msec, p < 0.01), 2D LV EF 33.0 ± 9.5 vs 25.3 ± 6.5, p < 0.001), LVESV (156.0 ± 82.9 vs177.6 ± 92.7 ml, p < 0.05), and 3D LVEF (29.1 ± 9.0 vs 23.6 ± 5.9, p < 0.001) irrespective of the etiology of heart failure. However, there were no significant differences between both groups regarding the same parameters (6-min walk test 470.8 ± 128.7 vs 428.3 ± 126.8 m, MLHFQ 56.8 ± 20.0 vs 58.11 ± 19.0, QRS duration 129.9 ± 12.4 vs 132.1 ± 15.1 msec, 2D LVEF 30.9 ± 8.3 vs 34.58 ± 10.9, LVESV 173.0 ± 110.0 vs 143.0 ± 67.9, 3D LVEF 26 ± 8 vs 31 ± 9, for groups A and B, respectively, p < 0.05).

CONCLUSIONS

Standard anatomical LV lead placement remains a simple, practical, and effective method in patients undergoing CRT. 3D echocardiography-guided LV lead placement added no clinical benefit compared to standard techniques.

Comparison of Flow and Volume Incentive Spirometry on Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical Trial

INTRODUCTION

Surgical procedures in abdominal area lead to changes in pulmonary function, respiratory mechanics and impaired physical capacity leading to postoperative pulmonary complications, which can affect up to 80% of upper abdominal surgery.

AIM

To evaluate the effects of flow and volume incentive spirometry on pulmonary function and exercise tolerance in patients undergoing open abdominal surgery.

MATERIALS AND METHODS

A randomized clinical trial was conducted in a hospital of Mangalore city in Southern India. Thirty-seven males and thirteen females who were undergoing abdominal surgeries were included and allocated into flow and volume incentive spirometry groups by block randomization. All subjects underwent evaluations of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow (PEF). Preoperative and postoperative measurements were taken up to day 5 for both groups. Exercise tolerance measured by Six- Minute Walk Test during preoperative period and measured again at the time of discharge for both groups. Pulmonary function was analysed by post-hoc analysis and carried out using Bonferroni's 't'-test. Exercise tolerance was analysed by Paired 'T'-test.

RESULTS

Pulmonary function (FVC, FEV1, and PEFR) was found to be significantly decreased in 1(st), 2(nd) and 3(rd) postoperative day when compared with preoperative day. On 4(th) and 5(th) postoperative day the pulmonary function (FVC, FEV1, and PEFR) was found to be better preserved in both flow and volume incentive spirometry groups. The Six-Minute Walk Test showed a statistically significant improvement in pulmonary function on the day of discharge than in the preoperative period. In terms of distance covered, the volume- incentive spirometry group showed a greater statistically significant improvement from the preoperative period to the time of discharge than was exhibited by the flow incentive spirometry group.

CONCLUSION

Flow and volume incentive spirometry can be safely recommended to patients undergoing open abdominal surgery as there have been no adverse events recorded. Also, these led to a demonstrable improvement in pulmonary function and exercise tolerance.

Enhancing behavioral change with motivational interviewing: a case study in a Cardiac Rehabilitation Unit

BACKGROUND

Psychological interventions in cardiac rehabilitation programs appear relevant in as much they significantly contribute to achieve the goals of rehabilitation, to reduce the risk of relapses and to improve patients' adherence to therapy. To this aim, motivational interviewing (MI) has shown promising results in improving motivation to change and individuals' confidence in their ability to do so.

OBJECTIVE

The purpose of this article is to integrate theory with practice by describing a three-session case scenario. It illustrates how MI's skills and strategies can be used to enhance heart-healthy habits. MI may be synergistic with other treatment approaches and it is used here in conjunction with brief strategic therapy.

CONCLUSION

By the use of MI principles and techniques, the patient reported an increase in his motivation and ability to change, developing a post discharge plan that incorporates self-care behaviors.

CLINICAL IMPLICATIONS

MI may be effective in motivating and facilitating health behavior change among obese patients suffering from heart failure.

Influence of cardiac rehabilitation in Primigravida with spontaneous coronary artery dissection during postpartum

BACKGROUND

The physical exercise consists of trainable physical abilities such as strength and endurance. It can be inferred that the individual cardiac patient is dependent on it as an associated therapy to the drug treatment for a rapid and lasting improvement of their overall clinical status.

CASE PRESENTATION

The patient - with Spontaneous Coronary Artery Dissection Postpartum period - was subjected to 21 sessions of cardiac rehabilitation. A physical evaluation was performed, before and after the treatment period, for data collection: anthropometric values, flexibility, aerobic capacity and strength of grip.

CONCLUSION

The patient had a positive response in aerobic capacity, flexibility and grip strength and the anthropometric values were kept in short term rehabilitation.