Telerrehabilitación en personas con enfermedad cardiovascular durante el periodo de aislamiento preventivo obligatorio por COVID-19 en Colombia

Introducción

La enfermedad cardiovascular es una de las principales causas de morbimortalidad a nivel mundial. Como resultado de la pandemia de COVID-19, muchos programas de rehabilitación han pasado a modelos de entrega remota. La telerrehabilitación es una forma de realizar rehabilitación cardiaca mientras se reduce el riesgo de transmisión del COVID-19.

Objetivo

Describir los efectos de un programa de ejercicio terapéutico en personas con enfermedad cardiovascular que realizan telerrehabilitación, en el periodo de aislamiento preventivo obligatorio por COVID-19.

Materiales y métodos

Estudio cuasiexperimental, de 6 meses, en personas con enfermedad cardiovascular que ingresaron a un programa de ejercicio terapéutico asistido por tecnología virtual en una clínica de Cali (Colombia).

Resultados

De 31 personas, 21 eran hombres. La edad promedio fue de 60,48 ± 11,21 años. Se encontraron diferencias significativas al inicio y al final del estudio en las variables de fracción de eyección del ventrículo izquierdo, frecuencia cardiaca, presión arterial, frecuencia respiratoria, índice de masa corporal, perímetro de abdomen, porcentaje de grasa, porcentaje de masa muscular, colesterol, estado de depresión, distancia recorrida, consumo de oxígeno e índice metabólico (MET), con p < 0,05.

Conclusión

Un programa de ejercicio terapéutico en personas con enfermedad cardiovascular que realizan telerrehabilitación resulta eficaz, al alcanzar las metas de tratamiento.

A Contemporary Review of the Effects of Exercise Training on Cardiac Structure and Function and Cardiovascular Risk Profile: Insights From Imaging

Exercise is a commonly prescribed therapy for patients with established cardiovascular disease or those at high risk for de novo disease. Exercise-based, multidisciplinary programs have been associated with improved clinical outcomes post myocardial infarction and is now recommended for patients with cancer at elevated risk for cardiovascular complications. Imaging studies have documented numerous beneficial effects of exercise on cardiac structure and function, vascular function and more recently on the cardiovascular risk profile. In this contemporary review, we will discuss the effects of exercise training on imaging-derived cardiovascular outcomes. For cardiac imaging via echocardiography or magnetic resonance, we will review the effects of exercise on left ventricular function and remodeling in patients with established or at risk for cardiac disease (myocardial infarction, heart failure, cancer survivors), and the potential utility of exercise stress to assess cardiac reserve. Exercise training also has salient effects on vascular function and health including the attenuation of age-associated arterial stiffness and thickening as assessed by Doppler ultrasound. Finally, we will review recent data on the relationship between exercise training and regional adipose tissue deposition, an emerging marker of cardiovascular risk. Imaging provides comprehensive and accurate quantification of cardiac, vascular and cardiometabolic health, and may allow refinement of risk stratification in select patient populations. Future studies are needed to evaluate the clinical utility of novel imaging metrics following exercise training.

Weight gain post-heart transplantation is associated with an increased risk for allograft vasculopathy and rejection

OBJECTIVE

Obesity and overweight are associated with an increased risk for cardiovascular disease. Since fat mass (FM) and fat-free mass (FFM) both contribute to total body weight (TBW), we characterized the post-heart transplantation (HT) change in TBW and its implications for outcomes.

METHODS

Post-HT changes in TBW, FM, and FFM were reviewed for 211 HT patients assessed during 1997-2017. Endpoints included cardiac allograft vasculopathy (CAV) and rejection.

RESULTS

Median TBW increased by 7.3% at 1 year, with a significant rise in the obese category (28% vs. 13%, p < 0.001) and with FM versus FFM making the main contribution (23% vs. 3%, p < 0.001). When patients were divided according to median TBW change ("high" vs. "low"), Kaplan-Meier analysis showed that 10-year freedom from CAV (log-rank p < 0.005) and rejection (log-rank p < 0.01) was significantly higher for the "low" TBW change group. Consistently, multivariable analyses showed that the "high" group was independently associated with significant 3.5-fold and 4.2-fold increased risks for CAV (95% CI 1.4-8.7, p = 0.01) and rejection (95% CI 1.2-15.4, p = 0.03), respectively.

CONCLUSIONS

Weight gain, contributed mostly by FM, is independently associated with an increased risk for CAV and rejection. Follow-up emphasis should be placed on weight gain and preventative measures.

Android to gynoid fat ratio and its association with functional capacity in male patients with heart failure

AIMS

We studied the association between android (A) to gynoid (G) fat ratio and functional capacity (peak VO₂ ) in male patients with heart failure with reduced ejection fraction (HFrEF).

METHODS AND RESULTS

We enrolled 118 male patients with HFrEF with left ventricular ejection fraction (LVEF) <40%. Body composition (by using dual x-ray absorptiometry) and peak VO₂ (by cardiopulmonary exercise testing) were measured. Sarcopenic obesity was defined according to the Foundation for the National Institutes of Health criteria (FNIH). Blood sample for metabolic and hormonal parameters were measured. Fifteen patients (12.7%) showed sarcopenic obesity (body mass index > 25 kg/m² with FNIH index < 0.789). The median A/G ratio was 0.55. A/G ratio > 0.55 was detected in 60 patients. Relative peak VO₂ was lower in patients with A/G ratio > 0.55 than in patients with A/G ratio <0.55 (18.7 ± 5.3 vs. 22.5 ± 6.1 mL/kg/min, P < 0.001). Logistic regression analysis showed A/G ratio >0.55 to be independently associated with reduced peak VO₂ adjusted for age, body mass index, LVEF, presence of sarcopenia, anabolic hormones, and haemoglobin (odds ratio 3.895, 95% confidence interval 1.030-14.730, P = 0.045).

CONCLUSIONS

Body fat distribution, particularly android and gynoid fat composition, together with other cofactors, might have an important adverse role on functional capacity in male patients with HFrEF. Future studies are needed to address possible mechanisms involved in this relationship.

Peak Work Rate during Exercise Could Detect Frailty Status in Elderly Patients with Stable Heart Failure

The Kihon Checklist (KCL) is a reliable tool for determining frailty status in the elderly. However, there is no information in the literature about the relationship between frailty status and exercise capacity. Here, we examined the associations between cardiopulmonary exercise testing parameters and frailty status in elderly patients with stable heart failure (HF).Ninety-two elderly patients with stable HF were evaluated using cardiopulmonary exercise testing and the KCL. A KCL score of 0-3 was classified as robust, 4-7 as pre-frail, and ≥ 8 as frail.Mean age, peak VO₂, and KCL score were 81.7 years, 13.2 mL/kg/minute, and 10.7, respectively. KCL score was significantly correlated with peak VO₂ (r = -0.527, P < 0.001) and peak work rate (r = -0.632, P < 0.001). In patients with frailty (n = 63), the peak work rate (WR) was significantly lower than it was in patients without frailty (n = 29; 39.9 versus 69.5 W, respectively; P < 0.001). Multivariate analysis revealed that peak WR and peak systolic blood pressure were significant, independent predictors of frailty (β = -0.108 and -0.045, respectively). In a diagnostic performance plot analysis, a cutoff value for peak WR of 51.9 W was the best predictor of frailty.Frailty status was significantly associated with peak WR and peak systolic blood pressure in elderly patients with stable HF. Therefore, cardiopulmonary exercise testing may be useful for assessing frailty status in this patient population.