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Palevičiūtė E, Čelutkienė J, Šimbelytė T, Gumbienė L, Jurevičienė E, Zakarkaitė D, Čėsna S, Eichstaedt CA, Benjamin N, Grünig E. Safety and effectiveness of standardized exercise training in patients with pulmonary hypertension associated with heart failure with preserved ejection fraction (TRAIN-HFpEF-PH): study protocol for a randomized controlled multicenter trial. Trials 2023; 24:281. [PMID: 37072812 PMCID: PMC10114476 DOI: 10.1186/s13063-023-07297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/05/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Left heart failure (HF) is characterized by an elevation in left-sided filling pressures, causing symptoms of dyspnea, impairing exercise capacity, and leading to pulmonary venous congestion and secondary pulmonary hypertension (PH). There is an increased incidence of PH associated with left heart disease, particularly with heart failure with preserved ejection fraction (HFpEF-PH). Treatment possibilities in HFpEF-PH are non-specific and very limited, thus additional pharmacological and non-pharmacological therapeutic strategies are needed. Various types of exercise-based rehabilitation programs have been shown to improve exercise capacity and quality of life (QoL) of HF and PH patients. However, no study focused on exercise training in the population of HFpEF-PH. This study is designed to investigate whether a standardized low-intensity exercise and respiratory training program is safe and may improve exercise capacity, QoL, hemodynamics, diastolic function, and biomarkers in patients with HFpEF-PH. METHODS A total of 90 stable patients with HFpEF-PH (World Health Organization functional class II-IV) will be randomized (1:1) to receive a 15-week specialized low-intensity rehabilitation program, including exercise and respiratory therapy and mental gait training, with an in-hospital start, or standard care alone. The primary endpoint of the study is a change in 6-min walk test distance; secondary endpoints are changes in peak exercise oxygen uptake, QoL, echocardiographic parameters, prognostic biomarkers, and safety parameters. DISCUSSION To date, no study has investigated the safety and efficacy of exercising specifically in the HFpEF-PH population. We believe that a randomized controlled multicenter trial, which protocol we are sharing in this article, will add important knowledge about the potential utility of a specialized low-intensity exercise and respiratory training program for HFpEF-PH and will be valuable in finding optimal treatment strategies for these patients. TRIAL REGISTRATION ClinicalTrials.gov NCT05464238. July 19, 2022.
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Affiliation(s)
- Eglė Palevičiūtė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu-2, 08661, Vilnius, Lithuania.
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu-2, 08661, Vilnius, Lithuania
| | - Toma Šimbelytė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu-2, 08661, Vilnius, Lithuania
| | - Lina Gumbienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu-2, 08661, Vilnius, Lithuania
| | | | - Diana Zakarkaitė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu-2, 08661, Vilnius, Lithuania
| | - Sigitas Čėsna
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu-2, 08661, Vilnius, Lithuania
| | - Christina A Eichstaedt
- Centre for Pulmonary Hypertension, German Center for Lung Research (DZL), Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
- Laboratory for Molecular Genetic Diagnostics, Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Nicola Benjamin
- Centre for Pulmonary Hypertension, German Center for Lung Research (DZL), Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, German Center for Lung Research (DZL), Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
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Bajoras V, Diečkus L, Wong I, Laurinavičienė A, Davidavičius G, Čėsna S. Transcatheter aortic valve implantation in patients with anomalous coronary artery. Catheter Cardiovasc Interv 2023; 101:485-493. [PMID: 36640415 DOI: 10.1002/ccd.30540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/27/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this review was to analyze literature and provide systematic algorithm to guide decision making during TAVI procedure. BACKGROUND Transcatheter aortic valve implantation (TAVI) is growing in popularity and expanding to younger patients with lower risk profiles. Currently, there is no concise guideline on the management strategy during TAVI in patients with anomalous coronary artery (ACA) anatomy undergoing this procedure. METHODS A systematic search was conducted for relevant case reports of TAVI in patients who had confirmed ACA anatomy. Twenty-four case reports, that met the criteria for this review, were identified and included in the final study size. RESULTS TAVI was successful in 23 out of 24 cases. Half of the cases (12) described performing balloon aortic valvuloplasty (BAV) before TAVI. The majority (15) reported using angiogram Postimplantation. Only one-third of cases (8) reported performing coronary protection (with either wire, wire and stent or wire and balloon). Two-third of case reports (16/24, 67%) mentioned using Edwards SAPIEN balloon expandable transcatheter heart valves (THV). CONCLUSIONS Preprocedural diagnostic imaging tests play important role in determining the ACA anatomy and its relation to the aortic valve. BAV with simultaneous coronary arteries angiography or aortography should be performed before implantation of THV, as it could potentially predict whether the ACA would be compressed. Using at least a coronary wire for ACA protection is recommended in case there is high risk of ACA obstruction. Management strategy should be individualized when performing TAVI in patients with ACA.
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Affiliation(s)
- Vilhelmas Bajoras
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Vilnius University Hospital Santaros Clinics, Division of Cardiology and Vascular Diseases, Vilnius, Lithuania
| | - Laurynas Diečkus
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ivan Wong
- Division of Cardiology, Queen Elizabeth Hospital, Hong Kong SAR, Hong Kong
| | - Anna Laurinavičienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedrius Davidavičius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Vilnius University Hospital Santaros Clinics, Division of Cardiology and Vascular Diseases, Vilnius, Lithuania
| | - Sigitas Čėsna
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Vilnius University Hospital Santaros Clinics, Division of Cardiology and Vascular Diseases, Vilnius, Lithuania
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Diečkus L, Čėsna S, Bajoras V. Transcatheter aortic valve replacement in a patient with unusual left circumflex artery anatomy. Kardiol Pol 2023; 81:182-183. [PMID: 36300532 DOI: 10.33963/kp.a2022.0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 03/04/2023]
Affiliation(s)
- Laurynas Diečkus
- Center of Internal Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania. .,Department of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Sigitas Čėsna
- Department of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Interventional Cardiology, Division of Cardiology and Vascular Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Vilhelmas Bajoras
- Department of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Interventional Cardiology, Division of Cardiology and Vascular Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
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