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Cardiac rehabilitation in ischemic cardiomyopathy with reduced ejection fraction: why not?
Session:
CO 04 - Reabilitação Cardíaca
Speaker:
Maria Trêpa
Congress:
CPC 2018
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Maria Trêpa; Marta Fontes Oliveira; Raquel Baggen Santos; Inês Silveira; Vasco Alves Dias; Ana Barreira; Sandra Magalhães; Preza Fernandes; Severo Torres
Abstract
<p>Introduction</p> <p>The benefits of cardiac rehabilitation (CR) in ischemic cardiomyopathy with preserved left ventricular ejection fraction (pEF) are widely recognized. However, few studies have assessed the effects of CR in patients with reduced EF (rEF) and even less have compared them to pEF.</p> <p>We aimed to study the benefits and safety of CR in ischemic patients with rEF and compare them with pEF patients.</p> <p>Methods</p> <p>We analyzed data from 1411 patients with ischemic cardiomyopathy referred to CR were divided in 2 groups according to baseline EF: <40% - rEF group and >40% -pEF group. We studied the baseline characteristics and change at 3 months (3M) in the metabolic equivalents (METS) achieved at exercise test, metabolic profile and NT-BNP. Safety was assessed during a median 10 month follow-up.</p> <p>We used chi square test and independent T Test for statistical analysis.</p> <p>Results (table 1)</p> <p>1139 patients (80%) were in the pEF group and 272 patients (19%) in the rEF group. Both groups had a male prevalence and there were no statistically significant differences in mean age (61 vs 62yo), hypertension, dyslipidemia, or smoking. Patients in the rEF group were more likely diabetics (36% vs 42%, p 0.07) and reported more heart failure symptoms (33% vs 48%, p<0.01).</p> <p>Regarding to functional capacity, patients with rEF achieved less METS both at baseline and 3M but had the similar increases in METs between the two exercise tests (mean at 3M: + 1.2 vs +1.2). </p> <p>There were no differences between groups in the metabolic profile at baseline (body mass index, LDL, HDL, triglycerides and glycated hemoglobin). At 3 months both groups achieved similar reductions in: weight (-1.6 vs -1.8kg, p= 0.4), LDL (-30 vs -31mg/dL, p=0.9), HDL (+2.3 vs +1.8mg/dL, p= 0.5), triglycerides (-31 vs -24mg/dL, p=0,3). Patients in the rEF group achieved higher reductions in glycated hemoglobin (-0.26% vs – 0.41%, p= 0.007). </p> <p>The NT-proBNP levels were significantly higher in the rEF group at baseline and at 3M but at 12M follow-up the NT-proBNP levels were similar in btoh groups (mean: 570 vs 678pg/mL, p=0.74). </p> <p>Both groups completed CR program safely and there was no difference in hospitalizations or death for cardiac causes during the ~10M follow-up (p=0.67). </p> <p>Conclusion</p> <p>In this study, CR proved to be safe and equally effective in patients with rEF. This high-risk population derives significant benefits from CR and these findings support a wider referral of rEF patients to CR. </p>
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