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Cardiac Rehabilitation - tackling ventricular remodeling and improving functional capacity
Session:
Posters (Sessão 5 - Écran 8) - Reabilitação cardíaca
Speaker:
João Mendes Cravo
Congress:
CPC 2023
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Mendes Cravo; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Miguel Azaredo Raposo; Ana Abrantes; Bruno Bento; Nelson Cunha; Inês Ricardo; Rita Pinto; Fausto J. Pinto; Ana Abreu
Abstract
<p><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Cardiac Rehabilitation - tackling ventricular remodeling and improving functional capacity</strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> Exercise-based cardiac rehabilitation (CR) is part of the management of patients with established cardiovascular disease. Echocardiography and CPET are used to evaluate cardiac function and cardiorespiratory fitness improvement after such interventions.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Purpose</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">: To analyze the cardiovascular impact of an exercise based CR program on ventricular remodeling and functional capacity. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">: </span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff">Prospective cohort study which included consecutive pts who were participating in a center-based CR program lasting 8-12 weeks from 2019 to 2021. The CR program included initial evaluation by cardiologist and rehabilitation specialist with collection of clinical characteristics, three times weekly supervised exercise sessions, appointment with rehabilitation nurse, nutritionist and psychologist and educational sessions. Lab tests, echocardiogram and CPET were done before and after completion of the program.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Results:</strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff"> We analysed 349 patients (82% male, mean age 60 ±11,4 years) most of which referred by ischemic heart disease (83%) followed by valvular heart disease (7%). After program completion there was a significant improvement in echo ejection fraction (</span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">48,4 ± 12,8% vs 52,07 ± 12,8% Z=-5,036 p<0.001), although other parameters didn’t show the same trend namely left atrial volume and TAPSE. Regarding CPET data, there was a significant improvement in test duration (496,6 ± 158 seconds vs 542,9 ± 147 seconds, p<0.001), in workload (66,2 ± 41,6W vs 123,6 ± 48W, p<0.001), peak VO2 (15,8 ± 4,72mL/(kg.min) vs 16,75 ± 5,17mL/(kg.min) p=0.004) and O2 pulse (11,1 ± 2,8 vs 11,8 ± 2,9; p<0.001). Similar improvements were also seen when analysing </span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff">pts with reduced ejection fraction regarding ejection fraction, duration of test and workload (p<0.005) but not on peak VO2 (14,4 +- 4,3mL/(kg.min) vs 15,2 +- 4,7mL/(kg.min), p=0.11) or pulse O2.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Conclusions: </strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><span style="background-color:#ffffff">Exercise based cardiac rehabilitation has a very favorable impact in terms of cardiorespiratory fitness evaluated by several CPET parameters and such impact is also present in high risk individuals with reduced ejection fraction. Advocating for increasing referral of these patients is key to better improve cardiorespiratory capacity.</span></span></span></span></p> <p> </p>
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