S14
EuroPRevent Congress Abstracts May 2015
Poster Session I Thursday, 14 May 2015, 08:30–12:30 P100 Ventricular tachyarrhythmias reduction in heart failure by modulation of cardiac autonomic nervous system with cardiac rehabilitation
D Mesquita1, A Abreu1, G Portugal1, S Rosa1, P Rio1, M Oliveira1, P S Cunha1, V Santos2, H Santa-Clara2, R Ferreira1 1 Hospital de Santa Marta, Lisbon, Portugal, 2Human Motricity Faculty, Lisbon University, Lisbon, Portugal Topic: Cardiac rehabilitation Purpose: Autonomic nervous system (ANS) dysfunction plays a central role in chronic heart failure (HF). Patients (P) with severe left ventricle (LV) systolic dysfunction have increased risk of malignant ventricular tachyarrhythmias (VT/VF). Besides the cardioverter-defibrillator (ICD) and optimal medical therapy no other strategies have shown to reduce the negative impact of VT/VF on survival. It has been suggested that cardiac rehabilitation programs can induce a positive modulation of ANS. It’s uncertain whether this can be translated in clinical practice by a reduction of VT/VF. Our aim was to assess if a phase 2 cardiac rehabilitation program could reduce the occurrence of sustained VT/VF in P with chronic HF and documented ANS dysfunction. Methods: Prospective study in a cohort of 108P submitted to cardiac resynchronization therapy (CRT), with an ICD in a primary prevention strategy. All P performed cardiac scintigraphy with 123 metaiodo-benzylguanidine in the 48h previous to CRT implant to assess cardiac ANS dysfunction. We considered cardiac ANS dysfunction parameters of Early and Late "heart to mediastinum" rate HMR - below 1,5 or a washout rate (WR) above 30%. Afterwards, P were randomized to perform a phase 2 cardiac rehabilitation program (30 programed and surveyed sessions) or no rehabilitation. We assessed the medium (3months) to long-term (2 years) occurrence of VT/VF by the interrogation of the CRT device. Results: There were 67,9% male, with 68,19,9 years, and a mean LV ejection fraction of 277%, with ischemic etiology in 33,3% and diabetes in 38,9%. Sixty three P (57,8%) were in class III of NYHA and 73% on beta blockers. There were no significant differences between basal characteristics of the 2 groups, namely the occurrence of cardiac ANS (early HMR: p=0,810, late HMR: p=1,0 and WR: p=1,0). The rehabilitation group had a higher rate of previous cardiac surgery (p=0,023). During a follow-up of 630,8 309,7 days, 16P (14,8%) had VT/VF with appropriate treatment via ICD. The occurrence of VT/VF was higher in the cohort of P with cardiac ANS dysfunction, as assessed by the early HMR (p=0,034). P with baseline cardiac ANS dysfunction that did not underwent cardiac rehabilitation were at higher risk of VT/VF (Odds Ratio 4,38; p=0,035), whereas the occurrence of VT/VF was similar in P that completed the cardiac rehabilitation program compared to P without cardiac ANS dysfunction (p=0,597). Conclusions: HF is associated with a high incidence of cardiac ANS dysfunction. Cardiac rehabilitation seems to modulate ANS in these population and contribute to reduce the incidence of VT/VF. P101 Six-minute walk distance predicts the readmission due to decompensated heart failure in patients with chronic heart failure
M Tabata1, M Kato2, R Shimizu2, A Akiyama2, Y Kamada2, S Tanaka2, N Hamazaki2, A Aoyama2, K Kamiya3, T Masuda2 Toyohashi SOZO University, School of Health Sciences, Toyohashi, Japan, 2Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan, 3Kitasato University Hospital, Rehabilitation center, Sagamihara, Japan
decompensated heart failure in CHF patients. The predictive cut-off values of 6MWD were 425, 405, and 345 meters in the three groups, respectively. ROC to predict readmission using 6MWD
P102 Cardiopulmonary exercise testing variables as independent predictors of return to work in cardiac rehabilitation participants
H Voller1, A Salzwedel1, R Reibis2, S Kaminski3, H Buhlert3, S Eichler1, K Wegscheider4 1 University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany, 2Cardiac Outpatient Clinik Park Sanssouci, Potsdam, Germany, 3Klinik am See, Ruedersdorf, Germany, 4University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany
Topic: Cardiac rehabilitation Introduction: Cardiopulmonary exercise testing (CPX) has an independent prognostic value, especially in cardiovascular patients. We aimed to evaluate parameters of CPX as predictors for return to work (RTW) at discharge of cardiac rehabilitation (CR). Methods: We analysed sociodemographic and clinical data from a prospective registry of 489 patients (mean age 51.56.9 years, 87.9% men), who were referred to shortterm (3 weeks) inpatient CR between 06/2009 to 12/2011, predominantly after PCI (62.6%), CABG (17.2%) and heart valve replacement (9.0%). At admission, patients underwent noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and a psychodiagnostic screening (HADS). CPX was performed at discharge for defining fitness. Results: During a mean follow up of 26.511.9 months 373 (76.3%) patients returned to work, 116 (23.7%) did not and 60 (12.3%) were retired. A higher number of comorbidities (p=0.011) and heavy work (p
EuroPRevent Congress Abstracts May 2015
Poster Session I Thursday, 14 May 2015, 08:30–12:30 P100 Ventricular tachyarrhythmias reduction in heart failure by modulation of cardiac autonomic nervous system with cardiac rehabilitation
D Mesquita1, A Abreu1, G Portugal1, S Rosa1, P Rio1, M Oliveira1, P S Cunha1, V Santos2, H Santa-Clara2, R Ferreira1 1 Hospital de Santa Marta, Lisbon, Portugal, 2Human Motricity Faculty, Lisbon University, Lisbon, Portugal Topic: Cardiac rehabilitation Purpose: Autonomic nervous system (ANS) dysfunction plays a central role in chronic heart failure (HF). Patients (P) with severe left ventricle (LV) systolic dysfunction have increased risk of malignant ventricular tachyarrhythmias (VT/VF). Besides the cardioverter-defibrillator (ICD) and optimal medical therapy no other strategies have shown to reduce the negative impact of VT/VF on survival. It has been suggested that cardiac rehabilitation programs can induce a positive modulation of ANS. It’s uncertain whether this can be translated in clinical practice by a reduction of VT/VF. Our aim was to assess if a phase 2 cardiac rehabilitation program could reduce the occurrence of sustained VT/VF in P with chronic HF and documented ANS dysfunction. Methods: Prospective study in a cohort of 108P submitted to cardiac resynchronization therapy (CRT), with an ICD in a primary prevention strategy. All P performed cardiac scintigraphy with 123 metaiodo-benzylguanidine in the 48h previous to CRT implant to assess cardiac ANS dysfunction. We considered cardiac ANS dysfunction parameters of Early and Late "heart to mediastinum" rate HMR - below 1,5 or a washout rate (WR) above 30%. Afterwards, P were randomized to perform a phase 2 cardiac rehabilitation program (30 programed and surveyed sessions) or no rehabilitation. We assessed the medium (3months) to long-term (2 years) occurrence of VT/VF by the interrogation of the CRT device. Results: There were 67,9% male, with 68,19,9 years, and a mean LV ejection fraction of 277%, with ischemic etiology in 33,3% and diabetes in 38,9%. Sixty three P (57,8%) were in class III of NYHA and 73% on beta blockers. There were no significant differences between basal characteristics of the 2 groups, namely the occurrence of cardiac ANS (early HMR: p=0,810, late HMR: p=1,0 and WR: p=1,0). The rehabilitation group had a higher rate of previous cardiac surgery (p=0,023). During a follow-up of 630,8 309,7 days, 16P (14,8%) had VT/VF with appropriate treatment via ICD. The occurrence of VT/VF was higher in the cohort of P with cardiac ANS dysfunction, as assessed by the early HMR (p=0,034). P with baseline cardiac ANS dysfunction that did not underwent cardiac rehabilitation were at higher risk of VT/VF (Odds Ratio 4,38; p=0,035), whereas the occurrence of VT/VF was similar in P that completed the cardiac rehabilitation program compared to P without cardiac ANS dysfunction (p=0,597). Conclusions: HF is associated with a high incidence of cardiac ANS dysfunction. Cardiac rehabilitation seems to modulate ANS in these population and contribute to reduce the incidence of VT/VF. P101 Six-minute walk distance predicts the readmission due to decompensated heart failure in patients with chronic heart failure
M Tabata1, M Kato2, R Shimizu2, A Akiyama2, Y Kamada2, S Tanaka2, N Hamazaki2, A Aoyama2, K Kamiya3, T Masuda2 Toyohashi SOZO University, School of Health Sciences, Toyohashi, Japan, 2Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan, 3Kitasato University Hospital, Rehabilitation center, Sagamihara, Japan
decompensated heart failure in CHF patients. The predictive cut-off values of 6MWD were 425, 405, and 345 meters in the three groups, respectively. ROC to predict readmission using 6MWD
P102 Cardiopulmonary exercise testing variables as independent predictors of return to work in cardiac rehabilitation participants
H Voller1, A Salzwedel1, R Reibis2, S Kaminski3, H Buhlert3, S Eichler1, K Wegscheider4 1 University of Potsdam, Center of Rehabilitation Research, Potsdam, Germany, 2Cardiac Outpatient Clinik Park Sanssouci, Potsdam, Germany, 3Klinik am See, Ruedersdorf, Germany, 4University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany
Topic: Cardiac rehabilitation Introduction: Cardiopulmonary exercise testing (CPX) has an independent prognostic value, especially in cardiovascular patients. We aimed to evaluate parameters of CPX as predictors for return to work (RTW) at discharge of cardiac rehabilitation (CR). Methods: We analysed sociodemographic and clinical data from a prospective registry of 489 patients (mean age 51.56.9 years, 87.9% men), who were referred to shortterm (3 weeks) inpatient CR between 06/2009 to 12/2011, predominantly after PCI (62.6%), CABG (17.2%) and heart valve replacement (9.0%). At admission, patients underwent noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and a psychodiagnostic screening (HADS). CPX was performed at discharge for defining fitness. Results: During a mean follow up of 26.511.9 months 373 (76.3%) patients returned to work, 116 (23.7%) did not and 60 (12.3%) were retired. A higher number of comorbidities (p=0.011) and heavy work (p
