P13
Patients with recurrent AF episodes treated with beta-blockers: evaluation of exercise tolerance and quality of life. Prospective, 1-year evaluation
E Smolis-Bak, R Dabrowski, B Kazimierska, I Kowalik, H Szwed
National Institute of Cardiology, Warsaw, Poland
Topic: Exercise physiology, testing and training
Atrial fibrillation [AF] significantly influences everyday performance of patients, their exercise capacity, quality of life (qol) and psychic condition. the aim of the study was comprehensive evaluation of 1-year beta-blocker therapy in patients with different forms of AF.
Material and methods: the study group consist of 93 patients, age 40–83 years. there were 42 pts with paroxysmal AF (PAF)-age 66±8.5, 30 pts with persistent, (PeAF)-age 65.1± 10.1 and 20 pts with chronic (CHAF)-64.0 ±7.0. All the patients were treated with beta-blockers (propranolol, metoprolol, bisoprolol). During first (V 0) and after 1-year (V 1) visits, pts performed 6 minutes walking test (6-MWT), qol was estimated according to Nottingham Health Profile questionnaire (NHP) and risk of depression occurrence was estimated by Beck Depression Inventory scale (BDI).
Results: In 6-MWT resting and maximum heart rate was significantly lower in pts with PAF than in the pts with CHAF. Walking distance was significantly longer in all studied groups after 1-year therapy. Pts with CHAF had the longest distance in 6-MWT, but patients with PAF had the greatest improvement in walking distance. Mild symptoms of depression were diagnosed in pts with PAF, but not with CHAF and were not changed after 1-year in spite of beta-blocker therapy. Studied quality of life parameters were not changed in either group after 1-year follow-up. Generally AF significantly limited (V0 vs V1) professional activity (33% vs 22%), home activities (30% vs 39%) and sexual activity (30% vs 34%), least of all social life (15% vs 9%) and family life (15% vs 9%).
Conclusions: 1-year beta-blocker therapy significantly improves exercise tolerance, but not qol parameters. the depression symptoms were more prevalent in patients with paroxysmal AF, but in all patients with different forms of AF were not changed during 1-year follow-up in spite of using older (propranolol) and modern (bisoprolol) beta-blocking drugs.
∗p<0.05 vs baseline;∗∗p<0.05 CHAF vs PAF in the same time
P401
Assessment of functional capacity and stratification patients with isolated left ventricular diastolic dysfunction
MN Dekleva1, J Suzic Lazic1, S Mazic2
1
Clinical Hospital Center Dr D Misovic, University Clinic for Internal Medicine, Belgrade, Serbia, 2Institute of Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Topic: Exercise physiology, testing and training
Cardiopulmonary Exercise Testing (CPET) is a recommended technique for evaluation of putative mechanism that underlies exercise intolerance in HF. Left ventricle (LV) filling abnormalities presented by Doppler echocardiography with similar patterns can be actually the result of different forms of heart disease.
the aim of the study was to assess value of CPET profiles in stratificating patients with different etiology but similar degree of LVDD.
Methods: LV and left atrium (LA) diameters was measured by M mode echocardiography, LA and LV volumes normalized by body surface area (EDV/bsa, ESV/bsa), ejection fraction (LVEF) by biplane Simpson s rule. Mitral inflow velocities (E and A), E/A, dec t E and mitral regurgitation (MR) were assessed by pulse wave Doppler, velocity propagation (Vp) by Color M mode and annular e wave by tissue Doppler imaging.
All patients underwent incremental bicycle exercise whereas respiratory exchange ratio >1 was taken to indicate maximal effort. Peak oxygen uptake (pVO2), oxygen pulse (VO2/HR) ventilatory anaerobic threshold (VAT) and ventilatory gas equivalents (VE/VO2, VE/VCO2) were obtained.
Study patients consisted from 50 patients aged 50.76 ± 8.9 with history of hypertension >2 years and 31 patients aged 49.84 ± 6.9 with history of previous myocardial infarction >1 year. All patients had mild LVDD i.e. impaired relaxation (E/A <1, DTE >220ms) and preserved systolic function (EF >50%)
Results: Demographic, Doppler Echocardiographic and Cardiopulmonary characteristics at rest were similar among two groups. However, significantly higher values of reached pVO2 (1715 vs. 2083 ml, p <0.001), VO2/HR (12 vs. 14.6, p <0.001), and percentage of pVO2 at VAT (55 vs. 64, p = 0.007) were found in patients after AMI compared with hypertensive group. there were significant correlations in both groups between pVO2 and LV dimensions (LVDD, LVSD) (r = 0.433, r = 0.513, respectively, p <0.001), between pVO2 and V max A and E/em (r = –0.413, r = 0.398, respectively, p <0.001).
Conclusion: CPET is a promising method for identifying patients with impaired physical performance in early stage of LVDD. CPET profiles can be various, respective to etiology of the heart disease. Functional capacity in patients with hypertension and coronary disease are closely related to proper LV expansion during cardiac cycle and degree of impaired LV relaxation.
P402
Development of a regression equation to determine the best six minute walk distance (6MWD) in a cardiac rehabilitation (CR) population
J M JenniePatrick1, H Mcburney2
1
Caulfield Hospital, Melbourne, Australia, 2LaTrobe University, Bendigo, Australia
Topic: Exercise physiology, testing and training
Purpose: Previous studies of the six minute walk test (6MWT) have indicated that at least two walks are needed to ensure reproducibility of the 6MWD in the CR population. this study assessed whether the second 6MWD can be predicted from one 6MWT result.
Method: the 6MWD s from three groups of CR subjects were used. Each 6MWT was performed over a 25 metre indoor track, with a minimum of 20 minutes rest between walks. Groups 1 and 2 had performed their tests on admission to CR and Group 3 on discharge.
Group 1 (initial sample, n=119, 99 male, 20 female, mean age 62.32 ±12.58 years)
Group 2 (validation sample, n=156, 119 male, 37 female, mean age 63.0 ± 13.6 years)
Group 3 (discharge sample, n=85, 57 male, 18 female, mean age 59.92 ± 12.67 years)
Results: For each group there was a high correlation between first and second 6MWD (Group 1 R=.977, Group 2 R=.948, Group 3 R=.963) but also a statistically significant difference between the mean 6MWD of each walk (p<0.001 for all groups).
Using the data from Group 1, multiple regression was used to generate an equation that could predict second 6MWD from the variables of: first 6MWD, age, gender, height, weight, body mass index. A statistically significant equation was generated that used only first 6MWD, age and a constant. 6MWD2 = (0.986 x 6MWD1) (0.438 x age in years) + 49.34. Each predictor was significant within the equation. Using the equation, a predicted 6MWD2 was generated for each of the three groups and compared to the actual 6MWD2 achieved by each subject.
Correlations between the actual and predicted 6MWD2 for each group were:
Group 1 R =.978
Group 2 R =.948
Group 3 R=.963
the mean differences between the actual and predicted 6MWD2 for each group were compared using paired t tests (see Table 1).
Conclusions: this suggests that for all three groups the mean distances predicted by the equation for the second walk were close to the actual mean distances walked by the subjects. therefore the equation 6MWD2 = (0.986 × 6MWD1) (0.438 × age in years) +49.34 can be used to reliably predict the second 6MWD from one 6MWT, in the CR population.
Mean differences between actual and predicted 6MWD2 for each group.
P403
Troponin T elevation after endurance exercise is related to running experience independent of run time and total number of heart beats
P Aagaard, M Stahlberg, A Sahlen, F Braunschweig
Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
Topic: Exercise physiology, testing and training
Background/Objective: Elevation of cardiac troponin is seen after strenuous physical exertion. Previous reports indicate that this occurs predominantly in inexperienced athletes. A potential cause for this phenomenon is that inexperienced runners have longer race durations which may involve a larger total number of heart beats during the race. this study investigated the association between post-exertional troponin levels, race experience and the number of heart beats during a long-distance race.
Methods: 34 male participants in a 30 km cross-country race were recruited based on prior endurance running experience and matched by age: 16 novices (no previous events; 46±7 ys) and 18 experienced runners (defined as =10 previous events; 15±6 events; 48±6 ys). We recorded their body mass index (BMI) and analysed their pre- and post-race troponin T levels. During the race all subjects carried a pulse watch which registered the total number of heart beats.
Results: Novices had a higher BMI than experienced runners (BMI 25.9±3.2 vs. 23.8±2.6 kg/m2; p=0.04), they were slower (race duration 207±38 vs. 174±29 min; p<0.01) and released more troponin (median 0.03 [IQR 0.0150.06] vs. 0.01 [0.010.02]; p<0.01). the total number of heart beats differed between groups (32546±5251 vs. 27785±4367 beats; p<0.01). When adjusting for these differences in multivariable analysis, a significant association between inexperience and post-race troponin elevation (p=0.03) remained.
Conclusion: Post-exertional troponin release is higher in inexperienced than in experienced long distance runners. though these groups differed in terms of BMI and total number of heart beats during the race, previous race experience was the only independent predictor of troponin release. this may reflect protective adaptations of cardiac physiology in experienced runners.
P404
Are recovery VO2 indices necessary for additional evaluation of ischemic patients by cardiopulmonary exercise test?
E Klainman1, A Yarmolovsky2, R Vishnitzer2, I Rosenberg2, G Fink2
1
Gefen Cardiac Health Center, Givatayim, Israel, 2Pulmonary Institute, Kaplan MC, Exercise Physiology U., Rehovot, Israel
Topic: Exercise physiology, testing and training
Objectives: To assess the significance of recovery VO2 kinetics indices in testing of pts with various degrees of CAD, in relationship to the exercise cardiopulmonary indices.
Methods: 62 male pts were divided into four groups according to their CAD degree: A:17 normal subjects (control); B:26 pts with one vessel disease (1VD); C:11 pts with 2VD; D:8 pts with 3VD. All pts underwent a cardiopulmonary exercise test (CPET), during which peak-VO2, peak-O2P and VAT, among others, were measured. the recovery indices measured were:1) Half time recovery (1/2tRec) of VO2; 2)1/2tRec of oxygen pulse (O2P); 3) Total time recovery of VO2 (TtRec-VO2), until RER reached value of 1 or less.
Conclusions: Significant differences in the recovery indices of VO2 kinetics were observed among the pts with various degrees of CAD and seem to be even more significant than the exercise CPET indices. Such findings validate the recovery indices as an important addition for further functional assessment of CAD pts.
P values: Significant: ∗ vs Ï or; vs. Borderline: ∗ vs or Ñ; vs Ï; Ï vs; and vs Ñ. Not Significant: ∗ vs ∗; vs; and Ñ vs Ñ.
P405
Increased exercise performance in patients with Ebstein's anomaly after surgical intervention
J Mueller, A Hager, J Hess
German Heart Center, Clinic at the Technical University of Munich, Munich, Germany
Topic: Exercise physiology, testing and training
Objective: the purpose of the study was to assess whether patients with Ebstein s anomaly profit from surgical intervention with regard to exercise performance and quality of life.
Patients and methods: In total forty-two patients with Ebstein s anomaly underwent a cardiopulmonary exercise test in our institution. At the redo test, twenty-one of them had undergone surgical intervention of their tricuspid valve and, if present, closure of an atrial shunt. the other twenty-one were free from surgical intervention in between the two tests.
Results: Peak oxygen consumption increased significantly in the intervention group (9.1% vs. 1.7%, p=0.043) and slope was improved markedly (–2.9 vs. 0.8; p<0.001) in contrast to those in control group. Moreover, oxygen saturation increased significantly at rest (p=0.001) and under peak exercise (p=0.012). the improvements in cardiopulmonary exercise test parameters were correlated to peak oxygen consumption, ventilation efficiency and oxygen saturation but not correlated to the operation method, body mass and body height in the intervention group. Self-estimated quality of life was fairly good, but there were no significant changes when comparing the differences from pre- and post-testing of the two diagnostic subgroups.
Conclusions: Patients with Ebstein s anomaly profit from surgical intervention and patients with a bad exercise performance had the greatest improvement in the redo test after surgical intervention.
P406
the first experince of passive physical trainings in elderly patients with myocardial infarction
A N Alexey Sumin1, AV Bezdenezhnykh1, OM Baidina2, TA Popova2, OP Hayredinova2
1
RAMS Scientific-Research Institute for Complex Studying of Cardiovascular Diseases, Kemerovo, Russian Federation, 2Scientific-Clinical Center of the Miners Health Protection, Leninsk-Kuznetsky, Russian Federation
Topic: Exercise physiology, testing and training
Purpose: Aging is associated with progressive loss of neuromuscular function. therefore aged patients with myocardial infarction (MI) especially require rehabilitation programs. Electrical stimulation of skeletal muscles (EMS) could represent a rehabilitation alternative for patients with chronic heart failure. the aim of study was to evaluate the EMS safety and effeciency in elderly MI patients.
Methods: We examined 57 patients older than 70 yrs (75.4±0.6 years) with MI. In control group (n=25) the patients received only the usual program of phase I rehabilitations, in the EMS group (n=32) there was an additional EMS course − 2 times a day for 60 minutes within 10 days. After course of treatment patients were underwent bicycle ergometric test (VEM), six-minute walking test (6MWT) and Holter ECG monitoring with estimation of heart rate variability. the estimation of the left ventricular function was performed by echocadiography.
Results: (see table) the EMS have resulted to more significant increase of maximal VEM workload, without anything unfluence on left ventricular volumes, number of extrasystoles and parameters of heart rate variability in Holter monitoring.
Conclusion: Passive physical trainings with EMS result to significant increase of tolerance to physical loading without negative influence on systolic left ventricular function, autonomic and arrhythmic status. this method deserves the further application for rehabilitation of elderly MI patients.
RPPmax rate-pressure product during maximal workload in VEM, EFLF left ventricular ejection fraction, EDVLF left ventricular end diastolic volume, VES - ventricular extrasystoles; SVES - supraventricular extrasystoles, SDNN time domain analyses of heart rate variability.
P407
Causes of positive exercise stress test in post PCI patients undergoing cardiac rehabilitation; are we missing something?
A Khan, A Mcgowan, R Boner, S Arnous, B Macneil, J Crowley, P Nash, K Daly
University Hospital Galway, Galway, Ireland
Topic: Exercise physiology, testing and training
Purpose: Controversy exists regarding the diagnostic accuracy, optimal technique, and timing of exercise testing after percutaneous coronary intervention (PCI). the objectives of the present study were to analyze variables resulting in a positive exercise stress test (EST), in post PCI patients, undergoing cardiac rehabilitation.
Methods: We performed a retrospective analysis of 116 patients who underwent percutaneous coronary revascularization and performed exercise stress test after 6 weeks, before undergoing cardiac rehab.58 patients had a positive exercise stress test while 58 had negative EST. Demographics, diagnosis on admission, co-morbidities such as DM, HTN, CCF, smoking status, cholesterol level, diseased arteries, treated and untreated disease, angioplasty, number and types of stents used, symptoms and ECG changes during stress test, CABG and repeat angiogram results were compared between the groups. Diseased artery was defined as =25% stenosis in a coronary segment. Exercise stress tests were classified as positive or negative according to ACC guidelines.
Results: In the positive EST group, only 7(12%) had single vessel disease while 51(88%) had mutivessel disease and stenting - p<0.01. In the negative stress test population 52(90%) had multivessel disease while 6(10%) had single vessel disease. there was no significant statistical difference (p>0.5) between status of DM, HTN, CCF, MI, smoking, cholesterol level, untreated diseased arteries, usage of bare metal or drug eluted stents.
Conclusions: the results of this study show that patients with single vessel disease, who remain symptom free after revascularization, are unlikely to get a positive stress test. In the absence of symptoms, positive EST is likely to represent minor residual coronary artery disease in revascularized patients. the presence of cardiac risk factors doesn't seem to play a significant role in determining the test result.
