Abstract
Physical activity and low sedentary time in a post-myocardial infarction patient
Few and controversial findings exist on the effect of sedentary behaviour and physical activity after myocardial infarction (MI).1,2 Here a well-conducted prospective community-based cohort study including 101,510 Chinese adults, in service or retired employees, demonstrated that the combination of sedentary behaviour (>4 hours per day sitting) and physical inactivity (practising < 20 minutes of physical activity once per week) led to an increased risk of all-cause mortality. However, sedentary individuals only, although engaging in moderate to vigorous activity (MVPA), also still remained at higher mortality risk than the reference group. It was previously shown that MVPA alone did not protect also against the heart failure and mortality after non-fatal MI. 3
Postoperative myocardial injury: cause and prevention
A panel of tests, based on physical examination, electrocardiogram, biomarkers and imaging in the prevention and early management of postoperative myocardial injury is here proposed. However, as pointed out by the authors, there are still several outstanding issues, for example the role of several biomarkers or pre-operative training. 4 Moreover, remarkable sex-related differences are present with regard to preoperative risk stratification. 5
Cardiac rehabilitation
Rehabilitation after cardiac surgery
The opportunity to start aerobic exercise as soon as possible (plausibly after 1 week from cardiac surgery, if allowed by clinical conditions), is highlighted: ‘an aerobic exercise commenced in the immediate postoperative period and completed at hospital discharge’ is followed on average by a better outcome and entails a lower risk than that started weeks after discharge. Whether cardiac rehabilitation after surgical 6 or transcatheter 7 valve treatment may benefit from early commencement is still an open question, a topic that should be dealt with as soon as possible, particularly as the frail elderly are considered.
Cognitive performance, disease-related knowledge and rehabilitation
During cardiac rehabilitation following an acute coronary syndrome and/or coronary artery bypass graft, disease-related self awareness was enhanced significantly. At follow-up, the average level of medical education was reduced significantly, while lifestyle knowledge remained at a stable level: the maintenance of knowledge was predominantly predicted by prior education, cognitive performance and, in the case of medical knowledge, by coronary artery bypass graft. Thus, patient education concepts in cardiac rehabilitation should be reconsidered and intervention should be adjusted according to the individual characteristics and need.
Heart failure
Erythropoietin and anaemia in heart failure
Despite a myriad of factors having been linked to anaemia in heart failure (i.e. low Hb levels), the main mechanisms remain to be established. 8 In a systematic review and meta-analysis, which pooled data from 41 studies determining endogenous erythropoietin (Epo) and Hb levels in a total of 3137 heart failure patients, it was shown that anaemia in heart failure was predominantly linked to impaired Epo production, exacerbated by clinical variables commonly linked to anaemia such as disease severity, age, female sex, left ventricular ejection fraction (LVEF), inflammatory reaction, iron status and estimated glomerular filtration rate (eGFR).
Undiagnosed diabetes in heart failure
Diabetes mellitus (DM) was found to be an independent predictor of poor prognosis among ambulatory patients with heart failure with a reduced ejection fraction. 9 Here is presented the first study reporting the prevalence of pre-diabetes in real-life consecutive patients admitted for worsening heart failure: prediabetes and DM, respectively, were diagnosed in 43% and 19% of patients. Furthermore, dysglycaemia was associated with a graded increased risk of all-cause and cardiovascular mortality with the highest risk of death observed in patients with newly diagnosed DM. Although, in patients with DM, treatment with sodium–glucose co-transporter type 2 inhibitors was associated with a significant decrease in all-cause mortality and heart failure readmissions, 10 further research should explore this effect in the larger group of patients with diverse dysglycaemic phenotypes.
Biomarkers in left ventricular dysfunction
The natural history and pathophysiology of left ventricular diastolic dysfunction (LVDD) has attributed a potential role for biomarkers in the diagnosis, prevention and management of LVDD. The Horn study has helped to fill this research gap by relating different biomarkers with echocardiographic parameters of LVDD. 11 In addition the FLEMENGHO study, a landmark family-based population study from Belgium, presents here results from a non-targeted metabolomic approach showing in a cross-sectional analysis and longitudinal analysis the association between biomarkers (e.g. valine, glucose plus taurine, valine and 2-oxobutyrate) and LVDD. Importantly, there is biological plausibility to propose branched chain amino acids as biomarkers, based on their catabolic pathway in LVDD. A new potential circulating biomarker for early stages of LVDD is proposed.
Pulmonary hypertension in congenital heart disease
Pulmonary arterial hypertension (PAH) and adult congenital heart disease (ACHD) represent very heterogeneous patient populations with a unique pulmonary circulation physiology characterised by initially persistent exposure of the pulmonary vasculature to increased blood flow owing to systemic-to-pulmonary shunts. The latter leads, in the long term, to a typical pulmonary obstructive arteriopathy leading to an increase in pulmonary vascular resistance. Here a multicentre retrospective study investigated 167 PAH patients with and without ACHD, using invasive cardiopulmonary exercise test (iCPET), a variant of the test that adds pulmonary and radial artery catheter-derived pressure and blood gas sampling to the non-invasive CPET. 12 ACHD patients presented higher pulmonary pressure and VE/VCO2 while pulmonary blood flow and peak VO2 were lower. After matching patients for gender and peak VO2, ACHD–PAH patients maintain worse haemodynamics, suggesting that long-term adaptation to PAH and low pulmonary blood flow has, at least partially, preserved their exercise performance. Several mechanisms are likely to be involved including vascular adaptation to hypoxia, 13 erythrocytosis or persistence of right ventricular congenital hypertrophy.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.