Hellenic Journal of Cardiology最新文献

{"title":"Energy metabolism: from physiological changes to targets in sepsis-induced cardiomyopathy.","authors":"Dan Ni, Xiaofang Lin, Chuanhuan Deng, Ludong Yuan, Jing Li, Yuxuan Liu, Pengfei Liang, Bimei Jiang","doi":"10.1016/j.hjc.2024.05.010","DOIUrl":"10.1016/j.hjc.2024.05.010","url":null,"abstract":"<p><p>Sepsis is a systemic inflammatory response syndrome caused by a variety of dysregulated responses to host infection with life-threatening multi-organ dysfunction. Among the injuries or dysfunctions involved in the course of sepsis, cardiac injury and dysfunction often occur and are associated with the pathogenesis of hemodynamic disturbances, also defined as sepsis-induced cardiomyopathy (SIC). The process of myocardial metabolism is tightly regulated and adapts to various cardiac output demands. The heart is a metabolically flexible organ capable of utilizing all classes of energy substrates, including carbohydrates, lipids, amino acids, and ketone bodies, to produce ATP. The demand of cardiac cells for energy metabolism changes substantially in septic cardiomyopathy, with distinct etiological causes and different times. This review describes changes in cardiomyocyte energy metabolism under normal physiological conditions and some features of myocardial energy metabolism in septic cardiomyopathy and briefly outlines the role of the mitochondria as a center of energy metabolism in the septic myocardium, revealing that changes in energy metabolism can serve as a potential future therapy for infectious cardiomyopathy.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Young and older patients with acute myocardial infarction: differences in risk factors and angiographic characteristics.","authors":"Marios Sagris, Panagiotis Theofilis, Vasiliki Mistakidou, Evangelos Oikonomou, Konstantinos Tsioufis, Dimitris Tousoulis","doi":"10.1016/j.hjc.2024.05.008","DOIUrl":"10.1016/j.hjc.2024.05.008","url":null,"abstract":"<p><strong>Objective: </strong>Although coronary artery disease mainly affects older individuals, the incidence of myocardial infarction (MI) among younger adults (<55 years) has increased during the past decade. Young and older MI patients have different underlying pathophysiologic characteristics, atherosclerotic plaque morphology, and risk factor profiles.</p><p><strong>Methods: </strong>We studied 977 patients (≤55 years old: 322, >55 years old: 655) who were hospitalized for MI in the previous 5 years. Patients' baseline characteristics and daily habits were recorded. Angiographic characteristics and vascular lesions were detected, and further examinations, including flow-mediated dilation (FMD), pulse wave velocity (PWV), and central augmentation index (AIx), were performed. Biomarkers of inflammation (Interleukin-6, Tumor-Necrosis factor-a, Intercellular Adhesion Molecule 1, and Osteopontin) were also tested.</p><p><strong>Results: </strong>The median age in the younger age group was 49 years [interquartile range (IQR: 44-53)] and 66 years (IQR: 61-73) in the older age group. Arterial hypertension was less prevalent in the young compared to the elderly with MI (47.4% vs. 76.2%, p < 0.01). The younger counterparts presented significantly lower rates of diabetes mellitus (19.3% vs. 30.6%, p < 0.01), dyslipidemia (59% vs. 70.8%, p < 0.01), and atrial fibrillation (2.6% vs. 9.7%, p < 0.01) and were more casual smokers (49.3% vs. 23.8%, p < 0.01) compared to older patients with MI. In terms of arterial stiffness, lower PWV [7.3 m/s (IQR: 6.5-8.4 m/s) vs. 9 m/s (IQR: 8-10.8 m/s), p < 0.01] and AIx (20.5 ± 10.8 vs. 25.5 ± 7.8, p < 0.01) were recorded in the young compared to the elderly with MI. Concerning angiographic characteristics, younger patients were more likely to have none or single-vessel disease (55.6% vs. 45.8%, p < 0.02), whereas the older participants more frequently had three or more vessel disease (23.5% vs. 13.6% in the young, p < 0.02). Although significant disparities in blood test results were detected during the acute phase, the great majority of young MI patients were undertreated.</p><p><strong>Conclusion: </strong>Younger patients with MI are more likely to be smokers with impaired PWV measures, present with non-obstructive or single-vessel disease, and often remain undertreated. A better knowledge of the risk factors as well as the anatomic and pathophysiologic processes in young adults will help enhance MI prevention and treatment options in this patient population.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of cardiovascular disease and related risk factors in Greece: the ATTICA epidemiological study (2002-2022).","authors":"Demosthenes Panagiotakos, Evangelia G Sigala, Evangelia Damigou, Asimina Loukina, Dimitriοs Dalmyras, Georgios Mentzantonakis, Fotios Barkas, Petros S Adamidis, Evrydiki Kravvariti, Evangelos Liberopoulos, Petros P Sfikakis, Costas Tsioufis, Christos Pitsavos, Christina Chrysohoou","doi":"10.1016/j.hjc.2024.05.009","DOIUrl":"10.1016/j.hjc.2024.05.009","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to present the burden of cardiovascular disease (CVD) and its related risk factors based on a 20-year observation period (2002-2022).</p><p><strong>Methods: </strong>In 2002, 3042 Greek adults (aged: 45 (12) years) free of CVD, cancer, or any other chronic infections were enrolled. In 2022, the 20-year follow-up was performed on 2169 participants (1988 had complete data for CVD). Lifetime risk for CVDs and disability-adjusted-life-years (DALYs) lost were also calculated.</p><p><strong>Results: </strong>The 20-year CVD incidence was 3600 cases/10,000 individuals (man-to-woman ratio 5:4). At the index age of 40 years, the lifetime risk for developing CVD was 68% for men and 63% for women; as the participants were getting older, the lifetime risk declined by approximately 19% and 13% for men and women, respectively, but remained at high levels, reaching 55% for both sexes. Participants between 45 and 55 years exhibited the highest CVD burden concerning aggregated DALYs. The burden was greater in men than in women, at ages below 35 years; beyond this age threshold, this trend shifted, and women exhibited a higher CVD burden.</p><p><strong>Conclusion: </strong>The burden of CVD in Greece has shown increasing trends over the past 20 years as a result of the accumulative growth of the prevalence of modifiable CVD risk factors. The disability-adjusted life-years lost are the most observed ever before, urging for efficient public health strategies and measures.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield of implantable loop recorders: results from the hellenic registry.","authors":"Konstantinos P Letsas, Athanasios Saplaouras, Panagiotis Mililis, Ourania Kariki, George Bazoukis, Stefanos Archontakis, Ioannis Anagnostopoulos, Sokratis Triantafyllou, Lina Palaiodimou, Anastasios Chatziantoniou, Anastasios Lykoudis, Athena Mpatsouli, Georgia Katsa, Olga Kadda, Stylianos Dragasis, Vasileios Cheilas, Eleftheria Garyfalia Tsetika, Dimitrios Asvestas, Panagiotis Korantzopoulos, George Poulos, Themistocles Maounis, Anna Kostopoulou, Charalambos Kossyvakis, Sotirios Xydonas, Georgios Giannopoulos, John Papagiannis, Alexandros Tsoutsinos, George Sidiropoulos, Vassilios Vassilikos, Nikolaos Fragakis, Stylianos Tzeis, Spyridon Deftereos, Polychronis Dilaveris, Skevos Sideris, Michael Efremidis, Georgios Tsivgoulis","doi":"10.1016/j.hjc.2024.05.004","DOIUrl":"10.1016/j.hjc.2024.05.004","url":null,"abstract":"<p><strong>Objective: </strong>Implantable loop recorders (ILRs) are increasingly being used for long-term cardiac monitoring in different clinical settings. The aim of this study was to investigate the real-world performance of ILRs-including the time to diagnosis-in unselected patients with different ILR indications.</p><p><strong>Methods and results: </strong>In this multicenter, observational study, 871 patients with an indication of pre-syncope/syncope (61.9%), unexplained palpitations (10.4%), and atrial fibrillation (AF) detection with a history of cryptogenic stroke (CS) (27.7%) underwent ILR implantation. The median follow-up was 28.8 ± 12.9 months. In the presyncope/syncope group, 167 (31%) received a diagnosis established by the device. Kaplan-Meier estimates indicated that 16.9% of patients had a diagnosis at 6 months, and the proportion increased to 22.5% at 1 year. Of 91 patients with palpitations, 20 (22%) received a diagnosis based on the device. The diagnosis was established in 12.2% of patients at 6 months, and the proportion increased to 13.3% at 1 year. Among 241 patients with CS, 47 (19.5%) were diagnosed with AF. The diagnostic yield of the device was 10.4% at 6 months and 12.4% at 1 year. In all cases, oral anticoagulation was initiated. Overall, ILR diagnosis altered the therapeutic strategy in 26.1% of the presyncope/syncope group, 2.2% of the palpitations group, and 3.7% of the CS group in addition to oral anticoagulation initiation.</p><p><strong>Conclusion: </strong>In this real-world patient population, ILR determines diagnosis and initiates new therapeutic management for nearly one-fourth of patients. ILR implantation is valuable in the evaluation of patients with unexplained presyncope/syncope, CS, and palpitations.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the European Society of Cardiology pretest probability models for obstructive coronary artery disease in high-risk population.","authors":"Ivona Vranic, Ivan Stankovic, Aleksandra Ignjatovic, Srdjan Kafedzic, Mina Radovanovic-Radosavljevic, Aleksandar N Neskovic, Radosav Vidakovic","doi":"10.1016/j.hjc.2024.05.003","DOIUrl":"10.1016/j.hjc.2024.05.003","url":null,"abstract":"<p><strong>Objective: </strong>The pre-test probability (PTP) model for obstructive coronary artery disease (CAD) was updated in 2019 by the European Society of Cardiology (ESC). To our knowledge, this model was never externally validated in a population with a high incidence of CAD. The aim of this study is to validate the new PTP ESC model in our population, which has a high CAD incidence, and to compare it with the previous PTP ESC model from 2013.</p><p><strong>Methods: </strong>We retrospectively analysed 1294 symptomatic patients with suspected CAD referred to our centre between 2015 and 2019. In all patients, the PTP score was calculated based on age, gender, and symptoms according to the ESC model from 2013 (2013-ESC-PTP) and 2019 (2019-ESC-PTP). All patients underwent invasive coronary angiography (ICA).</p><p><strong>Results: </strong>Of the 1294 patients, obstructive CAD was diagnosed in 533 patients (41.2%). The 2019-ESC-PTP model categorised significantly more patients into the low probability group (PTP < 15%) than the 2013-ESC-PTP model (39.8% vs. 5.6%, p < 0.001). Obstructive CAD prevalence was underestimated using 2019-ESC-PTP at all PTP levels (calibration intercept 1.15, calibration slope 0.96). The 2013-ESC-PTP overestimated obstructive CAD prevalence (calibration intercept -0.24, calibration slope 0.73). The discrimination measured with an area under the curve was similar for both models, indicating moderate accuracy of the models.</p><p><strong>Conclusion: </strong>In high-risk Serbian population, both the 2013 and 2019 ESC-PTP models had moderate accuracy in diagnosing CAD, with the 2019-ESC-PTP underestimating the prevalence of CAD and the 2013-ESC-PTP overestimating it. Further studies are warranted to establish PTP models for high-risk countries.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-hospital variation of gut microbiota product, trimethylamine N-oxide (TMAO), predicts future major adverse cardiovascular events after myocardial infarction.","authors":"Aneta Aleksova, Alessandra Lucia Fluca, Mariano Stornaiuolo, Giulia Barbati, Alessandro Pierri, Donna R Zwas, Daniela Santon, Stefano D'Errico, Maria Marketou, Gianfranco Sinagra, Yosefa Avraham, Ettore Novellino, Milijana Janjusevic","doi":"10.1016/j.hjc.2024.05.007","DOIUrl":"10.1016/j.hjc.2024.05.007","url":null,"abstract":"<p><strong>Objective: </strong>Trimethylamine N-oxide (TMAO) has been associated with atherosclerosis and poor outcome. We evaluated the prognostic impact of intra-hospital TMAO variation on patient outcome.</p><p><strong>Methods and results: </strong>Blood samples from 149 patients with acute myocardial infarction (AMI) were taken on admission and discharge. Plasma TMAO was determined by HPLC-MS. The endpoint was a composite three-point MACE (major adverse cardiovascular events), including all-cause mortality, re-infarction, or heart failure (HF) development. Median TMAO concentration on admission was significantly higher than on discharge (respectively, 7.81 [3.47-19.98] vs 3.45 [2.3-4.78] μM, p < 0.001). After estimating the 3.45 μM TMAO cut-off with the analysis of the continuous hazard ratio, we divided our cohort into two groups. The first group included 75 (50.3%) patients whose TMAO levels remained below or decreased under cut-off (low-low/high-low; LL/HL), while the second group included 74 (49.7%) patients whose TMAO levels remained high or increased above the cut-off during hospitalisation (high-high/low-high; HH/LH). During the median 30-month follow-up, 21.5% of patients experienced the composite endpoint. At Kaplan-Meier analysis, a trend of increasing MACE risk was observed in patients in the HH/LH group (p = 0.05). At multivariable Cox analysis, patients from the HH/LH group had more than two times higher risk of MACE during the follow-up than the LL/HL group (HR = 2.15 [95% CI, 1.03-4.5], p = 0.04). Other independent predictors of MACE were older age and worse left ventricular systolic function.</p><p><strong>Conclusion: </strong>In patients with AMI, permanently high or increasing TMAO levels during hospitalisation are associated with a higher risk of MACE during long-term follow-up.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of shock in patients with type A acute aortic syndrome. Results of a nationwide multicenter study.","authors":"Carlos Ferrera, Isidre Vilacosta, José F Rodríguez Palomares, Francisco Calvo Iglesias, Antonio J Barros-Membrilla, Manel Azqueta Molluna, Víctor Mosquera, Rubén Tarrío, Ana Revilla Orodea, David Toral Sepúlveda, Inés Ramos González-Cristóbal, Luis Maroto Castellanos, Augusto Sao, Artur Evangelista","doi":"10.1016/j.hjc.2024.05.005","DOIUrl":"10.1016/j.hjc.2024.05.005","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical characteristics, imaging findings, treatment, and prognosis of patients with type A acute aortic syndrome (AAS-A) presenting with shock. To assess the impact of surgery on this patient population.</p><p><strong>Methods: </strong>The study included 521 patients with A-AAS enrolled in the Spanish Registry of Acute Aortic Syndrome (RESA-III) from January 2018 to December 2019. The RESA-III is a prospective, multicenter registry that contains AAS data from 30 tertiary-care hospitals. Patients were classified into two groups according to their clinical presentation, with or without shock. Shock was defined as persistent systolic blood pressure <80 mmHg despite adequate volume resuscitation.</p><p><strong>Results: </strong>97 (18.6%) patients with A-AAS presented with shock. Clinical presentation with syncope was much more common in the Shock group (45.4% vs 10.1%, p = 0.001). Patients in the Shock group had more complications at diagnosis and before surgery: cardiac tamponade (36.2% vs 9%, p < 0.001), acute renal failure (28.9% vs 18.2%, p = 0.018), and need for orotracheal intubation (40% vs 9.1%, p < 0.001). There were no significant differences in aortic regurgitation (51.6% vs 46.7%, p = 0.396) between groups. In-hospital mortality was higher among patients with shock (48.5% vs 27.4%, p < 0.001). Surgery was associated with a significant mortality reduction both in patients with and without shock. Surgery had an independent protective effect on mortality (OR 0.03, 95% CI (0.00-0.32)).</p><p><strong>Conclusion: </strong>Patients with AAS-A admitted with shock have a heavily increased risk of mortality. Syncope and pericardial effusion at diagnosis are strongly associated with shock. Surgery was independently associated with a mortality reduction in patients with AAS-A and shock.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life after pulmonary embolism: Prospective validation of the Greek version of the PEmb-QoL questionnaire","authors":"Olga Kardakari ,&nbsp;Christos Ballas ,&nbsp;Lampros Lakkas ,&nbsp;Ilias Gartzonikas ,&nbsp;Sotiria Giannou ,&nbsp;Evangelia Lagou ,&nbsp;Petros Skapinakis ,&nbsp;Georgios Dimakopoulos ,&nbsp;Athanasios Konstantinidis ,&nbsp;Lampros K. Michalis ,&nbsp;Katerina K. Naka ,&nbsp;Christos S. Katsouras","doi":"10.1016/j.hjc.2023.09.001","DOIUrl":"10.1016/j.hjc.2023.09.001","url":null,"abstract":"","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1109966623001513/pdfft?md5=34a31b0c9867f41a844e7ffc943e0e11&pid=1-s2.0-S1109966623001513-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10589738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 pandemic on the incidence of non-COVID-19 acute myocarditis in a Tertiary hospital in Greece","authors":"Onoufrios Malikides ,&nbsp;Maria Marketou ,&nbsp;Andria Papazachariou ,&nbsp;Vironas Malikides ,&nbsp;Maria Bonou ,&nbsp;George Kochiadakis","doi":"10.1016/j.hjc.2023.09.020","DOIUrl":"10.1016/j.hjc.2023.09.020","url":null,"abstract":"","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1109966623001914/pdfft?md5=7fa695aba3ae933bc6bae5dee9191b9c&pid=1-s2.0-S1109966623001914-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41163984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ergophysiological evaluation of heart failure patients with reduced ejection fraction undergoing exercise-based cardiac rehabilitation: A systematic review and meta-analysis","authors":"Georgios A. Christou ,&nbsp;Maria A. Christou ,&nbsp;Constantinos H. Davos ,&nbsp;Georgios Markozannes ,&nbsp;Konstantinos A. Christou ,&nbsp;Stefanos Mantzoukas ,&nbsp;Dimitrios K. Christodoulou ,&nbsp;Dimitrios N. Kiortsis ,&nbsp;Panagiota A. Christou ,&nbsp;Stelios Tigas ,&nbsp;Dimitra Nikoletou","doi":"10.1016/j.hjc.2024.01.004","DOIUrl":"10.1016/j.hjc.2024.01.004","url":null,"abstract":"<div><h3>Background</h3><p>This systematic review and meta-analysis aims to explore in heart failure (HF) patients with reduced ejection fraction (EF) undergoing exercise-based cardiac rehabilitation the following: 1) the comparison of temporal changes between peak oxygen uptake (VO2peak) and first ventilatory threshold (VO2VT1), 2) the association of VO2peak and VO2VT1 changes with physiological factors, and 3) the differential effects of continuous aerobic exercise (CAE) and interval training (IT) on VO2peak and VO2VT1.</p></div><div><h3>Methods</h3><p>A systematic literature search was conducted in PubMed, CENTRAL, and Scopus. Inclusion criteria were 1) original research articles using exercise-based cardiac rehabilitation, 2) stable HF patients with reduced EF, 3) available values of VO2peak and VO2VT1 (in mL/kg/min) both at baseline and after exercise training with comparison between these time points.</p></div><div><h3>Results</h3><p>Among the 30 eligible trials, 24 used CAE, 5 IT, and one CAE and IT. Multivariable meta-regression with duration of exercise training and percentage of males as independent variables and the change in VO2peak as a dependent variable showed that the change in VO2peak was negatively associated with duration of exercise training (coefficient=-0.061, p=0.027), implying the possible existence of a waning effect of exercise training on VO2peak in the long term. Multivariable meta-regression demonstrated that both age (coefficient=-0.140, p&lt;0.001) and EF (coefficient=-0.149, p&lt;0.001) could predict the change in VO2VT1, whereas only age (coefficient=-0.095, p=0.022), but not EF (coefficient = 0.082, p = 0.100), could predict the change in VO2peak. The posttraining peak respiratory exchange ratio, as an index of maximum effort during exercise testing, correlated positively with the change in VO2peak (coefficient=-0.021, p=0.044). The exercise-induced changes of VO2peak (p = 0.438) and VO2VT1 (p = 0.474) did not differ between CAE and IT groups.</p></div><div><h3>Conclusions</h3><p>Improvement of endurance capacity during cardiac rehabilitation may be detected more accurately with the assessment of VO2VT1 rather than VO2peak.</p></div>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1109966624000046/pdfft?md5=f720864091b906c7d8d678f93452ecfe&pid=1-s2.0-S1109966624000046-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139501503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}