Funding Acknowledgements Type of funding sources: None. Background Coronavirus disease 2019 (Covid-19) has become a global pandemic. Covid-19 increases morbidity in patients with underlying cardiovascular disease. The six-minute walk test (6MWT) is a simple test for assessing cardiopulmonary fitness and has been applied to assess post-surgical recovery in cardiac populations. Decreased heart rate recovery (HRR) over 1 or 2 minutes after exercise shows autonomic dysfunction and is associated with an increased risk of mortality. We conducted a cross sectional study to determine if Covid-19 affects cardiac rehabilitation parameters, such as 6MWT distance, HRR-1, and HRR-2 among patients who have undergone cardiac surgery. Methods This analysis included 155 adults who had elective cardiac surgery at the National Heart Center Harapan Kita (NHCHK) from January to June 2022. Each participant performed a 6MWT and treadmill evaluation in phase II cardiac rehabilitation (CR) program. To analyze the association of 6mwt distances and heart rate recovery among patients with covid-19 and without covid-19 who had undergone elective cardiac surgery using Mann Whitney and Chi-Square tests. Results Forty-Seven (30.3%) patients had a history of Covid-19. The mean 6MWT was 339.53 ± 59.90 m in the pre-CR program, increased to 415.37 ± 46.46 m in the post-CR program. The mean HRR1 was 15.16 ± 9.44, and HRR2 was 56.59± 35.47. There were no differences in 6MWT distance, HRR1, and HRR2 among patients with a history of Covid-19 and without a history of Covid-19 (P= 0.48, p=0.56, p=0.12). Conclusion The cardiac rehabilitation (CR) program improves the 6MWT distance. Covid-19 does not affect the ability of patients to do six-minute walk tests; neither HRR-1 nor HRR-2 among patients who have undergone cardiac surgery.
Funding Acknowledgements Type of funding sources: None. Background Heart rate recovery (HRR) describes the ability of the autonomic nervous system changes from the sympathetic to the parasympathetic nervous system. The slower heart rate recovery means there is an autonomic dysfunction of the nervous system. Heart rate recovery has been known to be a predictor of mortality in patients undergoing exercise stress test. Patients with slow heart rate recovery have a higher risk of cardiovascular death. Decreased exercise capacity is also known to increase the risk of cardiovascular death. Purpose This study aims to determine the relationship between low exercise capacity and slow heart rate recovery. Methods Patients who underwent post-coronary artery bypass (CABG) surgery cardiovascular rehabilitation program at our national cardiovascular center in 2022 were enrolled in this study. We assessed heart rate recovery during the maximal exercise stress test, by subtracting from maximal heart rate during the exercise stress test with heart rate at the first and second minute after exercise stress test. We used predicted METs from Bruce protocols treadmill test time to determine each patient’s exercise capacity. Results There were 238 patients (age 58±7 years old, 89.9% male). The mean exercise capacity was 6.42±2.21 METs and the mean first and second-minute heart rate recovery was 14±11 and 26±15 beats per minute. Predicted exercise capacity had a significant positive weak correlation with first-minute heart rate recovery/HRR1 (r=0.279; p=0.000) and a significant positive moderate correlation with second-minute heart rate recovery/HRR2 (r=0.409; p=0.000) in post-CABG patients. We performed receiver operating characteristic analysis that showed the area under the curve for exercise capacity was 0.69 for HRR1 and 0.71 for HRR2, and found the exercise capacity cut-off was 5.5 METs . Patients with exercise capacity less than 5.5 METs were likely to have slower HRR1 (OR=4.4 (95% CI, 2.7 – 7.2) p=0.000) and slower HRR2 (OR=3.8 (95% CI, 2.4 – 6.0) p=0.000). Conclusions There is a correlation between low exercise capacity and slow heart rate recovery. Patients with lower exercise capacity were likely to have slower heart rate recovery in post-CABG patients.
BACKGROUND: Heart failure (HF) is a clinical syndrome caused by structural or functional cardiac disorders and is the final stage of every heart disease, marked by decreased functional capacity and patients’ quality of life (QoL). Suppression of tumorigenicity-2 (ST2) is a biomarker depicting heart fibrosis and remodeling that altered left ventricular geometry, which in turn decreases left ventricular contractility, decreases functional capacity, and ultimately affects the QoL of the HF patient.METHODS: An observational study was conducted with a cross-sectional approach involving 60 patients with systolic heart failure. Left ventricular geometry, left ventricular ejection fraction (LVEF), ST2 level, and other biomarkers were examined, continued by QoL assessment.RESULTS: The ST2 level (33.25±23.55 ng/mL) was negatively correlated with LVEF (r=-0.257; p=0.024) and was positively correlated with QoL (r=0.255; p=0.05). The LVEF was negatively correlated with QoL (r=-0.224; p=0.031). However, no significant correlation was found between left ventricular geometry with ST2 level or patients’ QoL.CONCLUSION: Elevated ST2 levels are correlated with decreased LVEF and worse QoL in systolic heart failure subjects. Therefore, ST2 together with LVEF can be used as prognostic tools for patients with HF.KEYWORDS: heart failure, ST2, left ventricular geometry, left ventricular ejection fraction, quality of life
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