Right ventricular (RV) function is a prognostic factor in ischemic heart disease (IHD) patients, although its correlations with exercise capacity and cardiac rehabilitation (CR) efficacy are unknown. We aimed to clarify how RV function was associated with exercise tolerance and efficacy of phase II CR in IHD patients. We retrospectively analyzed 301 consecutive IHD patients who underwent phase II CR. We defined RV dysfunction using a combination of RV fractional area change < 35%, tricuspid annular plane systolic excursion < 1.6 cm, and systolic velocity < 10 cm/s. Exercise capacity was assessed using cardiopulmonary testing. The relation between RV function and exercise capacity was analyzed. The all-cause death and major adverse cardiac events (MACE) were evaluated by survival curve. The RV dysfunction group (n = 121) showed impaired left ventricular (LV) systolic and diastolic function before CR contrary to the normal RV function group (n = 180). The presence of RV dysfunction significantly reduced %AT by 4% and %Peak[Formula: see text] by 9% before CR, but increases the degree of improvement in %Peak[Formula: see text] with CR, independent of LV systolic and diastolic function. Univariate analysis demonstrated that previous coronary artery bypass grafting (CABG) was negatively associated with all-cause deaths and MACE. Adjusted for previous CABG, poor prognosis correlated with coexisting LV and RV dysfunction (hazard ratio [HR] 3.91, 95% confidence interval [CI] 1.13-13.53, P = 0.03) and RV dysfunction alone (HR 3.08, 95% CI 1.01-9.37, P = 0.05). In IHD patients, RV dysfunction is associated with exercise intolerance before CR and increased MACE risk, independent of LV function. The CR was effective in patients with RV dysfunction.
Objective: The aim of this study was to confirm the effects of chronic kidney disease (CKD) and anemia on physical function and to clarify whether the interaction between CKD and anemia has an additive effect. Design: Eligible subjects were chronic heart failure (HF) patients who were discharged between March 2007 and August 2009. A total of 102 chronic HF patients (33% females; mean age: 68 ± 14 years) were enrolled in the present study. CKD was defined as an estimated glomerular filtration rate of <60 ml/min/1.73 m2, and anemia was defined as a hemoglobin level of <12 g/dl in males and of <11 g/dl in females. The Short Physical Performance Battery (SPPB) was used to assess physical function. Results: The adjusted mean SPPB score was lower in patients with both CKD and anemia than in those with neither of the diseases or with either disease alone (p < 0.05). Conclusion: This study found that CKD and anemia are independently associated with reduced physical function.
Hospital-acquired functional decline is an important outcome that affects the long-term prognosis of patients after cardiac surgery. Phase II cardiac rehabilitation (CR) for outpatients is expected to improve prognosis; however, this is not clear in patients with hospital-acquired functional decline after cardiac surgery. Therefore, this study evaluated whether phase II CR improved the long-term prognosis of patients with hospital-acquired functional decline after cardiac surgery. This single-center, retrospective observational study included 2371 patients who required cardiac surgery. Hospital-acquired functional decline occurred in 377 patients (15.9%) after cardiac surgery. The mean follow-up period was 1219 ± 682 days in all patients, and there were 221 (9.3%) cases with major adverse cardiovascular events (MACE) after discharge during the follow-up period. The Kaplan–Meier survival curves indicated that hospital-acquired functional decline and non-phase II CR was associated with a higher incidence of MACE than other groups (log-rank, p < 0.001), additionally exhibiting prognosticating MACE in multivariate Cox regression analysis (HR, 1.59; 95% CI, 1.01–2.50; p = 0.047). Hospital-acquired functional decline after cardiac surgery and non-phase II CR were risk factors for MACE. The participation in phase II CR in patients with hospital-acquired functional decline after cardiac surgery could reduce the risk of MACE.
Purpose Methods < ≥ Results < ConclusionVol. 41, No. 5
As editors we are pleased to bring the proceedings of the 2nd Annual Convention of the Cardio Renal Society of America (CRSA) to clinicians. CRSA is a nonprofit community healthcare organization whose goal is to help prevent and manage heart and kidney disease through public and professional education and research. We aspire to be the foremost leader in identifying and raising awareness of the interconnections between heart and kidney disease, resulting in improved quality of life and survival. The 1st Annual Convention of the Society was held in March 2013 in Phoenix, Ariz. The proceedings described in this issue are from the 2nd Annual Convention of CRSA. The CME portion of the CRSA convention began with the plenary session lunch presentation, which was attended together with participants in the Southwest Nephrology Conference. This course was designed to review the state of the art and current state of knowledge of cardiovascular disease (CVD) in patients with chronic kidney disease and renal function deterioration in subjects with CVD. Cardiorenal syndrome (CRS) is defined as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of one organ may induce acute or chronic dysfunction of the other. This relationship includes the vast array of interrelated derangements and, to stress, the bidirectional nature of heartkidney interactions. The members of the faculty described below are world renowned with expertise in their respective field, who were able to present a state-of-the-art content on each of the topics. Upon completion of this course, participants were able to gain knowledge in the areas of: (1) The global impact of CRS; (2) New staging classification of heart failure in ESRD; (3) Diabetes and its cardiorenal impact; (4) Novel biomarkers in acute kidney injury, and (5) Pathogenesis and treatment of CRS. Continuing education credit for physicians and physicians in training was planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Phoenix Children's Hospital and CRSA. Phoenix Children's Hospital is accredited by the ACCME to sponsor continuing medical education for physicians. Phoenix Children's Hospital designated this live activity for a maximum of 5 AMA PRA Category 1 Credit/s. A certificate of attendance was provided to nurse practitioners, nurses, patient care technicians and physician assistants at the end of the conference for use in documenting their contact hours of continuing education at this conference. Social workers received credit from Arizona Chapter of the National Association of Social Workers, and dietitians received certificate of attendance from the Academy of Nutrition and Dietetics. We announced a disclaimer that attendance at this course did not indicate nor guarantee competence or proficiency in the performance of any procedures, which may be discussed or taught in this course. We hope that you are able to enjoy the pub...
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