Cardiorenal syndrome and the association with fitness: Data from a telerehabilitation randomized clinical trial

Abstract

AimsTo investigate the associations of cardiorespiratory fitness with cardiac, vascular, renal and cardiorenal characteristics in chronic heart failure in a telerehabilitation randomized clinical trial. Secondly, to evaluate the associations of cardiorenal syndrome with the effects of exercise. Methods and resultsSixty-nine heart failure patients attended baseline examination, and 61 patients were randomly assigned 1:1 to 3-month telerehabilitation or control. Data were collected at baseline and 3-month post-intervention, including echocardiography and vascular ultrasound, laboratory tests, exercise test with peak oxygen consumption (VO 2peak ) measurement and 6-min walk test (6MWT). Baseline VO 2peak and 6MWT distance was 0.85 mL*min À1 *kg À1 lower and 20 m shorter per 10 mL/min/1.73m 2 lower estimated glomerular filtration rate (both P < 0.001). Heart failure patients with cardiorenal syndrome had 3.5 (1.1) mL*min À1 *kg À1 lower VO 2peak and diastolic dysfunction grade 2-3, and elevated filling pressure was >50% more common compared with those without (all P < 0.05). At the 3-month post-intervention follow-up, only the non-CRS patients in the intervention group increased VO 2peak (0.73 (0.51) mL*min À1 *kg À1 ), whereas VO 2peak in the CRS subpopulation of controls decreased (À1.34 (0.43) mL*min À1 *kg À1 ). Cardiorenal syndrome was associated with a decrease in VO 2peak in CRS patients compared with non-CRS patients, À0.91 (0.31) vs. 0.39 (0.35) mL*min À1 *kg À1 respectively, P = 0.013. Conclusions Cardiorenal syndrome was negatively associated with VO 2peak and 6MWT distance in chronic HF, and the associations were stronger than for heart failure phenotypes and other characteristics. The effect of exercise was negatively associated with cardiorenal syndrome. Exercise seems to be as important in heart failure patients with cardiorenal syndrome, and future studies should include CRS patients to reveal the most beneficial type of exercise.

Different doses of atorvastatin in the treatment of patients with cardiorenal syndrome Type-2: A retrospective cohort study

“…It helps to improve vascular endothelial cell function, eliminate free radicals, inhibit their production, as well as helps to inhibit the activation of the neuroendocrine system, thereby reducing kidney damage and improving kidney function. 12 , 13 …”

“…It helps to improve vascular endothelial cell function, eliminate free radicals, inhibit their production, as well as helps to inhibit the activation of the neuroendocrine system, thereby reducing kidney damage and improving kidney function. 12,13 RCT by Yao Jianhua et al 14 showed that the addition of atorvastatin to the conventional treatment for cardiorenal syndrome can significantly improve renal function, and that the 40mg/day dose is more effective than the 20mg/day dose. Vogt L et al 8 analyzed six double-blind randomized controlled trials and found that atorvastatin has a dose-dependent beneficial effect on renal function and related cardiovascular outcomes, with a dose effect of 80mg/day significantly higher than 10mg/day.…”

Indexing cardiac volumes for peak oxygen uptake to improve differentiation of physiological and pathological remodeling: from elite athletes to heart failure patients

“…We also used baseline data from a sample of 61 heart failure patients with reduced ( n = 44), mildly reduced ( n = 12), or preserved ( n = 5) ejection fraction from a randomized clinical trial performed by our group aiming to evaluate the effect of telerehabilitation on a primary outcome of improvement in long-term physical activity (the ITISHOPE4HF trial; Implementation of Telerehabilitation In Support of HOme-based Physical Exercise for Heart Failure). 6 Heart failure diagnoses were made according to guidelines, including symptoms or signs of heart failure and reduced or mildly reduced ejection fraction or findings of preserved ejection fraction with diastolic dysfunction. 7 …”

“…Study-specific protocols aligned to the present recommendations 8 were followed for all image acquisitions and measurements in both the sample from the HUNT study, elite athletes, and the heart failure sample. 6 , 9 Each recording included at least three cardiac cycles acquired during quiet respiration or breath hold. Two experienced sonographers performed all echocardiographic analyses in the HUNT population, and one cardiologist expert accredited in transthoracic echocardiography by the European Association of Cardiovascular Imaging (EACVI) performed the analyses in the heart failure and elite endurance athlete population.…”

“… 11 The heart failure patients used an individualized and constant walking speed with inclination increasing every other minute until voluntary exhaustion using the Vyntus CPX system (Erich Jaeger GmbH, Hoechberg, Germany). 6 Using the same Vyntus system, the elite endurance athletes performed CPET after a thorough warm-up using their preferred modality (e.g. cyclists and speed skaters on a stationary bike and cross-country skiers on a roller ski treadmill).…”