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Factors Affecting the Blood Pressure Response to Aerobic and Anaerobic Exercise in Patients with Heart Disease
S184 Journal of Cardiac Failure Vol. 20 No. 10S October 2014 cardiopulmonary exercise testing (CPX) and exercise stress echocardiography. We calculated diastolic wall strain (DWS) from parasternal long-axis view. Echocardiographic indices were measured at baseline and peak exercise. Results: In HT group, peak oxygen uptake (peakVO2) was significantly lower compared to control group (17.865.2 vs. 26.064.2 mL/kg/min, P!0.01). DWS in HT group was significantly lower than that of control group in each point (baseline; 0.260.06 vs. 0.360.08, peak; 0.260.05 vs. 0.460.05, P!0.01). PeakVO2 was significantly correlated with DWS at baseline (r50.43, P!0.01) (Figure) and at peak exercise (r50.65, P!0.01). Conclusion: Myocardial extensibility could be related to exercise capacity.
O-224 Despite Elderly Patient with Refractory Heart Failure, Her Physical Frailty was Dramatically Overcome by DOPPO Rehabilitation Program AKIFUMI UEHARA, AKIHIRO YOKOYAMA, KANAKO OISHI, YUKI IZUMI, SATORU ABE, MASAYUKI ONISHI, TORU IZUMI Department of Internal Medicine, Niigataminami Hospital, Niigata, Japan A 92-year-old woman was admitted because of acute decompensated heart failure. She had repetitive episodes of hospitalization suffering from congestive heart failure. After just former discharge (one year ago), she started living in her own house again and was using the short stay care from support organization frequently. At that time, she could maintain IADL (Instrumental Activities of Daily Living). But on the present admission, her activity was severely depressed. After medical treatment of acute heart failure, her short physical performance battery (SPPB) score was only 6 points, 10m maximum walking speed (10MWS) was 0.55m/s and she could not stand one leg at all. With the consent, she took part to DOPPO (Discharge Of elderly Patients from hosPital On the basis of their independent gait) rehabilitation proposed by us. After 177 units extending 53 days, her ADL improved gradually but dramatically, she could stand one leg for 4 seconds and walk 207 meter during 6 minutes. Her SPPB score and 10MWS improved to 10 points and 0.81m/s. After 3 months rehabilitation, she could go home ambulatory independently. Even if patients are advanced elderly with physical frailty and repetitive heart failure, DOPPO rehabilitation, which reinforce lower extremity muscle strength and balance function, can overcome physical frailty. This project seems to be one future promising proposal for home care medicine of elderly.
O-225 Factors Affecting the Blood Pressure Response to Aerobic and Anaerobic Exercise in Patients with Heart Disease NAOTO KUMAGAI1, NAOKI FUJIMOTO2, KAORU DOHI1, MUNEYOSHI TANIMURA1, YUICHI SATO1, EMIYO SUGIURA1, SHIRO NAKAMORI1, NORIKAZU YAMADA1, MASHIO NAKAMURA3, MASAAKI ITO1 1 Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan, 2Department of Molecular and Laboratory Medicin, Mie University Graduate School of Medicine, Mie, Japan, 3Department of Clinical Cardiovascular Research, Mie University, Mie, Japan Background: We evaluated the association of blood pressure (BP) response to aerobic and anaerobic exercise (AE and AN) with exercise tolerance in patients with cardiovascular disease (CVD). Methods: Sixty-two patients who underwent maximal cardiopulmonary exercise test were stratified into 2 groups according to the difference between BP response from rest to anaerobic threshold (Rest-AT), and from AT to peak exercise (AT-Peak). Results: The AE group (DBPRest-AT O DBPAT-Peak) was older and more diabetic than the AN group (DBPRest-AT ! DBPAT-Peak). The AE group had higher BP at AT but not at rest or during peak exercise, and had smaller peak oxygen uptake and work rate. Multivariate analysis showed that peak work rate was independently associated with DBPRest-AT. Conclusion: CVD patients with greater BP response to AE have lower exercise tolerance.
O-226 Effect of Comprehensive Cardiac Rehabilitation on Oxidized Stress in Patients with Heart Failure TAKAYUKI ISE1, SYUSUKE YAGI1, TAKASHI IWASE1, MASASHI AKAIKE2, AYUMI ISHII3, KOJI NISHIKAWA3, HIROTSUGU YAMADA1, TAKESHI SOEKI1, TETSUZO WAKATSUKI1, MASATAKA SATA1 1 Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan, 2Department of Medical Education, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan, 3Department of Rehabilitation, Tokushima University Hospital, Tokushima, Japan Background: Comprehensive cardiac rehabilitation (CR) with exercise training improves cardiac function and heart failure. It has been reported that oxidized stress is enhanced in patients with heart failure. However, the effect of CR on oxidized stress has been unclear. The purpose of this study was to clarify the effect of CR on oxidized stress in patients with heart failure. Methods and Results: We enrolled 30 patients who completed the CR program (CR group) and 25 patients who failed to continue the CR program. We measured the urinary levels of 8- hydroxydeoxyguanosine (8-OHdG), a sensitive marker of oxidized stress, before and at 6 months after enrollment. At 6 months, peak VO2 in the CR group was significantly higher than the baseline value (p ! 0.01). 8-OHdG level at 6 months was significantly lower than the baseline value in the CR group (p ! 0.05), but the difference was not significant in the non-CR group. Furthermore, the increase in peak VO2 inversely correlated with the decrease in level of 8-OHdG (r5 -0.49, p ! 0.01). Conclusion: The CR program significantly reduced levels of 8-OHdG but not in non-CR group. CR may improve heart failure through improvement of oxidized stress.
O-227 Improvement in Exercise Capacity by Exercise Training is associated with Favorable Clinical Outcome in Advanced Chronic Heart Failure Patients MICHIO NAKANISHI, REON KUMASAKA, TETSUO ARAKAWA, TERUO NOGUCHI, TAKAHIRO OHARA, SHIGEFUMI FUKUI, NASANOBU YANASE, MASAHARU ISHIHARA, SATOSHI YASUDA, YOICHI GOTO Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Background: Exercise training (ET) improves exercise capacity in heart failure (HF) patients, but the effect of ET on exercise capacity and prognosis in advanced HF patients remains unclear. Methods and Results: We studied 164 HF patients with reduced peak oxygen uptake (peak VO2 !70%) who participated in a 3-month ET program (mean age, 61 years). After ET program, peak VO2 increased by 9.4% among patients with left ventricular ejection fraction $25% (high LVEF; n580; mean LVEF, 36%) and 9.6% among those with LVEF !25% (low LVEF; n584; mean LVEF, 19%) (P50.96). During a median follow-up of 40 months, the composite of all-cause death or HF hospitalization occurred in 30 patients (38%) among the high LVEF group and in 38 (45%) among the low LVEF group (P50.31). Among the low LVEF group, the 3-year event rate was significantly lower in patients with a change in peak VO2 $9% (median value) than those with a change in peak VO2 !9% (19.4% and 54.9%, P50.0002). In multivariate analysis, the change in peak VO2 was a significant predictor of the outcome (P!0.0001), independently of LVEF. Conclusion: Even in advanced HF patients with exercise intolerance and severely reduced LVEF, ET program can improve exercise capacity, and a greater improvement in exercise capacity after ET program is associated with more favorable outcome.
O-228 The Impact of Cardiac Rehabilitation on Frequency of Emergency Room Visit MIRAI KINOSHITA, KEIJI MATSUDA, ARINORI TAKEUCHI, NORITAKA FUJIMURA, TATSUYA HONDO, SHIN ENO Department of Cardiology, Chugoku Rousai Hospital, Hiroshima, Japan Background: Although beneficial effects of cardiac rehabilitation have been emphasized, impact on frequency of ER visit is unclear. Method: We have implemented as much cardiac rehabilitation for AMI patients as possible. We divided 51 patients treated recently into two groups, and compared them for ER visits and hospitalizations. Group A: 24 patients who were implemented cardiac rehabilitation for 6 months. Group B: 27 patients who have not done rehabilitation. Result: In 6 months from AMI onset. In group A, Number of ER visits: 3 (0.125 times per person), Number of hospitalizations: 1 (0.042 times per person). In group B, Number of ER visits: 5 (0.185 times per person), Number of hospitalizations: 5 (0.185 times per person). In 6-12 months after AMI onset. In group A, Number of ER visits: 11 (0.458 times per person), Number of hospitalizations: 6 (0.250 times per person). In group B, Number of ER visits: 2 (0.074 times per person), Number of hospitalizations: 5 (0.185 times per person). Frequency of ER visits in group A increased after rehabilitation. It was more than that of group B in the same period. But there was no difference between the number of hospitalizations in two groups. Conclusion: In group A, patient’s
O-224 Despite Elderly Patient with Refractory Heart Failure, Her Physical Frailty was Dramatically Overcome by DOPPO Rehabilitation Program AKIFUMI UEHARA, AKIHIRO YOKOYAMA, KANAKO OISHI, YUKI IZUMI, SATORU ABE, MASAYUKI ONISHI, TORU IZUMI Department of Internal Medicine, Niigataminami Hospital, Niigata, Japan A 92-year-old woman was admitted because of acute decompensated heart failure. She had repetitive episodes of hospitalization suffering from congestive heart failure. After just former discharge (one year ago), she started living in her own house again and was using the short stay care from support organization frequently. At that time, she could maintain IADL (Instrumental Activities of Daily Living). But on the present admission, her activity was severely depressed. After medical treatment of acute heart failure, her short physical performance battery (SPPB) score was only 6 points, 10m maximum walking speed (10MWS) was 0.55m/s and she could not stand one leg at all. With the consent, she took part to DOPPO (Discharge Of elderly Patients from hosPital On the basis of their independent gait) rehabilitation proposed by us. After 177 units extending 53 days, her ADL improved gradually but dramatically, she could stand one leg for 4 seconds and walk 207 meter during 6 minutes. Her SPPB score and 10MWS improved to 10 points and 0.81m/s. After 3 months rehabilitation, she could go home ambulatory independently. Even if patients are advanced elderly with physical frailty and repetitive heart failure, DOPPO rehabilitation, which reinforce lower extremity muscle strength and balance function, can overcome physical frailty. This project seems to be one future promising proposal for home care medicine of elderly.
O-225 Factors Affecting the Blood Pressure Response to Aerobic and Anaerobic Exercise in Patients with Heart Disease NAOTO KUMAGAI1, NAOKI FUJIMOTO2, KAORU DOHI1, MUNEYOSHI TANIMURA1, YUICHI SATO1, EMIYO SUGIURA1, SHIRO NAKAMORI1, NORIKAZU YAMADA1, MASHIO NAKAMURA3, MASAAKI ITO1 1 Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan, 2Department of Molecular and Laboratory Medicin, Mie University Graduate School of Medicine, Mie, Japan, 3Department of Clinical Cardiovascular Research, Mie University, Mie, Japan Background: We evaluated the association of blood pressure (BP) response to aerobic and anaerobic exercise (AE and AN) with exercise tolerance in patients with cardiovascular disease (CVD). Methods: Sixty-two patients who underwent maximal cardiopulmonary exercise test were stratified into 2 groups according to the difference between BP response from rest to anaerobic threshold (Rest-AT), and from AT to peak exercise (AT-Peak). Results: The AE group (DBPRest-AT O DBPAT-Peak) was older and more diabetic than the AN group (DBPRest-AT ! DBPAT-Peak). The AE group had higher BP at AT but not at rest or during peak exercise, and had smaller peak oxygen uptake and work rate. Multivariate analysis showed that peak work rate was independently associated with DBPRest-AT. Conclusion: CVD patients with greater BP response to AE have lower exercise tolerance.
O-226 Effect of Comprehensive Cardiac Rehabilitation on Oxidized Stress in Patients with Heart Failure TAKAYUKI ISE1, SYUSUKE YAGI1, TAKASHI IWASE1, MASASHI AKAIKE2, AYUMI ISHII3, KOJI NISHIKAWA3, HIROTSUGU YAMADA1, TAKESHI SOEKI1, TETSUZO WAKATSUKI1, MASATAKA SATA1 1 Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan, 2Department of Medical Education, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan, 3Department of Rehabilitation, Tokushima University Hospital, Tokushima, Japan Background: Comprehensive cardiac rehabilitation (CR) with exercise training improves cardiac function and heart failure. It has been reported that oxidized stress is enhanced in patients with heart failure. However, the effect of CR on oxidized stress has been unclear. The purpose of this study was to clarify the effect of CR on oxidized stress in patients with heart failure. Methods and Results: We enrolled 30 patients who completed the CR program (CR group) and 25 patients who failed to continue the CR program. We measured the urinary levels of 8- hydroxydeoxyguanosine (8-OHdG), a sensitive marker of oxidized stress, before and at 6 months after enrollment. At 6 months, peak VO2 in the CR group was significantly higher than the baseline value (p ! 0.01). 8-OHdG level at 6 months was significantly lower than the baseline value in the CR group (p ! 0.05), but the difference was not significant in the non-CR group. Furthermore, the increase in peak VO2 inversely correlated with the decrease in level of 8-OHdG (r5 -0.49, p ! 0.01). Conclusion: The CR program significantly reduced levels of 8-OHdG but not in non-CR group. CR may improve heart failure through improvement of oxidized stress.
O-227 Improvement in Exercise Capacity by Exercise Training is associated with Favorable Clinical Outcome in Advanced Chronic Heart Failure Patients MICHIO NAKANISHI, REON KUMASAKA, TETSUO ARAKAWA, TERUO NOGUCHI, TAKAHIRO OHARA, SHIGEFUMI FUKUI, NASANOBU YANASE, MASAHARU ISHIHARA, SATOSHI YASUDA, YOICHI GOTO Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Background: Exercise training (ET) improves exercise capacity in heart failure (HF) patients, but the effect of ET on exercise capacity and prognosis in advanced HF patients remains unclear. Methods and Results: We studied 164 HF patients with reduced peak oxygen uptake (peak VO2 !70%) who participated in a 3-month ET program (mean age, 61 years). After ET program, peak VO2 increased by 9.4% among patients with left ventricular ejection fraction $25% (high LVEF; n580; mean LVEF, 36%) and 9.6% among those with LVEF !25% (low LVEF; n584; mean LVEF, 19%) (P50.96). During a median follow-up of 40 months, the composite of all-cause death or HF hospitalization occurred in 30 patients (38%) among the high LVEF group and in 38 (45%) among the low LVEF group (P50.31). Among the low LVEF group, the 3-year event rate was significantly lower in patients with a change in peak VO2 $9% (median value) than those with a change in peak VO2 !9% (19.4% and 54.9%, P50.0002). In multivariate analysis, the change in peak VO2 was a significant predictor of the outcome (P!0.0001), independently of LVEF. Conclusion: Even in advanced HF patients with exercise intolerance and severely reduced LVEF, ET program can improve exercise capacity, and a greater improvement in exercise capacity after ET program is associated with more favorable outcome.
O-228 The Impact of Cardiac Rehabilitation on Frequency of Emergency Room Visit MIRAI KINOSHITA, KEIJI MATSUDA, ARINORI TAKEUCHI, NORITAKA FUJIMURA, TATSUYA HONDO, SHIN ENO Department of Cardiology, Chugoku Rousai Hospital, Hiroshima, Japan Background: Although beneficial effects of cardiac rehabilitation have been emphasized, impact on frequency of ER visit is unclear. Method: We have implemented as much cardiac rehabilitation for AMI patients as possible. We divided 51 patients treated recently into two groups, and compared them for ER visits and hospitalizations. Group A: 24 patients who were implemented cardiac rehabilitation for 6 months. Group B: 27 patients who have not done rehabilitation. Result: In 6 months from AMI onset. In group A, Number of ER visits: 3 (0.125 times per person), Number of hospitalizations: 1 (0.042 times per person). In group B, Number of ER visits: 5 (0.185 times per person), Number of hospitalizations: 5 (0.185 times per person). In 6-12 months after AMI onset. In group A, Number of ER visits: 11 (0.458 times per person), Number of hospitalizations: 6 (0.250 times per person). In group B, Number of ER visits: 2 (0.074 times per person), Number of hospitalizations: 5 (0.185 times per person). Frequency of ER visits in group A increased after rehabilitation. It was more than that of group B in the same period. But there was no difference between the number of hospitalizations in two groups. Conclusion: In group A, patient’s