Background. The exercise capacity is a key issue in a diabetic patient's management, due to its well-known beneficial effects in terms of glycemic control, cardiovascular risk reduction and quality of life improvement. However the exercise capacity of diabetic patients is decreased many times and its determinants are sometimes less known. Our study aimed to assess the effort capacity in a cohort of diabetic patients and to find the main causative factors of its impairment. Method: 61 patients with type-2 diabetes mellitus were enrolled and underwent and transthoracic echocardiography and a cycloergometer exercise testing. Exercise performance was calculated and the influence of clinical data and ultrasound parameters was assessed. Sedentary status of each patient was established from total time/week of at least moderate physical activity. Results: the study group consisted of 48.4 % women, mean age 61.4 (±8.4) years. Disease median duration was 5 years and 21.3 % of the patients presented neuropathy, 4.5 % retinopathy and 6.5 % nephropathy. Exercise capacity was moderately and severe decreased (<5 METs) in 37.7 % of patients and in this subgroup the diastolic dysfunction, sedentary behavior and old age has a significantly higher prevalence. Interestingly, by multivariate regression, the sedentary lifestyle was the main determinant of decreased effort capacity (beta-coefficient 1.37, p<0.001), suggesting the potential benefits of physical training in these patients. Conclusion. Our study found a decreased effort capacity in at least one third of the patients and this is mainly due to sedentary lifestyle and deconditioning, the diastolic dysfunction also contributes to decreased effort capacity in diabetic patients.

Background: Microvascular angina is a common clinical entity, with about a three-fold higher frequency in women. The pathogenesis of microvascular angina has not been much studied, but inflammation and endothelial dysfunction have been incriminated as the main mechanisms of this disease. Methoss: Our purpose was to analyze whether certain inflammatory markers, i.e., interleukin 6 (IL-6) and endothelin 1 (ET-1), can play a role in the diagnosis of microvascular angina in women. Results: Ninety women with ischemic heart disease were divided into two groups, based on their affliction with either microvascular or macrovascular disease. In general, the levels of IL6 and ET1 were similar between the two groups. Analyzing these marker levels according to the number of coronary lesions, we obtained an increased IL6 value that was similar for patients with microvascular angina, one-vessel, and two-vessel coronary disease, but significantly lower than in women with three-vessel coronary lesions. Also, in microvascular angina, IL6 level was correlated with the NYHA IV functional class. Unexpectedly, the level of ET1 was correlated with left ventricular systolic dysfunction. Conclusions: In women with an increased suspicion of microvascular angina, in whom microvascular dysfunction cannot be tested invasively, IL-6 level, unlike the ET-1 level, might be considered a diagnostic marker of this disease.

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The incidence and prevalence of cardiovascular disease among women has increased significantly over the last 50 years. However, women diagnosed with ischemic cardiopathy benefit to a much lesser extent from both pharmacological or interventional treatment and inclusion in cardiovascular rehabilitation programs. Cardiovascular rehabilitation programs in women should be individualized, taking into account the particularities of cardiovascular risk factors, effort, aritmogenic risk, socio-economic status. Women's cardiovascular rehabilitation programs need to be diversified and deployed in smaller groups of female patiens. These programs should include, besides physical recovery, emotional, social and psychological support. The purpose of this article is to synthesize some of the particularities of cardiovascular rehabilitation in women with ischemic heart disease and rhythm disorders.

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