Exercise-based cardiac rehabilitation in surgically treated type-A aortic dissection patients

Fuglsang, Simon; Heiberg, Johan; Hjortdal, Vibeke E.; Laustsen, Sussie

doi:10.1080/14017431.2016.1257149

Cited by 44 publications

(51 citation statements)

References 24 publications

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“…If clinical benefits of cardiac rehabilitation post aortic dissection has not been evaluated well so far, cardiac rehabilitation activities seems to be beneficial in this context. In a small sample size study, peak oxygen consumption was significantly increased after a cardiac rehabilitation program 22 . Enhancement of peak oxygen uptake has already shown its benefit on cardiovascular secondary prevention in atherosclerotic populations.…”

Section: Discussionmentioning

confidence: 89%

Prognostic value of aerobic capacity and exercise oxygen pulse in postaortic dissection patients

Delsart

Delahaye

Devos

et al. 2020

Clinical Cardiology

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Background Although recommendations encourage daily moderate activities in post aortic dissection, very little data exists regarding cardiopulmonary exercise testing (CPET) to personalize those patient's physical rehabilitation and assess their cardiovascular prognosis. Design We aimed at testing the prognostic insight of CPET regarding aortic and cardiovascular events by exploring a prospective cohort of patients followed‐up after acute aortic dissection. Methods Patients referred to our department after an acute (type A or B) aortic dissection were prospectively included in a cohort between September 2012 and October 2017. CPET was performed once optimal blood pressure control was obtained. Clinical follow‐up was done after CPET for new aortic event and major cardio‐vascular events (MCE) not directly related to the aorta. Results Among the 165 patients who underwent CPET, no adverse event was observed during exercise testing. Peak oxygen pulse was 1.46(1.22‐1.84) mlO2/beat, that is, 97 (83–113) % of its predicted value, suggesting cardiac exercise limitation in a population under beta blockers (92% of the population). During a follow‐up of 39(20‐51) months from CPET, 42 aortic event recurrences and 22 MCE not related to aorta occurred. Low peak oxygen pulse (<85% of predicted value) was independently predictive of aortic event recurrence, while low peak oxygen uptake (<70% of predicted value) was an independent predictor of MCE occurrence. Conclusion CPET is safe in postaortic dissection patients should be used to not only to personalize exercise rehabilitation, but also to identify those patients with the highest risk for new aortic events and MCE not directly related to aorta.

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Section: Discussionmentioning

confidence: 89%

Prognostic value of aerobic capacity and exercise oxygen pulse in postaortic dissection patients

Delsart

Delahaye

Devos

et al. 2020

Clinical Cardiology

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“…Exercise has a comprehensive effect on the cardiovascular system, including resistance arteries. Thus, the effect of exercise on elastic arteries, including the aorta, may be also important for some diseases, for example, aortic dissection 24. Although exercise can reduce or even reverse the detrimental effects of aging on vascular function, the mechanisms underlying the favorable effects of exercise on age-related endothelial dysfunction have not been fully evaluated.…”

Section: Discussionmentioning

confidence: 99%

<p>Exercise restores impaired endothelium-derived hyperpolarizing factor–mediated vasodilation in aged rat aortic arteries via the TRPV4-K<sub>Ca</sub>2.3 signaling complex</p>

Huang

Hai

Tan

et al. 2019

CIA

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Background Aging leads to structural and functional changes in the vasculature characterized by arterial endothelial dysfunction and stiffening of large elastic arteries and is a predominant risk factor for cardiovascular disease, the leading cause of morbidity and mortality in modern societies. Although exercise reduces the risk of many age-related diseases, including cardiovascular disease, the mechanisms underlying the beneficial effects of exercise on age-related endothelial function fully elucidated. Purpose The present study explored the effects of exercise on the impaired endothelium-derived hyperpolarizing factor (EDHF)–mediated vasodilation in aged arteries and on the involvement of the transient receptor potential vanilloid 4 (TRPV4) channel and the small-conductance calcium-activated potassium (K Ca 2.3) channel signaling in this process. Methods Male Sprague-Dawley rats aged 19–21 months were randomly assigned to a sedentary group or to an exercise group. Two-month-old rats were used as young controls. Results We found that TRPV4 and K Ca 2.3 isolated from primary cultured rat aortic endothelial cells pulled each other down in co-immunoprecipitation assays, indicating that the two channels could physically interact. Using ex vivo functional arterial tension assays, we found that EDHF-mediated relaxation induced by acetylcholine or by the TRPV4 activator GSK1016790A was markedly decreased in aged rats compared with that in young rats and was significantly inhibited by TRPV4 or K Ca 2.3 blockers in both young and aged rats. However, exercise restored both the age-related and the TRPV4-mediated and K Ca 2.3-mediated EDHF responses. Conclusion These results suggest an important role for the TRPV4-K Ca 2.3 signaling undergirding the beneficial effect of exercise to ameliorate age-related arterial dysfunction.

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“…During exercise systolic blood pressures reached levels up to 150-170 mmHg or even more without complications but caution is still warranted and exercise levels remain to be individually adapted. Lowering blood pressure with beta-blockers or calcium antagonists was associated with a reduction in repeat surgery and improved survival [115][116][117][118][119].…”

Section: Scientific Evidencementioning

confidence: 99%

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 1

Rauch

Salzwedel

Bjarnason-Wehrens

et al. 2021

JCM

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Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the “Association of the Scientific Medical Societies in Germany” (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. Results: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on “treatment intensity” including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. Conclusions: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.

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Exercise-based cardiac rehabilitation in surgically treated type-A aortic dissection patients

Abstract: Our results suggest that type-A aortic dissection patients have hemodynamic responses to exercise that are comparable to other cardiovascular patients. Moreover, we found significant increases in peak oxygen uptake, maximal workload, and quality-of-life after ended ECR.

Cited by 44 publications

References 24 publications

Prognostic value of aerobic capacity and exercise oxygen pulse in postaortic dissection patients

Prognostic value of aerobic capacity and exercise oxygen pulse in postaortic dissection patients

<p>Exercise restores impaired endothelium-derived hyperpolarizing factor–mediated vasodilation in aged rat aortic arteries via the TRPV4-K<sub>Ca</sub>2.3 signaling complex</p>

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 1

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