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Background Patients implanted with ventricular assist device (VAD) still have impairment of exercise capacity. Only few recipients’ patients were included in a cardiac rehabilitation program and moreover have sufficient intensity training. Purpose The aim of this study was to evaluate the impact of exercise training on exercise capacity in patients implanted with VAD. Methods This monocentric restrospective study includes 71 VAD patients (67 males, mean age: 53,6 ± 3,2 years) referred to CR 63 ± 54 days after implantation; 13 biventricular and 58 left VAD. Patients underwent clinical and exercise capacity (cardiopulmonary exercise test; CPET) evaluation before and at the end of the program; education and personalized exercise training including endurance and resistance training for 20 sessions. The main outcome was the changes on maximal and submaximal exercise capacity (peak VO2 and VT1). Results Among the whole population, 70 were able to perform the baseline CPET (peak VO2 is 39 ± 9% of normal values). The CPET after CR was available for 81,6% (13 patients not completing the entire program due to early transplantation, complications or willingness). For the 58 patients who have completed the program, results are displayed in Table 1 . Conclusions Exercise training improves significantly the exercise capacities of VAD patients. This contributes to enhance quality of life and probably better clinical status in awaiting transplant patients.

Background The EU-CaRE study is a prospective study comparing cardiac rehabilitation (CR) in 7 European countries including consecutive elderly patients (> 65 years) with coronary disease and/or cardiac surgery. Aim To evaluate the results on exercise capacity at one year follow up of different CR programmes. Methods We compared results of the French (Paris) CR program with Denmark (Copenhagen), Germany (Ludwigshafen), Italy (Parma), Netherlands (Zwolle, Nijmegen), Spain (Santiago), Switzerland (Bern). These programs differ by referral delay, number of sessions and the program duration. Results A total of 1633 patients were included, 219 for France. French patients were males (79%), aged by 73.2 ± 5.5 years, similarly to other countries. We included more CABG/valve replacement (67%) like Italy (61%) than non-surgical patients (33% in Paris vs. 50% in Netherlands, 62% in Denmark, 71% in Germany, 83% in Switzerland and 97% in Spain). In France, patients were referred early (15 days;11–23), enrolled in a short program (14 ± 3 sessions during 38 ± 15 days) compared to others. Results on gain of exercise capacity were obtained faster, without affecting the long-term (1 year) results ( Table 1 ). Conclusion Cardiac rehabilitation delay after index event, number of sessions and duration do not seem to impact long-term exercise capacity in coronary patients. We can presume that long-term results might be more due to the adherence/compliance and the educational measures during the CR program which have sustainable effects.

Background Improvement in autonomic responses is part of the benefits from the cardiac rehabilitation (CR). Acute effects during exercise on cardiac autonomy nervous activity in cardiac patients and their evolution after an exercise training program are not known. The aim of our study was to assess the evolution and the relation between parameters of cardiopulmonary exercise test (CPET) and markers of heart rate variability (HRV). Methods Prospective cohort study (French cohort from EU-CaRE study) of elderly patients with ischemic or valvular disease enrolled in CR. Only patients in sinus rhythm are included. The analysis of HRV include heart rate, SDNN and HF/LF ratio using a first 24-hours Holter-ECG performed at inclusion on the CR program including the CPET time and a second short Holter ECG (during CPET) at the end of CR. Results One hundred and eighteen patients (72.7 years, 79% male) who complete the CR program and had full data available were included. We define two groups: 74 patients after cardiac surgery (CABG, valve replacement), 44 patients in post-acute coronary syndrome (ACS). We found no correlation between the baseline 24-hours HRV parameters and the gain of peak VO2 for the whole population, but an r = 0.45 (P Table 1 ). Correlations between SDNN and HRR were found statistically significant (P Conclusion Exercise training improves HRV in elderly cardiac patients. Cardiac autonomic function recovery seems more pronounced after cardiac surgery than after an acute coronary syndrome.

Background The benefits of exercise based cardiac rehabilitation (CR) have been documented in elderly patients. The EUCaRE project included elderly patients (> 65 years) in 7 European countries, however in France, patient > 75 years were considered as elderly. Aim To compare the results of CR in patients aged ≤ or > 75 years old. Methods The prospective French cohort study from EU-CaRE study included 220 consecutive elderly patients (65+ years old) with coronary artery disease and/or heart valve replacement undergoing CR. All patients underwent cardiopulmonary exercise test (CPET) at baseline, at the end of CR and after 1 year of follow up. Results Of 217 patients with complete data, 71 were older than 75 years (32.72 %). Demographic characteristics, cardiac risk factors and comorbidities were similar between the 2 groups except for age, and the mean BMI that was lower in the > 75 years group. Rate of residential vs. ambulatory and the mean time from index event to start CR were comparable between older and ≤ 75 years (73.3 % vs. 67.6 % ; P = 0.385 and 18.8 ± 13 I vs. 20.9 ± 16 days ; P = 0.689, respectively). CPET results are displayed in the Table 1 . We found that the gain of exercise capacity after CR is similar between the two groups (P = ns), with a same sustainability at one year. Conclusion Patients older than 75 years improved functional capacity after CR similarly to youngers and should not be excluded if they are able to perform an exercise training program.

Non-invasive methods of measuring cardiac performances are highly desirable in patient with heart failure. Cardiopulmonary exercise testing (CPET) and this change after cardiac rehabilitation provides not only important prognostic value, but also derived information about the stroke volume (SV) and

Resume Un avantage majeur des stents actifs est lie a la diminution de la restenose. Cependant, ils sont plus onereux que les stents nus et necessite un traitement antiagregant plus lourd. En France, la Societe francaise de cardiologie et la Haute Autorite de sante ont defini des recommandations concernant l’utilisation des stents actifs (reserves au patient a haut risque). L’objectif de ce travail a ete d’evaluer notre pratique (a savoir si les recommandations dans notre centre etaient ou non bien respectees). Entre novembre 2007 et janvier 2008 et entre novembre 2008 et janvier 2009, nous avons evalue toutes les procedures d’angioplasties realisees. Deux cent seize patients (âge moyen 65 ± 13 ans, 164 (76 %) d’hommes, 41 (19 %) diabetiques) avec un angor stable ou une ischemie silencieuse (47 %), un syndrome coronaire aigu (SCA) ST− (26 %), SCA ST+ 48 h−1 mois (3 %). Deux cent soixante seize stents ont ete implantes (dont 35 % d’actifs). Les recommandations ont ete respectees dans 82 % des cas. Vingt-sept pour cent des stents nus implantes auraient pu etre actifs. Les recommandations des stents actifs en France constituent une reference pour aider les praticiens. Elles necessitent cependant d’etre adaptees a chaque malade en fonction du contexte clinique.

Summary Objectives 33 years after the UGDP study, the question of deleterious effects of the sulfoylurea (SU) is still raised. We have made a systematic review of the literature from experimental studies to clinical and epidemiological studies. Results The main molecule studied is glibenclamide (GB). In vitro and in animal studies, GB is both deleterious for ischemic preconditionning (IPC) and protective for arrhythmia during acute ischemia. Glimepiride (GM) and gliclazide (GCZ) do not seem to have effect on IPC. These effects have been few studied in diabetic animals. In human, according to the investigations used, the GB seems nil or suppressing for IPC, it seems elsewhere decreases ventricular arrhythmias during periods of acute ischemia. It is possible that these two actions account for the non-appearance of concordant deleterious effects between short and long-term studies. With regards to other drugs, only the GM has been specifically studied in human and appears to be nil on IPC. The only prospective clinical study available, although not having for objective to answer to this question, is the UKPDS study. This trial demonstrates the absence of deleterious cardiac effects of GB compared to chlorpropamide and particularly compared to insulin. Conclusion In conclusion, in experimental studies the cardiac effects of SU differ: both deleterious and protective for GB, nil for GM and GCZ on IPC. In all cases the clinical consequences seems to be nil.

Resume Propos. – Dans la litterature, l’hypertension arterielle pulmonaire primitive est retrouvee chez 0,5 % des patients infectes par le virus de l’immunodeficience humaine (VIH), quel que soit le stade de la maladie VIH, et concerne plus souvent des patients usagers de drogues. L’arteriopathie plexogenique est la lesion histologique la plus souvent retrouvee. Methodes. – Nous rapportons neuf observations retrospectives d’hypertension arterielle pulmonaire primitive au cours de l’infection par le VIH. Resultats. – Il s’agissait de quatre femmes et cinq hommes, d’âge moyen de 38 ans, contamines par voie sexuelle dans quatre cas et par toxicomanie intraveineuse dans cinq cas. Au moment du diagnostic d’hypertension arterielle pulmonaire primitive, les CD4 moyens etaient de 234 ± 217/mm3 et la charge virale moyenne etait basse ou indetectable. Le diagnostic d’hypertension arterielle pulmonaire primitive a ete porte en moyenne sept mois apres le debut des premiers signes cliniques cardiovasculaires. Malgre un traitement anticoagulant (sept cas sur neuf), vasodilatateur (quatre cas sur neuf) et/ou diuretiques (sept cas sur neuf), l’evolution a ete rapidement defavorable (sept deces). Conclusion. – Le diagnostic d’hypertension arterielle pulmonaire primitive doit etre evoque devant toute dyspnee inexpliquee chez un patient seropositif. Au moment du diagnostic, les alterations des parametres hemodynamiques sont en general moins severes qu’au cours des hypertensions arterielles pulmonaires primitives idiopathiques, mais leur evolution est plus rapide et plus grave, independamment du statut immunitaire. Les donnees actuelles ne permettent pas de determiner si le traitement antiretroviral joue un role dans l’evolution de l’hypertension arterielle pulmonaire primitive. Des essais therapeutiques avec la prostacycline sont en cours. Alors que l’esperance de vie des personnes infectees par le VIH s’allonge, l’incidence de l’hypertension arterielle pulmonaire primitive pourrait augmenter et necessiter un diagnostic precoce permettant une prise en charge specifique.