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Background Female heart diseases are underdiagnosed and undertreated. They are also probably under referred to cardiac rehabilitation (CR). The aim of our study is to compare CR benefits between men and women. Methods A total of 442 patients suffering from heart failure were referred to our center for CR between 2010 and 2014. Only 67 were women (15%). All patients had physical examination, electrocardiogram, echocardiography and a cardio-pulmonary exercise test (CPET) before and at the end of CR. Results Age was similar between men and women with 56.8±12.4 versus 56.2±14.5 years (p: NS). Ischemic heart disease was the main etiology for men (57.6%), but not for women (30%, p Patient’s CR characteristics are summarized in table. Abstract 0525 – Table: Patient’s clinical, echocardiographic and CPET’s characteristics Men (n=375) Women (n=67) p Before CR Heart Rate (bpm)80.3±15.7 80.3±15.7 77.3±16.4 NS Systolic blood pressure (mmHg) 109.8±19 102.8±19 Left ventricle Ejection Fraction (%) 28.8±8.7 29.3±8.9 NS CPET workload (watts) 76±27 58.1±20 Peak oxygen uptake: 15.6±5.2 14.7±4.9 NS – VO2 max (ml/kg/mn) – % of the normal value 56.2±17.8 63.9±22 First ventilatory threshold (VT1) (ml/kg/mn) 10.9±3.4 10.5±4 NS After CR Heart Rate (bpm) 76.8±14.6 75.4±14.3 NS Systolic blood pressure (mmHg) 110.4±20.8 98.5±19.2 NS CPET workload (watts) 92.5±32 67.8±20 Peak oxygen uptake: 18.2±5.7 16.1±4.8 NS – VO2 max (ml/kg/mn) – % of the normal value 65.5±19.3 68.5±18 First ventilatory threshold (VT1) (ml/kg/mn) 12.4±3.9 11.9±3.7 NS The benefit on CPET strength was similar (24.8±33 W for men and 22.1±35.4 W for women, p: NS), and also for the VO2 max. There were no differences in treatments at discharge. Conclusion: Women have the same benefits after CR for heart failure. Efforts must be provided to increase their referral to CR.

Introduction The gain of peak VO2 after exercise training has prognostic value in CHF patients. The predictive factors influencing this response remain debated. As oxygen pulse is correlated with the stroke volume, it could reflect cardiac adaptation during exercise. The aim of this study is to evaluate the cardiac participation in benefits of exercise training (ET). Methods We included prospectively 53 CHF patients (mean age: 57± 12 years, LVEF 29 ± 6%) who underwent two cardiopulmonary exercises (CPX): before and after 20 endurance exercise training sessions. We analysed for the two CPX heart rate, workload, VO2, oxygen pulse and calculated stroke volume and cardiac output at rest, anaerobic threshold (AT) and peak exercise. We measured BNP levels before and after the exercise training program. Patients were considered as responders if the gain of peak VO2 was >10%. Results Mean change in peak VO2 after exercise training is 17% for global population, 36% for responders (n=27) and – 4% for non responders (n=26). At baseline, responder patients have a lower worload at AT and at peak exercise (52.6 ± 19 vs 62.2 ± 17 watts p: 0.035 and 68.9 ± 28 vs 86.6 ± 27 watts p:0.035); a lower oxygen uptake (14.8 ± 4.8 vs 17.5 ± 4,6ml/kg/min p: 0.04), a chronotropic incompetence (max heart rate 99.8 ± 19.8 vs 116 ± 25 b/min p:0.01), a lower maximal cardiac output (6.6 ± 2.5 vs 8.0 ± 2,3l/min p:0.019) and a higher BNP serum level (median 506 vs 279 pg/l p:0.019). However oxygen pulse trends or left ventricular function do not influence changes in peak VO2 at any time and regardless of the training type (continuous vs interval training). Conclusion Cardiac adaptations in CHF patients do not seem to play major role in the response to exercise. Benefits of exercise training on exercise tolerance in CHF patients are mainly due to peripheral improvements.

Background Cardiac rehabilitation (CR) is recommended after acute coronary syndrome (ACS), as it reduces morbidity and improves quality of life. In France, about 20 to 30% of patients are referred to CR after ACS. The aim of our study is to evaluate if early referral ( Methods From April 2014 to April 2015, thirty nine patients were referred to CR after their discharge from cardiac care unit (one center). The early referral group (ERG) included 16 patients, all of them had their first medical contact in CR within 7 days after ACS. The late referral group (LRG) included 23 patients. All patients had physical examination, electrocardiogram, echocardiography and exercise test (ExT) before and at the end of CR. Results 21% of patients hospitalized for ACS were referred to CR. Mean age was 55.5±9.8 years with only 3 females (7.6%). The characteristics of each group are summarized in table. Abstract 0487 – Table: Characteristics of each group ERG (n=16) LRG (n=23) p Age (Years) 58.8±10.8 53.5±9.7 P=0.04 BMI (Kg/m 2 ) 25.6±2.7 25.08±2.6 NS Hypertension (%) 37.5 34.7 NS Diabetes (%) 18 17.3 NS Smoking (%) 81.2 69.56 P ACS complications 12.5 21.7 P Delay ACS-First medical CR contact (days) 5.8±1 13.7±8.6 P Delay ACS-CR starting (days) 18.4±15 25.4±14 P LV EF (%) 54.2±6.6 60.8 8.7 NS ExT before CR 7±1.1 6.9±1.6 NS METS 128.7 ±27.3 126.5±34.7 NS Workload (watts) 11.1 ±2.2 11.4±2.4 NS Number of CR sessions 0 8% NS Complications during CR (%) 8.4±2.7 8±1.9 NS Ext after CR 152.8±32 151.3±43.3 NS METS Workload (watts) No complications occurred during CR in ERG, for the LRG 2 patients had chest angina due to an incomplete initial revascularization procedure. Conclusion Referral rate to CR after ACS is in the range of French national rates. Benefits of CR are similar independently from referral delay. CR is also safe even when started early after ACS.