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BACKGROUND: Exercise training is included in cardiac rehabilitation programs to enhance physical capacity and cardiovascular function. Among the existing rehabilitation programs, exercises in water are increasingly prescribed. However, it has been questioned whether exercises in water are safe and relevant in patients with stable chronic heart failure (CHF), coronary artery disease (CAD) with normal systolic left ventricular function. The goal was to assess whether a rehabilitation program, including water-based gymnastic exercises, is safe and induces at least similar benefits as a traditional land-based training. METHODS AND RESULTS: Twenty-four male CAD patients and 24 male CHF patients with stable clinical status participated in a 3-week rehabilitation. They were randomized to either a group performing the training program totally on land (CADl, CHFl; endurance + callisthenic exercises) or partly in water (CADw, CHFw; land endurance + water callisthenic exercises). Before and after rehabilitation, left ventricular systolic and cardiorespiratory functions, hemodynamic variables and autonomic nervous activities were measured. No particular complications were associated with both of our programs. At rest, significant improvements were seen in CHF patients after both types of rehabilitation (increases in stroke volume and left ventricular ejection fraction [LVEF]) as well as a decrease in heart rate (HR) and in diastolic arterial pressure. Significant increases in peaks VO(2), HR, and power output were observed in all patients after rehabilitation in exercise test. The increase in LVEF at rest, in HR and power output at the exercise peak were slightly higher in CHFw than in CHFl. CONCLUSIONS: Altogether, both land and water-based programs were well tolerated and triggered improvements in cardiorespiratory function. [ABSTRACT FROM AUTHOR]

Introduction: Coronary heart disease remains one of the leading causes of morbidity and mortality, and is responsible for significant social costs. Resumption of work is an essential objective when this pathology concerns working patients. French data remain patchy and relatively old. The French Society of Cardiology's Exercise, Rehabilitation, Sport and Prevention Group has proposed a multicentre study to update these data., Methods: Following an acute coronary syndrome (ACS), the cardiology team asked the patient, who was currently working, to complete a questionnaire on his or her pathology, occupation and plans to return to work. An interview after 6 months enabled the clinical and professional situation of the patient to be analyzed, in order to study the factors predictive of a return to work., Results: 364 patients were included in 6 interventional and 17 cardiac rehabilitation centres between 2018 and 2019. The resumption rate was 81% (n = 295), 93% of them in the same position, with a mean delay of 106 ± 56 days. The cardiologic independent factors for non-return were left ventricular ejection fraction, the presence of an anticoagulant, angina or heart failure, and occupational factors, shift work, exposure to cold, and imposed work rates. Factors that lengthened the time taken to return to work included delayed access to rehabilitation, the carrying of heavy loads, difficult postures and imposed work rates, as well as the patient's lack of a project, the absence of a cardiologist's opinion and the request for a modified workstation., Conclusion: The rate of return to work remains fairly stable despite the evolution of disease management, and the time to return to work relatively high. One way of improving the situation is to enhance access to cardiac rehabilitation programs, for example by offering alternatives such as tele-rehabilitation for a proportion of patients. This will free up more time for more severe patients, to better prepare them physically and psychologically for a return to work, which will also have a beneficial economic effect., Competing Interests: Déclaration de liens d'intérêt Les auteurs déclarent ne pas avoir de lien d'intérêt avec cet article, (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background Exercise training as part of a comprehensive cardiac rehabilitation is recommended for patients with cardiac heart failure. It is a valuable method for the improvement of exercise tolerance. Some studies reported a similar improvement with quadricipital electrical myostimulation, but the effect of combined exercise training and electrical myostimulation in cardiac heart failure has not been yet evaluated in a large prospective multicentre study. Purpose The aim of this study was to determine whether the addition of low frequency electrical myostimulation to exercise training may improve exercise capacity and/or muscular strength in cardiac heart failure patients. Methods Ninety-one patients were included (mean age: 58 ± 9 years; New York Heart Association II/III: 52/48%, left ventricular ejection fraction: 30 ± 7%) in a prospective French study. The patients were randomised into two groups: 41 patients in exercise training and 50 in exercise training + electrical myostimulation. All patients underwent 20 exercise training sessions. In addition, in the exercise training + electrical myostimulation group, patients underwent 20 low frequency (10 Hz) quadricipital electrical myostimulation sessions. Each patient underwent a cardiopulmonary exercise test, a six-minute walk test, a muscular function evaluation and a quality of life questionnaire, before and at the end of the study. Results A significant improvement of exercise capacity (Δ peak oxygen uptake+15% in exercise training group and +14% in exercise training + electrical myostimulation group) and of quality of life was observed in both groups without statistically significant differences between the two groups. Mean creatine kinase level increased in the exercise training group whereas it remained stable in the combined group. Conclusions This prospective multicentre study shows that electrical myostimulation on top of exercise training does not demonstrate any significant additional improvement in exercise capacity in cardiac heart failure patients.

Cardiovascular mortality has decreased over the past 25 years, largely because of acute coronary syndrome care and preventive actions. Nevertheless, the rate of coronary heart disease remains high, with an annual risk of 4.7% (cardiac mortality, myocardial infarction, stroke). Cardiovascular risk factor management must be a priority in primary and secondary prevention, to improve the prognosis of this severe disease, in which absence of symptoms does not mean benignity. The current goals of therapeutic patient education are smoking cessation, regular physical activity, a cardioprotective (Mediterranean) diet, management of stress, good treatment adherence (which improves compliance), judicious use of the care system and help with occupational reintegration. Current and future programmes must be in accordance with the Haute Autorité de Santé recommendations published in 2007., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

The Diabetes and Cardiovascular Disease study group of the Société francophone du diabète (SFD, French Society of Diabetes) in collaboration with the Société française de cardiologie (SFC, French Society of Cardiology) have devised a consensus statement on the care of the hyperglycaemic/diabetic patient during and in the immediate follow-up of acute coronary syndrome (ACS); in particular, it includes the different phases of ACS [the intensive care unit (ICU) period, the post-ICU period and the short-term follow-up period after discharge, including cardiac rehabilitation] and also embraces all of the various diagnostic and therapeutic issues with a view to optimizing the collaboration between cardiologists and diabetologists. As regards diagnosis, subjects with HbA(1c) greater or equal to 6.5% on admission may be considered diabetic while, in those with no known diabetes and HbA(1c) less than 6.5%, it is recommended that an OGTT be performed 7 to 28 days after ACS. During hospitalization in the ICU, continuous insulin treatment should be initiated in all patients when admission blood glucose levels are greater or equal to 180 mg/dL (10.0 mmol/L) and, in those with previously known diabetes, when preprandial glucose levels are greater or equal to 140 mg/dL (7.77 mmol/L) during follow-up. The recommended blood glucose target is 140-180 mg/dL (7.7-10 mmol/L) for most patients. Following the ICU period, insulin treatment is not mandatory for every patient, and other antidiabetic treatments may be considered, with the choice of optimal treatment depending on the metabolic profile of the patient. Patients should be referred to a diabetologist before discharge from hospital in cases of unknown diabetes diagnosed during ACS hospitalization, of HbA(1c) greater or equal to 8% at the time of admission, or newly introduced insulin therapy or severe/repeated hypoglycaemia. Referral to a diabetologist after hospital discharge is recommended if diabetes is diagnosed by the OGTT, or during cardiac rehabilitation in cases of uncontrolled diabetes (HbA(1c) ≥ 8%) or severe/repeated hypoglycaemia.

Purpose: The aim of this study was to evaluate the predictive factors of return to work after coronary bypass graft surgery, for the subgroup of professionally active patients aged less than 60 years included in the PERISCOP study., Methods: In the principal, prospective, multicentre study, 2065 patients were evaluated 20+/-10 days after surgery by exercise testing, echocardiogram and 24-h ambulatory ECG monitoring. A questionnaire was completed one year after surgery. We studied a subgroup of this population, consisting of 530 patients previously defined (94.5% men; mean age: 50.5+/-5.8 years)., Results: One year after surgery, five of these patients had died and 21 were lost to follow-up. Among the remaining patients, 340 patients (67.5%) had returned to work. Forty patients (7.9%) had retired, 45 (8.9%) were on sick leave, 22 (4.4%) were unemployed, 49 (9.7%) returned to work after the deadline of 12 months, eight (1.6%) had given insufficient information on return to work. In multivariate analysis, the independent predictors of a failure to return to work were age >51 years [OR: 0.39 (95% CI: 0.25-0.59)], being a manual worker [OR: 0.49 (95% CI: 0.31-0.79)], being from South East France [(OR: 0.42 (95% CI: 0.23-0.74)], presence of angina [OR: 0.40 (95% CI: 0.20-0.82)], dyspnoea [(OR: 0.46 (95% CI: 0.28-0.77)] and a duration of exercise <420 s [(OR: 0.50 (95% CI: 0.33-0.76)]., Conclusions: Return to work after coronary bypass graft surgery is observed in 67.5% of cases and depends essentially on socio-professional factors and residual symptoms. A regional effect was also observed, which requires further study.

Aims: Little is known about which patients who have undergone coronary bypass surgery are at risk of future clinical cardiovascular events and may benefit from further medical treatment. We sought to determine if routine non-invasive cardiac investigations performed early after surgery were able to stratify the risk of cardiovascular events in this population., Methods: Two thousand and sixty-five consecutive patients were enrolled in a prospective multicenter study (PERISCOP). Exercise testing, echocardiography, and 24-h ambulatory ECG monitoring were performed at day 20+/-10 after coronary bypass surgery. Follow-up was performed 1 year after coronary bypass surgery. Causes of all hospitalisation and death occurring within 1 year were documented and classified by an End-point Committee. The principal endpoint was the combination of all-cause deaths and cardiovascular events requiring hospitalisation (myocardial infarction, unstable or severe angina, stroke, congestive heart failure)., Results: The 1-year frequency of first events was 155 (8%). In multivariate analysis, exercise duration <420s (RR=1.68; 95% CI: 1.13-2.49), exercise induced ST segment depression >1mm (RR=1.90; 95% CI: 1.18-3.05), and left ventricular (LV) dysfunction (wall motion index <1.15) (RR=1.97; 95% CI: 1.10-3.51) were independent predictors of cardiovascular events and deaths. Ambulatory ECG monitoring had no predictive value., Conclusions: Exercise testing and echocardiography performed early after coronary bypass surgery are able to identify high-risk patients who may benefit from intensive secondary prevention.

The aim of the PERISCOP study was to evaluate the predictive value of cardiological investigations performed after recent coronary bypass surgery with regards to cardiac event and mortality at one year. The treatment of lipid abnormalities was also analysed. This first article describes the methodology and patient characteristics at inclusion. This prospective national multicenter trial included 2065 patients (86% men) with an average age of 63.1 +/- 9.9 years. The number of diseased vessels was 2.6 +/- 0.6. Preoperative left ventricular function was normal (ejection fraction 60 +/- 13%). Revascularisation was complete in 73% of cases (22% of arterial grafts). The cardiological investigations were performed at Day 20 +/- 10 after surgery. The duration of exercise on stress testing was 429 +/- 170 seconds. It was positive or doubtful in 9% of cases. Ventricular arrhythmias were observed in 6.5% of cases. The blood pressure response was abnormal in 6% of cases. Holter monitoring showed a median number of ventricular extrasystoles over 24 hours of 44. Three per cent of patients had one episode of ventricular tachycardia and 7% had ischaemic episodes. The echocardiographic index of segmental contractility was on average 1.75 (ejection fraction: 52.6%). The lipid analysis performed at one month, under lipid therapy in 34% of cases, showed a total cholesterol level at 1.91 +/- 0.10 g/l, an LDL-cholesterol of 1.27 +/- 0.08 g/l. The therapeutic target (LDL-cholesterol < 1 g/l) was attained in 46% of cases with treatment and in 18% of cases without treatment.

This was a prospective study of the modalities of return to work in a male population of 128 patients (mean age 48.9 years)) admitted for cardiovascular rehabilitation after acute infarction or coronary bypass surgery and followed up for 7 years. At one year, 78.9% of the population had returned to work (average delay 126 +/- 97 days), usually to the same job (66.3%) after adaptation (25.8%) or professional reconversion (7.9%). After 3 and 7 years follow-up, the active population was 62.5% and 40.7% respectively and the main reason for definite stopping work was retirement (63%). Temporary stoppages were short (4.5 days and 8.2 days per patient per year at 3 and 7 years respectively), illustrating the good quality of professional rehabilitation. The factors influencing return to work during the first age were young age (47.5 versus 52.7 years) and negative exercise stress tests (83% versus 59% in cases of positive tests, p < 0.05). This study and a review of the literature were used to undertake a medico-economic analysis which showed decreased economic consequences in patients referred for rehabilitation: over 5 years in a group of 100 patients, an economy of 5,818 KF after myocardial infarction or 2,677 KF after coronary bypass surgery was demonstrated. The reasons for these economies were the reduced direct (hospital admissions) and indirect costs (social security reimbursement for off-work and invalidity pensions). Those favourable results underline the value of a consultation of professional aptitude in all programmes of cardiovascular rehabilitation.

The aim of this study was to assess the type and frequency of cardiac and extracardiac complications of coronary artery surgery in patients referred for cardiac rehabilitation (for which it is one of the principal indications): this was a prospective study carried out simultaneously in 30 cardiac rehabilitation units during December 1992 and including 533 patients (81 women, 452 men) with a mean age of 62.1 years. The total number of coronary grafts was 1,361 (on average 2.5 per patient); the internal mammary artery was used in 87% of cases; revascularisation was complete in 66.4% of patients. One or more complications were observed in 79% of patients during the hospital period (68.9%) and/or during the rehabilitation phase (44.7%), independently of age, sex, duration of cardiopulmonary bypass, or the interval to cardiac rehabilitation. The main extracardiac complications were respiratory (31.5%), disturbances of cerebral function (15.6%) and renal failure (10.3%). Cardiac complications comprised arrhythmias, essentially supraventricular (21.3%), infarction and residual postoperative ischaemia (8.4%), large pericardial effusion (7.5%), cardiac failure (4.5%), and wound infection (4.3% including 2.8% mediastinitis). Anaemia, a secondary effect of cardiopulmonary bypass, was observed in 25% of patients. This prospective study, though affected by a bias of selection and not fully representative of the surgical outcome, shows the need for a personalised management of these patients, the early indication of cardiovascular rehabilitation contributing to the optimisation of coronary artery surgery at less cost and with improved safety.

This study analysed the possibilities of returning to work of professional drivers after a cardiac event and rehabilitation. The population comprised 94 consecutive patients, all men, average age 48.8 years (range 30 to 63 years) referred after coronary bypass surgery (N = 39), myocardial infarction (N = 38), angina (N = 4) or valve replacement surgery (N = 13). Advice on professional reinsertion was given after the rehabilitation program, authorization to drive being given in the absence of cardiac symptoms, residual myocardial ischaemia, severe left ventricular dysfunction and serious ventricular arrhythmias. After 35 months, 4 patients were lost to follow-up; of the 90 remaining patients, the frequency of return to work (maximal at the 9th month) was 65.6% with 84.7% obtaining a renewal of their driving licence. In this series, 81% of patients were asymptomatic, 2 died, 16.7% had further cardiovascular complications. The morbidity and mortality were significantly greater in the group who had to stop driving (N = 40) (32.5% vs 8%, p < 0.001). Non complications occurred during work in those who resumed driving. This study confirms the safety of allowing low risk professional drivers, identified during cardiac rehabilitation by simple, reliable clinical and paraclinical criteria, to return to work.

Seldom mentioned as a possible etiology of false positive stress tests (ST), the right atrial hypertrophy (RAH) may cause electrocardiographic aspects evocative of myocardial ischemia in the lower areas. The retrospective study concerns STs in 4 patients, staying in a cardiac rehabilitation center, following (D14) surgery for isolated type II IAC, Fallot's trilogy (n = 1), or dual valvular disease (tricuspid insufficiency and mitral stenosis, n = 1), and presenting all on basal ECG a RAH (group I). These STs are compared to that of a reference group operated (D14) from a IAC type II (isolated n = 3, associated to RVPA n = 1), but without signs of RAH on the rest ECG (group II). All other possible causes of electrically positive STs were eliminated from this study. In patients with RAH, the stress test is positive in the lower area (ST = -1.27 +/- 0.25 mm). In four other patients without HAD, the STest is negative in 3 cases and uncertain in one. These results do not seem to be linked to pre-operative hemodynamic data, nor to sonocardiographic data. Atrial repolarization alone seems to be the cause of these ECG alterations during stress, as demonstrated, in one patient, by sudden variations of the ST segment during a change from an atrial rhythm (AR) (with retrograde atrial depolarization) to a sinus rhythm (SR). These observations suggest the role of atrial repolarization in the origin of false positive stress tests in patients with RAH.

18 of 39 cases of ischaemic papillary muscle dysfunction reported elsewhere underwent cardiac catheterisation and angiography. Fifteen patients had previous myocardial infarction. The average age of the patients was less than in the overall series (69 vs 73 years) but the incidence of infarction and the degree of cardiac disease were greater. The absence of catheter data in the other patients is explained by their older age (76.4 years) and the longer period of recruitment. Their results and outcome of medical or surgical treatment are reported. The pathogenesis of the syndrome is reconsidered in the perspective of paroxysmal forms. A protocol for investigation is suggested to guide the therapeutic options. Right heart catheterisation at rest (n = 16), on exercise (n = 12), under vasodilator therapy (n = 6) and during angiography (n = 2) does not show a specific profile. These investigations only provide haemodynamic data related to therapy but they are essential for the interpretation of ventriculography. Ventriculography (n = 8) demonstrated 4 cases of mitral regurgitation (2 major and 2 minor), a reduced EF (0.47 +/- 0.17), asynergy of 36.1 p. 100 of segments analysed, predominantly in the inferior and lateral zones. Coronary angiography showed triple vessel disease in 6 cases, double vessel disease in 1 case and 1 stenosis of the left main coronary artery. Stenosis was commonest on the left circumflex (87.5 p. 100) and right coronary arteries (87.5 p. 100) but also frequently involved the left anterior descending artery (75 p. 100). Of the 12 patients treated medically, 8 died (66.6 p. 100) and the survivors remain symptomatic (33.3 p. 100), half with and half without attacks. After surgery (n = 8) comprising coronary bypass surgery (n = 6) or mitral valve replacement (n = 2), patients were asymptomatic. 1 patient died of cancer. These paroxysmal forms of mitral regurgitation may be explained by the association of aggravating, reversible ischaemic or haemodynamic factors to organic mitral lesions. Mitral valve replacement is justified when dysfunction becomes permanent and coronary bypass surgery is advocated whenever possible. The indications for surgery can only be taken into account after complete haemodynamic and angiographic investigation. A protocol for the interpretation of these investigations is suggested.

A 21 year old patient was operated for bilateral ptosis and external ophthalmoplegia at 13 years of age. At this time there were no signs of retinitis pigmentosa or atrioventricular block, features of the Kearns and Sayre Syndrome (1958) which were detected five years later. His bundle recording showed an intrahisian block (1 degree proximal and a complete distal block) with a trifascicular block, the latter persisting alone during a brief return to sinus rhythm. This is one of the rare cases of the Kearns and Sayre Syndrome with documented His bundle recordings and the only reported case with intrahisian block. The patient also suffered from bilateral neural deafness. The patient's condition remains stable after implantation of an isotopic cardiac pacemaker and he now leads a normal life. A review of 52 previously published cases shows that this rare condition appears to be caused by a mitochondrial abnormality, which, for an unknown reason, affects only the neuromuscular and cardiac conduction systems. The prognosis is poor when swallowing and respiration are affected, but this does not occur in all cases. As cardiac conduction abnormalities are the other life-threatening complication, cardiac pacing has greatly improved the prognosis of these patients.

The objective of this study is to evaluate the effects of rehabilitation in 46 consecutive patients with triple vessel coronary disease, and unfit for by-pass surgery: there were 45 men and 1 woman (mean age = 58 years), admitted during the 3rd week of a myocardial infarction (N = 31) or following unstable angina (N = 15). The stroke volume (SV) is normal in 50 p. cent of the patients, but 15 p. cent presented as SV less than 0.30. 3 patients were unable to start their rehabilitation because of unstable angina (N = 2), or severe pulmonary edema (N = 1). Following 4 weeks of rehabilitation, comparison of the stress tests pre- and post-rehabilitation, reveals improved functional capacities (maximum level reached 103.6 +/- 27 vs 126.4 +/- 31; p less than 0.001, and an improvement of the ischemic threshold (82 +/- 32 vs 92 +/- 31; p less than 0.05). During the long-term follow-up (32.5 months), 4 patients died from cardiac complications (8.7%) and one from extra-cardiac reasons. Among the 41 alive patients, 58.6 p. cent were asymptomatic, 39 p. cent presented cardiac complications, one had a GI malignancy. The rate of return to work among the active population is 68.5 p. cent within a mean time of 1.7 months after rehabilitation. Overall, this study demonstrates the possibility of cardiac rehabilitation under medical supervision in patients with severe triple vessel coronary disease. The improvement of the functional abilities under stress conditions is obvious, enabling the patient to regain confidence in him/herself and improve his/her comfort.

This double-blind, placebo-controlled study sought to examine the short-term benefit of adding 60 mg of trimetazidine to the daily therapeutic regimen of 29 male patients with coronary insufficiency who had persistent ST depression on exercise tolerance test (greater than or equal to 1 mm), despite treatment with nifedipine 40 mg per day. As compared with the placebo group, after only 14 days, the patients treated with trimetazidine showed statistically significant increases in the maximum workload level attained before ST depression occurred (31% versus - 6%; P = 0.009), the total work performed (31% versus 2%; P = 0.024) and a significant decrease in the systolic tension time (double product)/workload ratio (-5% versus +11%; P = 0.005). Throughout the study the clinical acceptability was excellent, with no side effects attributable to trimetazidine being recorded. This study shows that the addition of trimetazidine to a calcium antagonist brings a valuable improvement in therapeutic results.

44 patients with refractory heart failure (RHF) were treated with a conversion enzyme inhibitor, captopril. Prior to treatment, 26 patients had stage IV RHF and 18 patients had stage III RHF (NYHA). The course of the trial was marked by early deaths (6 months) in 9 cases (20.4%), early treatment failure in 8 cases (18.2%), intolerance in 3 cases (6.8%) and 3 patients (6.8%) were lost to follow-up. 21 patients (48%) were improved by the treatment and were followed for a mean of 16 months +/- 8.6. The mean dosage of captopril was 157 mg per day in 3 oral doses (range: 75 to 300 mg per day). The pulmonary capillary pressure dropped, on average, from 30 +/- 10 mm Hg to 21 +/- 7 mm Hg (p less than 0.01) by the 8th day and remained stable thereafter. The cardiac index increased by 40%. The heart rate decreased by a mean of 10.4%, by the time of the first examination. The mean blood pressure was not significantly modified. Side effects which resolved after changing the dosage were seen in one third of cases: renal failure (4 cases), hypotension (2 cases), hyperkalaemia (1 case). In the long term, 6 patients (2.6%) died after a mean delay of 15.6 +/- 5.3 months.