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Byline: Manuel Ruiz-Bailen (1), Asuncion Lopez-Martinez (2), Jose Angel Ramos-Cuadra (1), Miguel Angel Diaz-Castellanos (1), Antonio Cardenas-Cruz (1), Manuel Rodriguez-Elvira (3), Angel Montiel-Trujillo (2) Keywords: Peripartum cardiomyopathy Dilated cardiomyopathy Myocarditis Pregnancy Idiopathic cardiomyopathy Abstract: Objectives: We describe our experience with peripartum cardiomyopathy. Design and setting: A case series in intensive care units (ICU) of a district hospital and a referral center. Patients: Six patients who required admission to an ICU after the onset of peripartum cardiomyopathy. Results: Five of the six patients survived, with total recovery of ventricular function. After 1 year of follow-up all five survivors were symptom free with a normal ventricular function. Conclusions: There is a low rate of ICU admissions for peripartum cardiomyopathy, which has a potentially fatal prognosis. However, this disease can be detected by echocardiography among patients without the semiology. Author Affiliation: (1) Intensive Care Unit, Critical Care and Emergencies Department, Hospital de Poniente, El Ejido, Almeria, Spain (2) Cardiology Unit, Hospital de Poniente, El Ejido, Almeria, Spain (3) Intensive Care Unit, Critical Care and Emergencies Department, Virgen de las Nieves University Hospital, Granada, Spain (4) Mailing address: C/. Las Torres 57, 23650 Torredonjimeno, Jaen, Spain, e-mail: MRB1604@teleline.es, Tel.: +34-950-572020, Fax: +34-950-570702 Article History: Received Date: 08/06/2000 Accepted Date: 02/11/2000 Article note: Final revision received: 15 September 2000 Electronic Publication

Background: programs of weight loss and a healthy diet are recommended for patients with cardiovascular risk but the effectiveness of these programs in decreasing cardiovascular mortality is controversial. Aim: to examine the acute and long-term effects of a 2-month cardiac rehabilitation program on chemokines related to inflammation in subjects with cardiovascular disease. Design: prospective cohort study. Methods: twenty-six patients with cardiovascular disease enrolled in a cardiac rehabilitation program based on nutritional and exercise interventions were studied. Lifestyle and clinical, metabolic and inflammatory variables were analysed. Results: 88.5% were men and the mean age was 54.9 ± 7.8 years. At the end of the cardiac rehabilitation program the levels of carbohydrate and lipid metabolism were lower, except for high density lipoprotein cholesterol which was higher. The levels of uric acid, interleukin- 6, interleukin-1Beta, adiponectin and leptin remained stable. Interleukin-6 correlated positively with levels of C-reactive protein and negatively with blood glucose. Interleukin-1Beta correlated positively with C-reactive protein levels and negatively with blood pressure figures. Significant correlations were seen between the changes in levels of interleukin-6 and interleukin-1Beta and changes in metabolic equivalents, and in C-reactive protein levels before and after the cardiac rehabilitation program. No significant correlations were observed with weight, waist circumference or fat mass. Conclusions: a cardiac rehabilitation program decreased anthropometric variables and blood pressure figures, and improved lipid metabolism and ergometry data. However, no changes regarding the inflammatory state were observed. [ABSTRACT FROM AUTHOR]

Background: Programs of weight loss and a healthy diet are recommended for patients with cardiovascular risk but the effectiveness of these programs in decreasing cardiovascular mortality is controversial., Aim: To examine the acute and long-term effects of a 2-month cardiac rehabilitation program on chemokines related to inflammation in subjects with cardiovascular disease., Design: Prospective cohort study., Methods: Twenty-six patients with cardiovascular disease enrolled in a cardiac rehabilitation program based on nutritional and exercise interventions were studied. Lifestyle and clinical, metabolic and inflammatory variables were analysed., Results: 88.5% were men and the mean age was 54.9 ± 7.8 years. At the end of the cardiac rehabilitation program the levels of carbohydrate and lipid metabolism were lower, except for high density lipoprotein cholesterol which was higher. The levels of uric acid, interleukin-6, interleukin-1Beta, adiponectin and leptin remained stable. Interleukin-6 correlated positively with levels of C-reactive protein and negatively with blood glucose. Interleukin-1Beta correlated positively with C-reactive protein levels and negatively with blood pressure figures. Significant correlations were seen between the changes in levels of interleukin-6 and interleukin-1Beta and changes in metabolic equivalents, and in C-reactive protein levels before and after the cardiac rehabilitation program. No significant correlations were observed with weight, waist circumference or fat mass., Conclusions: A cardiac rehabilitation program decreased anthropometric variables and blood pressure figures, and improved lipid metabolism and ergometry data. However, no changes regarding the inflammatory state were observed., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objective: Cardiac rehabilitation programmes result in reduced morbidity and mortality and improvement of functional class. Behaviour of natriuretic peptides coupled to these programmes is not well established. Our study's objective is to evaluate the behaviour of natriuretic peptides in a sample of patients undergoing a cardiac rehabilitation programme., Methods and Results: Moderate to high-risk patients undergoing a cardiac rehabilitation programme were included. Demographic and clinical characteristics were recorded. We performed four N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma determinations: on the first and last programme day, before and after training. To evaluate functional capacity, a stress test before and after the exercise programme was performed. Eighty-three patients were included. Exercise produces increased levels of NT-proBNP, although in the last exercise session the increase was lower (35.91 vs. 31.49 ng/ml (P = 0.71)). Patients with left ventricular dysfunction present higher NT-proBNP levels. After the rehabilitation programme we observed a significant improvement of functional capacity by 1.5 METS on average (P = 0.001), but not in the subgroup with lower NT-proBNP levels., Conclusions: Basal levels of peptides did not change significantly after the programme but rose with the workout, especially in patients with left ventricular dysfunction. Patients with higher baseline levels obtained greater functional recovery. We conclude that NT-proBNP measurement may be useful in selecting patients to perform a cardiac rehabilitation programme.

Heart failure due to systolic dysfunction is a clinical syndrome that is characterized by the appearance of the signs or symptoms of heart failure in the presence of structural heart disease that has led to decreased left ventricular contractility. Current clinical practice guidelines emphasize the importance of diagnosing and treating left ventricular dysfunction in patients without symptoms of heart disease. It is essential that currently available scientific findings are taken into account when treating all patients seen with this condition, from dietary advice to use of the most sophisticated devices. We do not know the precise treatment responses of patient belonging to subgroups that were underrepresented in large clinical trials. The present article, written after the recent publication of European and American clinical practice guidelines, provides a summary of recommended medical treatment for patients with heart failure due to systolic dysfunction.