scholarly journals Cardiac rehabilitation with intermittent myocardial ischaemia as a new therapeutic option in refractory angina?

2021 ◽  
Author(s):  
Jerome Corre ◽  
Herve Douard ◽  
Thibault Ronchard
Keyword(s):  
Cardiac Rehabilitation ◽  
Myocardial Ischaemia ◽  
Therapeutic Option ◽  
Refractory Angina

scholarly journals Real world experience with coronary sinus reducer implantation for the treatment of refractory angina: a single-centre experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J P Dias Ferreira Reis ◽  
R Ramos ◽  
P Rio ◽  
A Fiarresga ◽  
D Cacela ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Real World ◽  
Therapeutic Option ◽  
Objective Evaluation ◽  
Short Version ◽  
Refractory Angina ◽  
Single Centre ◽  
Real World Data ◽  
Serious Adverse Events

Abstract Background Coronary sinus Reducer device (CSF) implantation is a novel therapeutic option to relieve symptoms in patients with refractory angina (RA). There is limited real-world data describing its use outside of clinical trials. Aim To assess the safety and efficacy of this procedure in a real-world setting. Methods This is a report of a single centre prospective registry of consecutive patients with RA (CCS II-IV) deemed unsuitable for revascularization. Between May 2017 and August 2019, 17 patients were referred to CSF implantation. Baseline and follow-up evaluation consisted of clinical assessment, including completion of the short version of the Seattle Angina Questionnaire (SAQ-7) and CCS class evaluation and objective evaluation by transthoracic echocardiography and cardiopulmonary exercise test (CPET). Results A total of 13 patients (70,6±6,5 years, 76,9% male) underwent CSF implantation with a procedural success of 84.6%. No cases of periprocedural serious adverse events were reported. At 12-month follow-up, any reduction in CCS Class was achieved in 72.7% of cases, with 27.2% reducing 2 CCS classes. Baseline CCS score was reduced from 2.8±0.4 to 1.7±0.8 (p=0.009). Quality of life (QoL) was significantly improved as assessed by the improvement seen in all items of SAQ-7 (p<0.017 for all). CPET duration was significantly increased (p=0.034), but no change was noted in the remainder CPET variables. During follow-up, 3 patients suffered myocardial infarction, resulting in 1 death. Conclusion CSF implantation in patients with RA was safe and led to a significant reduction of the angina burden and improvement of QoL at 12-month follow-up. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study

Cardiology ◽  
2012 ◽  
Vol 122 (3) ◽  
pp. 170-177 ◽  
Author(s):  
Elizabeth A. Asbury ◽  
Carolyn M. Webb ◽  
Heather Probert ◽  
Christine Wright ◽  
Mahmoud Barbir ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cardiac Rehabilitation ◽  
Physical Functioning ◽  
Refractory Angina

Effects of thoracic epidural analgesia on exercise-induced myocardial ischaemia in refractory angina pectoris

2018 ◽  
Vol 63 (4) ◽  
pp. 515-522 ◽  
Author(s):  
Adrian Gonon ◽  
Arina Richter ◽  
Ingemar Cederholm ◽  
Jehangir Khan ◽  
Jacek Novak ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Epidural Analgesia ◽  
Myocardial Ischaemia ◽  
Thoracic Epidural Analgesia ◽  
Refractory Angina ◽  
Thoracic Epidural ◽  
Refractory Angina Pectoris ◽  
Exercise Induced

scholarly journals Cardiac rehabilitation in chronic heart failure

2016 ◽  
Vol 86 (1-2) ◽  
Author(s):  
Romualdo Belardinelli
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Rehabilitation ◽  
Functional Capacity ◽  
Diastolic Heart Failure ◽  
Therapeutic Option ◽  
Hospital Readmissions ◽  
Specific Stimulus ◽  
Number Of Patients ◽  
Clinical Benefits

<p>Chronic heart failure is a complex clinical syndrome characterized by multi-organ dysfunction and progressive functional deterioration. From the result of the literature, it is evident that the optimal care for heart failure is far from being reached, and exercise-based cardiac rehabilitation (Ex-CR) is a multidisciplinary therapeutic option with important clinical benefits. Longitudinal controlled studies and meta-analyses have demonstrated that Ex-CR improves functional capacity by 12-25%, and improves outcome by significantly decreasing hospital readmissions and cardiac mortality. These results have been obtained in patients with systolic dysfunction (HF-REF) with moderate aerobic endurance programs. More recently, greater improvements in functional capacity have been obtained even in older patients (&gt;75 years) with high intensity interval training, but the number of patients is too small at present to reach definitive conclusion, and follow up is lacking. In diastolic heart failure (HF-PEF) improvements in functional capacity have been described in a total of 282 patients, with similar results as HF-REF but no evidence on outcome. Ex-CR programs are safe with a very low number of cardiac arrest (1/300,000 patient/hour) in different trials. Clinical benefits are the result of central and peripheral adaptations induced by exercise, which acts as a trigger of protein synthesis by specific genes activated by it.  It is crucial to maintain a specific stimulus by repeating exercise bouts at least 2-3 times per week all life long, because after 2-3 weeks of inactivity functional adaptations disappear.</p>

scholarly journals New Advances in the Management of Refractory Angina Pectoris

2018 ◽  
Vol 13 (1) ◽  
pp. 70 ◽  
Author(s):  
Kevin Cheng ◽  
Ranil de Silva ◽  
◽  
◽  
◽  
...  
Keyword(s):  
Myocardial Ischaemia ◽  
Clinical Problem ◽  
Routine Clinical Practice ◽  
Ageing Population ◽  
Refractory Angina ◽  
Successful Management ◽  
Chronic Angina ◽  
Current Therapies ◽  
Artery Disease ◽  
Refractory Angina Pectoris

Refractory angina is a significant clinical problem and its successful management is often extremely challenging. Defined as chronic angina-type chest pain in the presence of myocardial ischaemia that persists despite optimal medical, interventional and surgical treatment, current therapies are limited and new approaches to treatment are needed. With an ageing population and increased survival from coronary artery disease, clinicians will increasingly encounter this complex condition in routine clinical practice. Novel therapies to target myocardial ischaemia in patients with refractory angina are at the forefront of research and in this review we discuss those in clinical translation and assess the evidence behind their efficacy.

Cardiac rehabilitation in patients with refractory angina trial: rationale and design (Preprint)

2019 ◽  
Author(s):  
Luciana Dourado ◽  
Camila Jordão ◽  
Camila Regina Assumpção ◽  
Carla Montenegro ◽  
Luis Henrique Gowdak ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Rehabilitation ◽  
Exercise Testing ◽  
Controlled Trial ◽  
Cardiopulmonary Exercise Testing ◽  
Refractory Angina ◽  
Target Heart Rate ◽  
Beneficial Effects ◽  
Cardiopulmonary Exercise

BACKGROUND Refractory angina is a chronic condition that implies significant impairment in quality of life; its management is a challenge. Current therapies are limited, and new approaches to treatment are needed that target symptoms and quality of life. Evidence is lacking regarding exercise-based cardiac rehabilitation safety and beneficial effects in patients with refractory angina. OBJECTIVE The aim of the present study is to evaluate the safety and feasibility of exercise-based cardiac rehabilitation in patients with refractory angina, and its effects on angina symptoms, functional capacity, and ischemic burden. METHODS This study is an ongoing prospective randomized controlled trial enrolling 52 patients with refractory angina randomized into 2 groups: optimal medical treatment (MT) or MT + exercise-based cardiac rehabilitation (CR) over 12 weeks (36 exercise sessions). Clinical evaluation, cardiopulmonary exercise testing, laboratory tests, and exercise echocardiography are performed before and after intervention. The CR group performs in-hospital exercise sessions. The aerobic training protocol is based on CPT parameters or ischemia/angina threshold. Each cardiac rehabilitation session is 60 minutes long (5 minutes of warm-up, 30 minutes of continuous aerobic exercise based on target heart rate corresponding to anaerobic threshold (AT) obtained in the cardiopulmonary exercise testing OR angina/ischemia threshold if it occurs before the AT, 5 minutes of cooling-down, 15 minutes of resistance training, and 5 minutes of stretching). RESULTS This research study is in progress, with 42 patients recruited as of August 2019. Data collection is expected to be finished before December 2020. No clinical adverse events related to CR have occurred. CONCLUSIONS The findings of this study will have important clinical implications in the treatment of refractory angina patients. CLINICALTRIAL NCT03218891

Coronary Sinus Reducer system™: A new therapeutic option in refractory angina patients unsuitable for revascularization

2016 ◽  
Vol 209 ◽  
pp. 122-130 ◽  
Author(s):  
Alfonso Ielasi ◽  
Maria Chiara Todaro ◽  
Giulietta Grigis ◽  
Maurizio Tespili
Keyword(s):  
Coronary Sinus ◽  
Therapeutic Option ◽  
Refractory Angina

scholarly journals Cell Therapy for Refractory Angina: A Reappraisal

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Beatrice Bassetti ◽  
Patrizia Nigro ◽  
Valentina Catto ◽  
Laura Cavallotti ◽  
Stefano Righetti ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Surrogate Endpoints ◽  
Limiting Factor ◽  
Cardiac Cell ◽  
Refractory Angina ◽  
Large Variability ◽  
Clinical Endpoints ◽  
Cell Based Therapy ◽  
Meta Analyses ◽  
Positive Results

Cardiac cell-based therapy has emerged as a novel therapeutic option for patients dealing with untreatable refractory angina (RA). However, after more than a decade of controlled studies, no definitive consensus has been reached regarding clinical efficacy. Although positive results in terms of surrogate endpoints have been suggested by early and phase II clinical studies as well as by meta-analyses, the more recent reports lacked the provision of definitive response in terms of hard clinical endpoints. Regrettably, pivotal trials designed to conclusively determine the efficacy of cell-based therapeutics in such a challenging clinical condition are therefore still missing. Considering this, a comprehensive reappraisal of cardiac cell-based therapy role in RA seems warranted and timely, since a number of crucial cell- and patient-related aspects need to be systematically analysed. As an example, the large variability in efficacy endpoint selection appears to be a limiting factor for the advancement of cardiac cell-based therapy in the field. This review will provide an overview of the key elements that may have influenced the results of cell-based trials in the context of RA, focusing in particular on the understanding at which the extent of angina-related endpoints may predict cell-based therapeutic efficacy.

Sign in / Sign up

Export Citation Format

Share Document