Efraim Ben-Ari

The effects of hormone replacement therapy in normal postmenopausal women: Measurements of Doppler-derived parameters of aortic flow

In this study the effects of hormone replacement therapy on cardiac function in healthy postmenopausal women were evaluated by Doppler echocardiography that was performed before (T1) and 2.5 months after the initiation of hormone replacement therapy (T2) in the peak estrogenic phase. The following parameters of aortic flow were measured: peak flow velocity, acceleration time, and ejection time. Additional parameters were calculated: flow velocity integral and mean acceleration. The study group included 24 postmenopausal women aged 43 to 60 years (mean 51.6 years). The control group consisted of 19 postmenopausal women aged 46 to 60 years (mean 53.5 years) who were not receiving hormone replacement therapy and who underwent the same evaluation. There were no changes in all Doppler parameters between T1 and T2 in the control group. However, in the study group there were significant increases in peak flow velocity (108.3 +/- 16.7 cm/sec at T1 vs 123 +/- 20.7 cm/sec at T2; p = 0.002), flow velocity integral (17.7 +/- 3.9 vs 21.5 +/- 4.7 cm; p = 0.0003), mean acceleration (11.5 +/- 1.9 vs 13.1 +/- 2.6 m/sec/sec; p = 0.001), and ejection time (324 +/- 37.6 vs 348.8 +/- 40.7 msec; p = 0.002). There was no change in acceleration time (94.8 +/- 6.6 vs 95 +/- 10.9 msec). These results demonstrate that estrogens increase both stroke volume and flow acceleration. The latter probably reflects a combination of enhanced inotropism and vasodilatation. We assume that the cardioprotective effect of hormone replacement therapy in postmenopausal women may be due not only to changes in lipid profile but also to direct effects of estrogens on central and peripheral hemodynamic parameters.

Benefits of a Monitored Rehabilitation Program Versus Physician Care After Emergency Percutaneous Transluminal Coronary Angioplasty: Follow-up of Risk Factors and Rate of Restenosis

To evaluate the effect 1of a monitored rehabilitation program on restenosis after successful emergency percutaneous transiuminal coronary angioplasty (PTCA), the authors compared the results of a rehabilitation group (N = 60) with a matched group (N = 68) of patients who received the usual post-PTCA care provided by their physician or cardiologist. The rehabilitation group trained for 12 weeks, 2 to 3 times/week for 45 to 60 minutes each on a variety of stationary equipment at a heart rate of 70 to 85% of the age-predicted maximum. They also underwent an 8-session educational program and 6 months follow-up of risk factors for secondary prevention of coronary artery disease (CAD). Because the majority of patients who restenose do so during the first 6 months after PTCA, the study was terminated 5 ± 1 months after the procedure. Between groups comparison after 5.5 ± 1 months showed: 1) significantly (T

Return to Work After Successful Coronary Angioplasty: Comparison Between a Comprehensive Rehabilitation Program and Patients Receiving Usual Care

The effects of a 12-week exercise training and cardiac education program on short-term and long-term employment and realted measures of quality of life were compared in a nonrandomized study. Eighty-three trained patients and 92 patients who received, usual physician care (usual care) after successful percutaneous transluminal coronary angioplasty (PTCA) were studied. Data, were collected from medical files and by a before-and-after PTCA questionnaire. At baseline, groups did not differ with respect to age, medical status, occupational status, level of income, presence of risk factors for coronary disease, and patients perception of health. Of those working full time before PTCA, 11% of the patients in the trained group and 23% of the patients in the usual care group did not resume their work status after 18 months of follow-up. At 18 months after PTCA, 37% of the trained vs 52% of the usual care patients quit working (P

Effects of prolonged intensive versus moderate leg training on the untrained arm exercise response in angina pectoris

To compare the effects of 2 different leg training intensities on the cardiocirculatory exercise response of the untrained arm, 58 patients with angina pectoris were randomized to either an intensive (at least 85% of symptom-limited exercise, n = 28) or a moderate (70 to 85% of symptom-limited exercise, n = 30) training group. Patients trained for 6 months, 2 times per week for 30 minutes each. Results of the 2 groups after training showed similar significant (p less than or equal to 0.001) decreases in heart rate (HR), systolic blood pressure (BP) and HR X BP product for trained legs and untrained arms at matched subanginal workloads and significant (p less than 0.01 to 0.001) increase in anginal threshold HR and HR X BP for the onset of 1 mm or more ST horizontal depression during testing of trained legs as well as of untrained arms. The improvement in exercise capacity at subanginal workloads results from decreased HR X BP product. In contrast, the significant increase in HR X BP product for the onset of ST-segment displacement and precipitation of anginal pain for both the trained and untrained limbs may imply an increase in myocardial blood flow. Thus, prolonged intensive or moderate training may significantly improve coronary blood flow in selected patients with angina pectoris. Patients with the highest anginal threshold HR and HR X BP product before training showed the most improvement at 6 months after training.