F. van Buuren

Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR (Part II)

In a previous paper, as the first of a series of three on the importance of characteristics and modalities of physical activity (PA) and exercise in the management of cardiovascular health within the general population, we concluded that, in the population at large, PA and aerobic exercise capacity clearly are inversely associated with increased cardiovascular disease risk and all-cause and cardiovascular mortality and that a dose–response curve on cardiovascular outcome has been demonstrated in most studies. More and more evidence is accumulated that engaging in regular PA and exercise interventions are essential components for reducing the severity of cardiovascular risk factors, such as obesity and abdominal fat, high BP, metabolic risk factors, and systemic inflammation. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit for each separate risk factor. The present paper, therefore, will review and make recommendations for PA and exercise training in the management of cardiovascular health in individuals with cardiovascular risk factors. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and individual members of the public. Based on previous and the current literature overviews, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and regarding appropriate risk evaluation during exercise in individuals with cardiovascular risk factors.

Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III)

The beneficial effect of exercise training and exercise-based cardiac rehabilitation on symptom-free exercise capacity, cardiovascular and skeletal muscle function, quality of life, general healthy lifestyle, and reduction of depressive symptoms and psychosocial stress is nowadays well recognized. However, it remains largely obscure, which characteristics of physical activity (PA) and exercise training ⊟ frequency, intensity, time (duration), type (mode), and volume (dose: intensity × duration) of exercise – are the most effective. The present paper, therefore, will deal with these exercise characteristics in the management of individuals with cardiovascular disease, i.e. coronary artery disease and chronic heart failure patients, but also in patients with congenital or valvular heart disease. Based on the current literature, and if sufficient evidence is available, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding frequency, intensity, time and type of PA, and safety aspects during exercise in patients with cardiovascular disease. This paper is the third in a series of three papers, all devoted to the same theme: the importance of the exercise characteristics in the management of cardiovascular health. Part I is directed to the general population and Part II to individuals with cardiovascular risk factors. In general, PA recommendations and exercise training programmes for patients with coronary artery disease or chronic heart failure need to be tailored to the individual’s exercise capacity and risk profile, with the aim to reach and maintain the individually highest fitness level possible and to perform endurance exercise training 30–60 min daily (3–5 days per week) in combination with resistance training 2–3 times a week. Because of the frequently reported dose–response relationship between training effect and exercise intensity, one should seek sufficiently high training intensities, although more scientific evidence on effect sizes and safety is warranted. At present, there is insufficient data to give more specific recommendations on type, dosage, and intensity of exercise in some other cardiovascular diseases, such as congenital heart disease, valve disease, cardiomyopathies, channelopathies, and patients with implanted devices.

20. Bericht über die Leistungszahlen der Herzkatheterlabore in der Bundesrepublik Deutschland

Dr. F. van Buuren ()) Priv.-Doz. Dr. H. Mannebach Prof. Dr. D. Horstkotte Kardiologische Klinik Herzund Diabeteszentrum NRW Universitätsklinik der Ruhr Universität Bochum Georgstr. 11 32545 Bad Oeynhausen E-Mail: fvbuuren@hdz-nrw.de Vor dem Hintergrund der aktuellen Diskussion über Mindestmengen in der Kardiologie und den Herausforderungen der Qualitätssicherung kommt der statistischen Erfassung der Leistungszahlen von Herzkatheteruntersuchungen eine zunehmende Bedeutung zu. Dieser Bericht schreibt die Leistungszahlen der seit 1985 regelmäßig vorgelegten Berichte fort [1–4]. Die Statistik basiert auf den Angaben von 432 invasiv tätigen Kliniken und Praxen (Vorjahr 438 Einrichtungen). Von 17 der 432 Einrichtungen (3,9%) wurden keine aktuellen Daten gemeldet; in diesen Fällen wurden die Vorjahreszahlen für die statistische Auswertung herangezogen. Die Entwicklung der Leistungszahlen zwischen 1984 und 2003 ist in der Tabelle 1 dargestellt. Für 2003 wurden 652 781 (Vorjahr: n = 641 973; +1,68%) diagnostische Herzkatheteruntersuchungen und

21. Bericht über die Leistungszahlen der Herzkatheterlabore in der Bundesrepublik Deutschland

Dr. F. van Buuren ()) · Prof. Dr. D. Horstkotte Kardiologische Klinik Herzund Diabeteszentrum NRW Universitätsklinik der Ruhr-Universität Bochum Georgstr. 11 32545 Bad Oeynhausen, Germany E-Mail: fvbuuren@hdz-nrw.de Gesundheitspolitische Umstrukturierungsprozesse und die damit verbundene Diskussion machen statistische Erhebungen zur zwingenden Voraussetzung für eine fundierte Einschätzung der medizinischen Versorgung in Deutschland. Auch für die invasive Kardiologie muss weiter eine Analyse des Leistungsspektrums gefordert werden. Dieser Beitrag schreibt die jährlichen Leistungszahlen deutscher Herzkatheterlabore seit 1985 fort [1–5]. Die Statistik basiert auf den Angaben von 470 invasiv tätigen Kliniken und Praxen (Vorjahr 432 Einrichtungen). Von 19 der 470 Einrichtungen (3,9%) wurden keine aktuellen Daten gemeldet; in diesen Fällen wurden die Vorjahreszahlen für die statistische Auswertung herangezogen. Die Entwicklung der Leistungszahlen zwischen 1984 und 2004 ist in der Tabelle 1 a dargestellt. Für 2004 wurden 711 607 (Vorjahr: n = 652 781; + 9,01%) diagnostische Herzkatheteruntersuchungen und 248 909 (Vorjahr: n = 221 867; + 12,18%) Koronarinterventionen gemeldet. Erstmals wird in Tabelle 1 b ein Überblick über die Stentquote im Verlauf der letzten Jahre gegeben. Diese stieg bezogen auf die Anzahl der PCIs von 68,35% in Jahr 2000 auf 80,45% in 2004 wobei sich zuletzt eine Stagnation dieser Quote abzeichnete. Be-

Elektromyostimulation: Verbesserung von Lebensqualität, Sauerstoffaufnahme und linksventrikulärer Funktion bei chronischer Herzinsuffizienz

AIM OF THE STUDY Regular physical activity has found to be a strategy to increase exercise capacity in patients with chronic heart failure (CHF). Next to endurance training also electromyostimulation (EMS) of thigh and gluteal muscles results in an increased capacity in CHF patients. EMS therapy was either done by stimulating 8 major muscle groups involving also trunk and arm muscles (extended electromyostimulation (exEMS)) in comparison to EMS therapy limited to gluteal and leg muscles (limEMS). METHODS 31 individuals completed the EMS training program. Stable CHF patients (NYHA class II-III) received either exEMS (18 patients, 11 males, mean age 59.8±13.8 years) or limEMS (13 patients, 10 males, 63.6±9.4 years). Training was performed for 10 weeks twice weekly for 20 min, the level of daily activity remained unchanged. Effects on exercise capacity, left ventricular function (EF - ejection fraction) and QoL (quality of life) were evaluated. RESULTS QoL was found to be improved in all domains of the SF-36 questionnaire. In the exEMS group there was a significant improvement in the domain physical functioning (54.09±29.9 to 75.45±15.6, p=0.48) and emotional role (63.63±45.8 to 93.93±20.1 p=0.048). LimEMS group showed significant improvement in the domain vitality (37.5±6.9 to 52.8±12.5, p=0.02).There was a significant increase of oxygen uptake at aerobic threshold in all groups (exEMS: +29.6%, p<0.001; limEMS +17.5%, p<0.001). EF -increased from 36.94±8.6 to 42.36±9.1% (+14.7%, p=0.003) in the exEMS group (limEMS 37.7±3.6 to 40.3±5.9% [+6.9%, p=0.18]). CONCLUSION EMS contributes to an improved quality of life and can improve oxygen uptake and EF in CHF. It may be an alternative therapy in CHF patients who are otherwise unable to undertake conventional forms of exercise training.

The value of brain natriuretic peptide and tissue doppler echocardiography for the diagnosis of myocardial dysfunction in top level athletes

echocardiography for the diagnosis of myocardial dysfunction in top level athletes E Oepangat, T Butz, KP Mellwig, L Faber, J Diekmann, F van Buuren, D Horstkotte Cardiology Department, Heart center North Rhein-Westphalia, Germany Background Brain natriuretic peptide (BNP) is a cardiac neurohormone that is secreted in response to ventricular volume expansion and pressure overload. Its measurement is used as a standard parameter for evaluation of cardiac dysfunction. The aim of this study is to see whether BNP can be used for the detection of diastolic abnormalities among top athletes. Methods We investigated 36 male professional Handball athletes (Ath.; 27.1 ± 5.3 years).BNP at rest and after Treadmill exercise (starting at 10 km/h with increasing speed of 2 km/h every 3 minutes) were measured. Ath. were divided into 2 groups according to a normal (group A: BNP < 18 pg/ml) or an elevated BNP level (group B). Both groups were then examined by Tissue Doppler Imaging (TDI) for the analysis of systolic and diastolic velocities of the mitral annulus (MA). Results 18 Ath.in group A had a mean BNP of 6.7 ± 0.9 pg/ml, whereas the other 18 in group B had significantly higher BNP levels (mean BNP:23.7 ± 3.6 pg/ml; P < 0.001. Peak oxygen consumption (54 ± 5 ml/ min/kg) was similar in both groups. Standard echocardiographic examination revealed a normal systolic function without structural abnormalities in all cases. TDI analysis all demonstrated normal findings with no significant difference of peak systolic velocities (Śseptal MA:in A: 10 ± 1 cm/s vs. B: 9.4 ± 1.5 cm/s), as well as peak early diastolic velocity (E‘) on lateral MA 16.8 ± 3.6 cm/s(A) vs. 16 ± 4.8(B) and 13.4 ± 3.1 cm/s (A) vs. 12.6 ± 2.5 cm/s(B) on the septal MA. The calculated EÈ ́ -ratio were 5.4 ± 1.5 cm/s(A) vs. 5.1 ± 1(B;lateral MA) and 6.7 ± 1.5 cm/s (A) vs. 6.5 ± 1.8 cm/(B;septal MA) respectively. Conclusions Elevated BNP levels in group B suggested myocardial dysfunction, but TDI showed normal systolic and diastolic velocities of the mitral annulus in both groups and does not reflect any pathologic findings. To determine a cutoff point of BNP level as a screening tool for diastolic dysfunction in athletes, a further investigation is needed.

21. Bericht über die Leistungszahlen der Herzkatheterlabore in der Bundesrepublik Deutschland: Ergebnisse der gemeinsamen Umfrage der Kommission für Klinische Kardiologie und der Arbeitsgruppen Interventionelle Kardiologie (für die ESC) und Angiologie der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung über das Jahr 2004

Dr. F. van Buuren ()) · Prof. Dr. D. Horstkotte Kardiologische Klinik Herzund Diabeteszentrum NRW Universitätsklinik der Ruhr-Universität Bochum Georgstr. 11 32545 Bad Oeynhausen, Germany E-Mail: fvbuuren@hdz-nrw.de Gesundheitspolitische Umstrukturierungsprozesse und die damit verbundene Diskussion machen statistische Erhebungen zur zwingenden Voraussetzung für eine fundierte Einschätzung der medizinischen Versorgung in Deutschland. Auch für die invasive Kardiologie muss weiter eine Analyse des Leistungsspektrums gefordert werden. Dieser Beitrag schreibt die jährlichen Leistungszahlen deutscher Herzkatheterlabore seit 1985 fort [1–5]. Die Statistik basiert auf den Angaben von 470 invasiv tätigen Kliniken und Praxen (Vorjahr 432 Einrichtungen). Von 19 der 470 Einrichtungen (3,9%) wurden keine aktuellen Daten gemeldet; in diesen Fällen wurden die Vorjahreszahlen für die statistische Auswertung herangezogen. Die Entwicklung der Leistungszahlen zwischen 1984 und 2004 ist in der Tabelle 1 a dargestellt. Für 2004 wurden 711 607 (Vorjahr: n = 652 781; + 9,01%) diagnostische Herzkatheteruntersuchungen und 248 909 (Vorjahr: n = 221 867; + 12,18%) Koronarinterventionen gemeldet. Erstmals wird in Tabelle 1 b ein Überblick über die Stentquote im Verlauf der letzten Jahre gegeben. Diese stieg bezogen auf die Anzahl der PCIs von 68,35% in Jahr 2000 auf 80,45% in 2004 wobei sich zuletzt eine Stagnation dieser Quote abzeichnete. Be-