Center for Cardiovascular Rehabilitation

Bad Schallerbach, Austria

Center for Cardiovascular Rehabilitation

Bad Schallerbach, Austria

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PubMed | Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz and Center for Cardiovascular Rehabilitation
Type: Journal Article | Journal: Trials | Year: 2016

Patients with type 2 diabetes (T2DM) are at increased risk for macrovascular events as well as for microvascular complications. There is evidence that in patients with coronary artery disease (CAD), about 35% suffer from manifest T2DM. Early glucose-lowering intervention in subjects with T2DM has been demonstrated to be beneficial in terms of cardiovascular risk reduction. But thus far, no data are available regarding investigating the impact of linagliptin treatment in patients with early diabetes on cardiovascular endpoints or surrogate parameters. Therefore, the aim of this study is to investigate the effects of linagliptin in CAD patients with early T2DM on various cardiovascular surrogate measurements including mechanical and biochemical endothelial function assessments.Forty-two subjects with early diabetes and CAD are included in this investigator-driven, randomized, placebo-controlled, double-blind, phase IV, single-center study. Participants will be randomized to receive either linagliptin (5mg) administered once daily per os or placebo for 12weeks. Before and after the intervention, evaluation of endothelial function (flow-mediated dilatation and biochemical biomarkers) and a Meal Tolerance Test are performed.Cardiovascular surrogate parameters, such as endothelial function, are able to provide insights into the potential mechanisms of the cardiovascular effects of antihyperglycemic agents. Currently ongoing trials do not specifically focus on early diabetes as a target of intervention and we therefore believe that our study will contribute to a better understanding of the cardiovascular effects of dipeptidylpeptidase-4 (DPP-4) inhibitors in early diabetes.NCT02350478 . Registered 26 January 2015. Protocol date/version 24 October 2014/version 2.4 EudraCT number: 2013-000330-35.


Mayer-Berger W.,Center for Cardiovascular Rehabilitation | Simic D.,Witten/Herdecke University | Mahmoodzad J.,Witten/Herdecke University | Burtscher R.,Witten/Herdecke University | And 3 more authors.
European Journal of Preventive Cardiology | Year: 2014

Objective: The aim of this study was to evaluate the efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on cardiovascular risk and health-related quality of life in a cohort of middle-aged (-58 years) coronary artery disease (CAD) patients of low educational level compared to usual care. Design and methods: The study included 600 patients with CAD, with 271 in the intervention group (IG) and 329 in the control group (CG). The average age was nearly 50 years in both groups, nearly 90% were male, and 77% had less than 10 years of school education. No significant differences existed between the groups at baseline. Both groups had a 3-week comprehensive cardiovascular inpatient rehabilitation programme at the beginning, the intervention consisted of one further rehabilitation session in hospital after 6 months and regular telephone reminders over a period of 36 months. Analyses were conducted on an intention-to-treat basis. To evaluate the individual risk level, we used the PROCAM score and intima-media thickness (IMT) was measured at the common carotid artery on both sides following international standards. Health-related quality of life was assessed with the EUROQOL and HADS. Results: Patients in the IG showed better 3-year risk profile outcomes. The PROCAM score increased by 3.0 (IG) and by 3.7 (CG) from the beginning to after 3 years (p>0.05 intention-to-treat). The average IMT increased by 0.04mm in the CG and was reduced by 0.03mm in the IG (p0.014 for the difference). The IG had a significant improvement in health-related quality of life. Mortality, myocardial infarction, and stroke were not different although 'other cardiac events' (cardiac surgery or intervention) were significantly lower in the IG than the CG patients (p<0.05). Conclusion: This long-term secondary prevention programme with inpatient rehabilitation at the beginning and telephone reminder for a 3-year period was successful. There were significant differences in health-related quality of life between the IG and CG, despite the relatively positive outcomes in the CG. In this low-education (predominantly male), middle-aged cohort, the positive impact on cardiovascular risk was pronounced in the high-risk subgroup (PROCAM 10-year risk 10-40%). © The European Society of Cardiology 2012.


Auer J.,General Hospital Braunau | Auer J.,General Hospital Wels | Auer J.,General Hospital Simbach | Leitner A.,General Hospital Wels | And 4 more authors.
Atherosclerosis | Year: 2010

Background: Although drug-eluting stents (DES) reduce restenosis rates relative to bare-metal stents (BMS), recent reports have indicated that the use of DES may be associated with an increased risk of stent thrombosis. Our study focused on the effect of stent type on clinical outcomes in a " real world" setting. Methods: 889 patients undergoing percutaneous coronary intervention (PCI) with either DES (Cypher or Taxus; n= 490) or BMS (n= 399) were enrolled in a prospective single center registry. The outcome analysis covered a period of up to 3.2 years (mean 2.7 years ± 0.5 years) and was based on 65 deaths, 27 myocardial infarctions, 76 clinically driven target lesion revascularizations (TLR), and 15 angiographically confirmed cases of definite stent thrombosis and was adjusted for differences in baseline characteristics. Results: In total 1277 stents (613 BMS and 664 DES) were implanted in 1215 lesions. Despite a significantly different unadjusted death rate (10.1% and 5.1% in BMS and DES patients, respectively; p<. 0.05), the patient groups did not differ significantly in the risk of myocardial infarction during 2.7 years of follow-up. After adjustment for differences in baseline characteristics between groups, the difference in the cumulative incidence of death did not remain statistically significant (p= 0.22). Target lesion revascularizations occurred significantly less frequently in patients with DES compared to individuals after BMS implantation (5.9% and 11.8% in patients with DES and BMS, respectively; p<. 0.05). The rate of angiographically confirmed stent thrombosis was 2.1% in patients with DES and 1.1% in BMS patients (p= 0.31). There was a significantly lower unadjusted event rate (including deaths, myocardial infarction, target lesion revascularization, and stent thrombosis) in patients with drug-eluting stents than in those with bare-metal stents (16.4% and 25.8%, respectively), with 9.4 fewer such events per 100 patients (unadjusted hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.46 to 0.87). After adjustment, the relative risk for all outcome events in patients with drug-eluting stents was 0.79 (95% CI, 0.67 to 0.95). However, the adjusted relative risk for death and myocardial infarction did not differ significantly between groups (adjusted relative risk in patients with drug-eluting stents 0.94 (95% CI, 0.77 to 1.37)). Conclusions: In this real-world population, the beneficial effect of first generation DES in reducing the need for new revascularization compared with BMS extends to more than 2.5 years without evidence of a worse safety profile. The minor risk of stent thrombosis and myocardial infarction within this period after implantation of DES seems unlikely to outweigh the benefit of these stents. © 2009 Elsevier Ireland Ltd.


Berent R.,Center for Cardiovascular Rehabilitation | Auer J.,Hospital Braunau | Franklin B.,William Beaumont Hospital | Schmid P.,Center for Cardiovascular Rehabilitation | Von Duvillard S.P.,Center for Cardiovascular Rehabilitation
American Journal of Cardiology | Year: 2011

Aspirin has been shown to decrease cardiovascular (CV) events by ∼25%. Despite aspirin therapy 10% to 20% of patients with arterial vascular disease develop atherothrombotic events. A meta-analysis of antiplatelet therapy showed a progressive decrease in clinical efficacy of aspirin after 2 years. Whether this is due to a decreased sensitivity to aspirin during long-term therapy remains unclear. A prospective randomized clinical trial with serial monitoring over 5 years was conducted in 100 patients with documented coronary heart disease. We investigated whether long-term treatment with aspirin 50 and 100 mg affects platelet response similarly. Occurrence of CV events was documented. Platelet sensitivity to aspirin, prostacyclin, and adenosine diphosphate-, collagen-, and epinephrine-induced platelet aggregation were evaluated over time. In addition, β-thromboglobulin and inflammatory markers were measured. Four patients were lost to follow-up and 10 patients died. Eleven patients developed nonfatal CV events. In the 2 groups platelet response to aspirin and the referenced variables remained unchanged over 5 years. In patients who developed CV events, the last monitoring interval revealed no difference in platelet response to aspirin. However, patients with nonfatal and fatal CV events showed increased inflammatory markers versus patients without CV events independent of aspirin 50 or 100 mg intake. In conclusion, our study revealed no difference in antiplatelet response to aspirin 50 versus 100 mg or CV events over 5 years in patients with coronary heart disease. © 2011 Elsevier Inc. All rights reserved.


Eder A.,University of Vienna | Koegl E.,University of Vienna | Von Duvillard S.P.,Norwegian School of Sport Sciences | Von Duvillard S.P.,Center for Cardiovascular Rehabilitation | And 2 more authors.
Archives of Oral Biology | Year: 2012

Arachidonic acid (AA) is metabolized to eicosanoids and isoprostanes (IPs) via different pathways. The presence of granuloma in apical periodontitis (AP) is linked with inflammation and the synthesis of metabolites of AA. Objective: We investigated the conversion rate of 14C labelled arachidonic acid (14C-AA), the lipoxygenases (LOX) products and the endogenous synthesis of eicosanoids and IPs in extracted granuloma. Furthermore, we assessed if there are markers for bone destruction and the influence of cigarette smoking. Patients and methods: In 46 patients with symptoms and corresponding radiological signs of AP, teeth were extracted including the periapical granuloma. The endogenous synthesis of eicosanoids and IPs, the conversion rate of 14C-AA and LOX products in extracted granuloma were analyzed. Results: We found that smoking increases significantly the synthesis of IPs and LOX-metabolites in granuloma. Furthermore, smoking may have contributed to significant differences in qualitative and quantitative profile of eicosanoids, IPs and the conversion rate of 14C-AA independent of the size of the granuloma. Conclusions: Our data demonstrate that in smokers with granuloma due to AP products of lipid peroxidation as 8-iso-PGF 2α and products of the LOX-pathway are increased at the expense of cyclooxygenase products. The size of granuloma did not influence the amount of synthesized eicosanoids, IPs or LOX-metabolites out of 14C-AA whereas cigarette smoking was a significantly influencing and modifiable risk factor. © 2012 Elsevier Ltd.


Berent R.,Center for Cardiovascular Rehabilitation | Von Duvillard S.P.,University of Salzburg | Crouse S.F.,Texas A&M University | Sinzinger H.,Institute for Diagnosis and Treatment of Atherosclerosis and Lipid Disorders | And 2 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2011

Berent R, von Duvillard SP, Crouse SF, Sinzinger H, Green JS, Schmid P. Resistance training dose response in combined endurance-resistance training in patients with cardiovascular disease: a randomized trial. Objective: To compare the effectiveness of 2 different volumes of resistance training (RT) combined with aerobic training in residential cardiac rehabilitation (CR). Design: Randomized prospective cohort study. Setting: Center for inpatient CR. Participants: Patients (N=295) with a mean age ± SD of 62.7±11.7 years participated in the study. Interventions: Patients were randomly divided into 2 groups (group 1 and group 2) with different volumes of RT; 2 sets × 12 repetitions (REPS) (group 1) and 3 sets × 15 REPS (group 2) per session, 2 times per week; each RT session consisting of 10 different resistance exercises. In addition, patients also completed continuous moderate intensity aerobic training composed of cycle ergometry 6 times per week for 17±4 minutes (mean ± SD) and walking 5 times per week for 45 minutes. Main Outcome Measures: At entry and after 26±4 (mean ± SD) days of CR, blood pressure, heart rate, maximal oxygen consumption, and maximal power determined during cycle ergometry, strength determined via RT, and blood biochemistries were assessed. Data were analyzed via a 2-way (group × time) repeated measures analysis of variance. Results: Statistical analysis revealed equivalent improvements in exercise capacity, muscular strength, hemodynamics, and blood chemistries regardless of RT volume (comparison-wise type I error rate, α<.01). Conclusions: Our results show that nearly doubling (3 sets × 15 REPS vs 2 sets × 12 REPS) the volume of RT as part of a residential CR program does not yield further improvement in strength and cardiovascular risk factors. © 2011 American Congress of Rehabilitation Medicine.


Berent R.,Center for Cardiovascular Rehabilitation | Von Duvillard S.P.,Center for Cardiovascular Rehabilitation | Von Duvillard S.P.,The College of Idaho | Auer J.,General Hospital Braunau | And 2 more authors.
European Journal of Cardiovascular Prevention and Rehabilitation | Year: 2010

BACKGROUND: Cardiovascular rehabilitation (CR) is an important component of care for patients with cardiovascular disease (CVD) and has been well documented and promoted by various health organizations and position statements worldwide. PURPOSE: The purpose of this study was to investigate whether patients readmitted to CR on average 16 months after their previous discharge, maintained the reduction in CVD risk factors, maintained or improved functional capacity, occurrence of adverse cardiovascular events, and possible modifications in prescribed medications. METHODS: Five hundred and seventy patients (60±10 years) underwent cycle ergometry and blood sampling at the beginning, the end of 21±2 days of the previous CR, and again at readmission to CR. The CR consisted of cycling for 17±4 min at frequency of six times a week and daily walking for 45 min at 60-70% of the maximal individual heart rate. RESULTS: Blood total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and body mass index decreased significantly during CR. Resting blood pressure, maximal performance (watts), maximal oxygen uptake, and heart rate recovery improved significantly in 1min (P<0.001). At readmission, all traditional CVD risk factors increased significantly, although medication was unchanged and angiotensin-converting enzyme inhibitors were partly replaced by angiotensin II receptor antagonists. Exercise performance remained unchanged. CONCLUSION: At readmission, we observed an increase in CVD risk factors, although, physical fitness remained stable. Thus, failure of lifestyle modification after CR indicates the cause for concern. Reinforcement of home setting sessions of CR patients or other strategies to enhance long-term compliance to lifestyle changes could reduce the observed attrition in CR benefits. © 2010 The European Society of Cardiology.


Berent R.,Center for Cardiovascular Rehabilitation | Sinzinger H.,Institute for Diagnosis and Treatment of Atherosclerosis and Lipid Disorders ATHOS
Vasa - Journal of Vascular Diseases | Year: 2011

Based upon various platelet function tests and the fact that patients experience vascular events despite taking acetylsalicylic acid (ASA or aspirin), it has been suggested that patients may become resistant to the action of this pharmacological compound. However, the term "aspirin resistance" was created almost two decades ago but is still not defined. Platelet function tests are not standardized, providing conflicting information and cut-off values are arbitrarily set. Intertest comparison reveals low agreement. Even point of care tests have been introduced before appropriate validation. Inflammation may activate platelets, co-medication(s) may interfere significantly with aspirin action on platelets. Platelet function and Cox-inhibition are only some of the effects of aspirin on haemostatic regulation. One single test is not reliable to identify an altered response. Th erefore, it may be more appropriate to speak about "treatment failure" to aspirin therapy than using the term "aspirin resistance". Th ere is no evidence based justification from either the laboratory or the clinical point of view for platelet function testing in patients taking aspirin as well as from an economic standpoint. Until evidence based data from controlled studies will be available the term "aspirin resistance" should not be further used. A more robust monitoring of factors resulting in cardiovascular events such as inflammation is recommended. © 2011 by Hans Huber Publishers, Hogrefe AG, Bern.


PubMed | Center for Cardiovascular Rehabilitation
Type: Journal Article | Journal: European journal of preventive cardiology | Year: 2014

The aim of this study was to evaluate the efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on cardiovascular risk and health-related quality of life in a cohort of middle-aged (58 years) coronary artery disease (CAD) patients of low educational level compared to usual care.The study included 600 patients with CAD, with 271 in the intervention group (IG) and 329 in the control group (CG). The average age was nearly 50 years in both groups, nearly 90% were male, and 77% had less than 10 years of school education. No significant differences existed between the groups at baseline. Both groups had a 3-week comprehensive cardiovascular inpatient rehabilitation programme at the beginning, the intervention consisted of one further rehabilitation session in hospital after 6 months and regular telephone reminders over a period of 36 months. Analyses were conducted on an intention-to-treat basis. To evaluate the individual risk level, we used the PROCAM score and intima-media thickness (IMT) was measured at the common carotid artery on both sides following international standards. Health-related quality of life was assessed with the EUROQOL and HADS.Patients in the IG showed better 3-year risk profile outcomes. The PROCAM score increased by 3.0 (IG) and by 3.7 (CG) from the beginning to after 3 years (p>0.05 intention-to-treat). The average IMT increased by 0.04mm in the CG and was reduced by 0.03mm in the IG (p=0.014 for the difference). The IG had a significant improvement in health-related quality of life. Mortality, myocardial infarction, and stroke were not different although other cardiac events (cardiac surgery or intervention) were significantly lower in the IG than the CG patients (p<0.05).This long-term secondary prevention programme with inpatient rehabilitation at the beginning and telephone reminder for a 3-year period was successful. There were significant differences in health-related quality of life between the IG and CG, despite the relatively positive outcomes in the CG. In this low-education (predominantly male), middle-aged cohort, the positive impact on cardiovascular risk was pronounced in the high-risk subgroup (PROCAM 10-year risk 10-40%).


PubMed | Center for Cardiovascular Rehabilitation
Type: Case Reports | Journal: Hellenic journal of nuclear medicine | Year: 2014

Right ventricular apical pacing (RVAP) with a left bundle branch block on the electrocardiogram may result in regional wall motion abnormalities and decreased left ventricular function (LVF). Furthermore, perfusion defects in dipyridamole technetium-99m-methoxisobutylisonitrile ((99m)Tc-MIBI) myocardial perfusion imaging may occur despite a normal coronary angiogram. In a 68 years old patient, RVAP resulted in regional wall motion abnormalities, markedly decreased LVF and perfusion defects in dipyridamole (99m)Tc-MIBI myocardial perfusion imaging by single photon emission tomography (SPET). Coronary angiography excluded coronary heart disease. Reprogramming of the pacemaker resulted in physiologic activation of the ventricles. Echocardiography showed a normal LV systolic function. Repeated myocardial perfusion imaging was unremarkable. In conclusion, our case confirms thatRVAP may lead to scintigraphic perfusion defects and wall motion abnormalities despite a normal coronary angiogram and this differentiate between ischemia-induced perfusion defects.

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