The purpose of the present study was to compare muscular strength of knee extensors and arm flexor muscles of cardiac patients (n = 638) and healthy controls (n = 961) in different age groups. Isometric torques were measured in a sitting position with the elbow, hip, and knee flexed to 90(0). For statistical analysis, age groups were pooled in decades from the age of 30 to 90 years. Additionally, the influence of physical lifestyle prior to disease on muscular strength was obtained in the patients. For statistical analysis three-way ANOVA (factors age, gender, and physical activity level) was used.Both in patients and in controls a significant age-dependent decline in maximal torque could be observed for arm flexors and knee extensors. Maximal leg extensor muscle showed statistically significant differences between healthy controls and cardiac patients as well as between subgroups of patients: Physically inactive patients showed lowest torques (male: 148 +/- 18 Nm; female: 82 +/- 25 Nm) while highest values were measured in control subjects (male: 167 +/- 16 Nm; female: 93 +/- 17 Nm). In contrast, arm flexor muscles did not show any significant influence of health status or sports history.This qualitative difference between weight-bearing leg muscles and the muscle group of the upper extremity suggest that lower skeletal muscle strength in heart patients is mainly a consequence of selective disuse of leg muscles rather than any pathological skeletal muscle metabolism. Since a certain level of skeletal muscle strength is a prerequisite to cope with everyday activities, strength training is recommended as an important part of cardiac rehabilitation.

BACKGROUND:Lengthy recovery and treatment times following cardiosurgical interventions were the motivation for introducing a pilot procedure to integrate acute and rehabilitative treatment structures. The advantage of such a pilot procedure is the medico-economic link between direct transition from acute care to rehabilitation treatment and cutting average case costs. With this in mind, shared case fees for patients following cardiosurgery are being agreed in a pilot project between health insurance companies, acute-care hospitals and rehabilitation clinics. The aim of this study was thus to investigate whether rehabilitation directly after cardiosurgery without prior transferral to an acute-care hospital is comparable with the conventional procedure involving acute care.METHODS:A total of 221 patients were included in the investigation. The pilot project group comprised 159 patients (mean age 70 +/- 6 yrs, 117 men and 42 women) who were transferred directly to rehabilitation following cardiosurgery. The control group, comprising 62 patients (mean age = 71 +/- 6 yrs, 42 men and 20 women), was transferred to an acute-care hospital following cardiosurgery before commencing rehabilitation. Sociodemographic and clinical data were comparable between the two groups.RESULTS:At the end of rehabilitation, the mean maximum ergometric performance in the pilot group was 96 +/- 33 W, significantly higher than the control group's performance of 81 +/- 31 W. One difference between the two groups related to complications. During rehabilitation, complications occurred more frequently within the pilot group. In the pilot group, compared to the control group, postcardiotomy syndrome occurred in 45.3 versus 25.8% and impaired wound healing in 10.1 versus 4.8% of cases. Despite these results, the pilot group demonstrated a significantly shorter overall hospital stay of 39.5 +/- 7.5 days compared to the control group stay of 45.7 +/- 9.7 days.CONCLUSION:Compared to the control group, the pilot group was at no disadvantage with regard to clinical or performance data by the end of rehabilitation. Cardiac complications occur more often during rehabilitation taking place directly after cardiosurgery than with the conventional procedure. These can be viewed, however, as complications occurring directly in temporal conjunction with the operation and as to be expected. Complications attributed directly to fast-track rehabilitation can be excluded. In the pilot group the overall hospital stay was thus shortened. In an environment of legislative restructuring within the healthcare sector, this shows that adequate treatment of cardiosurgical patients is still guaranteed with fast-track rehabilitation.

Endothelial dysfunction is found both in patients with chronic heart failure and in patients with insulin-treated type 2 diabetes mellitus. This endothelial dysfunction leads to a significant reduction in endothelium-derived vasodilation. Physical exercise can have a positive effect on endothelial dysfunction in patients with coronary artery disease, chronic heart failure and diabetes mellitus. It is not clear, however, whether an exercise program influences endothelial function in diabetics with chronic heart failure. Our study was thus aimed at investigating whether a special exercise program would affect endothelial function. Comparisons were made with insulintreated type 2 diabetics and with non-diabetics suffering from chronic heart failure.

BACKGROUND:Evidence is now evolving of the importance of team management for patients with chronic heart failure. This includes education, patient self-care and physical exercise training. How such programs should be implemented is still under discussion.AIM:To assess the efficacy of an in-hospital rehabilitation clinic-based program, we studied its influence on cardiopulmonary parameters and quality of life in an outpatient setting.METHODS AND RESULTS:75 patients (62 male, 13 female, mean age 65+/-8 years) underwent an exercise program including education, bicycle ergometer, muscle strength training and the 6-min walk test as a training unit for 4 weeks. Patients were studied at baseline (T1), before discharge (T2) and after a follow-up period of 29.9+/-5.5 weeks (T3). Baseline data (T1): left ventricular ejection fraction (LVEF): 33.8+/-7.6%, left ventricular end-diastolic volume (LVEDV): 130+/-51 ml, peak VO(2): 12.3+/-4.3 ml/kg, maximum work load (Watt max): 71+/-27 W. At discharge (T2) and follow-up (T3) LVEF increased to 36.8+/-8% and 41.8+/-9.2%, LVEDV decreased to 127+/-43 ml and 114+/-40 ml, peak VO(2) increased to 14.1+/-5.1 ml/kg and 15.2+/-5 ml/kg, and Watt max increased to 84+/-28 Wand 98+/-42 W (all p<0.01). Quality of life improved significantly at discharge and follow-up in nearly all domains and in the summary score for physical health. There were no significant changes for anxiety and depression at T2 and T3.CONCLUSION:A specialized in hospital rehabilitation program including education, patient self management and training has a sustained positive effect on cardiopulmonary parameters and physical well-being.

Background - The molecular mechanisms by which physical training improves peripheral and coronary artery disease are poorly understood. Bone marrow - derived endothelial progenitor cells (EPCs) are thought to exert beneficial effects on atherosclerosis, angiogenesis, and vascular repair.Methods and Results - To study the effect of physical activity on the bone marrow, EPCs were quantified by fluorescence-activated cell sorter analysis in mice randomized to running wheels (5.1 +/- 0.8 km/d, n = 12 to 16 per group) or no running wheel. Numbers of EPCs circulating in the peripheral blood of trained mice were enhanced to 267 +/- 19%, 289 +/- 22%, and 280 +/- 25% of control levels after 7, 14, and 28 days, respectively, accompanied by a similar increase of EPCs in the bone marrow and EPCs expanded from spleen-derived mononuclear cells. eNOS(-/-) mice and wild-type mice treated with N-G-nitro-L-arginine methyl ester showed lower EPC numbers at baseline and a significantly attenuated increase of EPC in response to physical activity. Exercise NO dependently increased serum levels of vascular endothelial growth factor and reduced the rate of apoptosis in spleen-derived EPCs. Running inhibited neointima formation after carotid artery injury by 22 +/- 2%. Neoangiogenesis, as assessed in a subcutaneous disc model, was increased by 41 +/- 16% compared with controls. In patients with stable coronary artery disease ( n = 19), moderate exercise training for 28 days led to a significant increase in circulating EPCs and reduced EPC apoptosis.Conclusions - Physical activity increases the production and circulating numbers of EPCs via a partially NO-dependent, antiapoptotic effect that could potentially underlie exercise-related beneficial effects on cardiovascular diseases.

Background: The rate constant for global fatty acid influx (k(1)) was studied in 12 male patients with dilated cardiomyopathy (DCM). Method: 10 normal subjects served as controls. 201-Thallium ((TI)-T-201) and [I-123]-phenyl-pentadecanoic acid (IPPA) were administered during bicycle exercise under fasting conditions. Results: All patients showed non-homogeneous tracer uptake defects for (TI)-T-201 and IPPA. k(1) was significantly higher in DCM patients than controls. k(1) showed significant inverse correlation between cardiac index, left-ventricular ejection fraction, left-ventricular enddiastolic pressure and echocardiographic left-ventricular ejection fraction. Conclusion: We presume that an increased regional rate constant of IPPA influx into the myocardial tissue in patients with DCM reflects a compensatory mechanism of altered myocardium. (C) 2002 European Society of Cardiology. Published by Elsevier Science B.V. All rights reserved.

Background: There is now evidence that moderate training plays an important role in the treatment of chronic heart failure. No clear instructions exist to date as to how such training programs should be carried out. Aim: to assess the efficiency of a training program including bicycle ergometer training, moderate muscle strength training and the 6-min walk test and their influence on quality of life, anxiety and depression. Methods and results: Patients (67 male, 21 female) underwent a standardized 4-week training program. Baseline data: LVEF = 31 +/- 8%; LVEDD = 143 +/- 59 ml; peak V-o2 = 13.9 +/- 4.6 kg/ml. No adverse side effects could be observed. At discharge LVEF was 37 +/- 9%, (P = 0.001); LVEDD = 131 +/- 44 ml (P = 0.01); and peak Vo(2) = 15.4 +/- 5.0 kg/ ml. Quality of life improved significantly in nearly all domains and in summary score. There were no significant changes in anxiety and depression. There is a negative correlation between the initial workload and changes in physical health (r= -0.42, P=0.001) and only a weak correlation between age and positive changes in physical health (r=0.26, P=0.05). Conclusions: A standardized training program including moderate muscle strength training could be performed safely and demonstrated improvement in clinical parameters and quality of life. (C) 2002 European Society of Cardiology. Published by Elsevier Science B.V. All rights reserved.

Primary tumors of the heart are very rare. We report a case of a 28-year old female patient in whom a tumor of the left ventricle was first diagnosed by transthoracic echocardiography. Angiography, nuclear magnetic resonance imaging and lasting positron emission tomography with 18-fluorodesoxyglucose suggested the diagnosis of a well vascularized tumor. The tumor was subtotally excised during heart surgery under total cardiopulmonary bypass and histological examination identified a predominantly vascular hamartoma.

Echocardiography has superseded phonocardiography in the diagnosis of heart valve diseases. The reliability of these two non-invasive methods for determining the severity of a pulmonary stenosis was tested in 35 patients (17 females aged 39 +/- 14 years; 18 males aged 39 +/- 14 years) using a total of 155 invasive comparative measurements before and after successful percutaneous balloon valvulotomy of the pulmonary valve.Continuous Doppler-flow-measurement can only be implemented to determine a transvalvular systolic pressure difference with relative certainty in cases of an unaccompanied pulmonary stenosis. an additionally existing infundibular stenosis renders certain differentiation of transvalvular and infundibular pressure differences impossible. In contrast the split-interval of the second heart sound proves to be positively related to invasive determination of the severity of a pulmonary stenosis.

Coronary angiography is considered to be the most important component in the diagnosis of coronary artery disease. Only the lumen may be visualized using contrast radiography of the coronary arteries, however. With intravascular ultrasound, on the other hand, pathological changes in the vascular wall can be recorded. Despite typical symptoms, an angiographical image of the coronary arteries is sometimes unable to show unambiguous stenotic lesions of the coronary arteries. In such cases, intravascular ultrasound provides a new complementary diagnostic tool for detecting even early forms of arteriosclerosis or angiographically underestimated coronary findings. Two cases are used to illustrate this. In those, angiographic visualization of the coronary arteries was unable to produce an unambiguous finding despite typical clinical symptoms, yet intravascular ultrasound could detect considerable arteriosclerotic wall changes.

Coronary angiography is considered to be the most important component in the diagnosis of coronary artery disease. Only the lumen may be visualized using contrast radiography of the coronary arteries, however. With intravascular ultrasound, on the other hand, pathological changes in the vascular wall can be recorded. Despite typical symptoms, an angiographical image of the coronary arteries is sometimes unable to show unambiguous stenotic lesions of the coronary arteries. In such cases, intravascular ultrasound provides a new complementary diagnostic tool for detecting even early forms of arteriosclerosis or angiographically underestimated coronary findings. Two cases are used to illustrate this. In those, angiographic visualization of the coronary arteries was unable to produce an unambiguous finding despite typical clinical symptoms, yet intravascular ultrasound could detect considerable arteriosclerotic wall changes.

Patients with mild pulmonary stenosis after infancy rarely have symptoms or develop increasing obstruction. We experienced a 68-year-old woman with severe pulmonary valvar and infundibular stenosis (peak to peak pressure gradient = 80 mmHg). She had been pointed out heart disease at the age of six. Endocarditis at the age of 17 might induce calcification of valve and affect the progression of pulmonary stenosis, and moreover, which might gradually develop severe subvalvar obstruction and poststenotic aneurysm of pulmonary trunk. She refused operative intervention because of mild clinical symptoms (NYHA class II), but we recommended surgical repair due to repeated transient ischemic attacks, which were suspected paradoxical embolism through persistent foramen ovale. She underwent pulmonary valvotomy and infundibular resection and is doing well.