TY - JOUR A1 - Salzwedel, Annett A1 - Jensen, Katrin A1 - Rauch, Bernhard A1 - Doherty, Patrick A1 - Metzendorf, Maria-Inti A1 - Hackbusch, Matthes A1 - Völler, Heinz A1 - Schmid, Jean-Paul A1 - Davos, Constantinos H. T1 - Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine BT - update of the Cardiac Rehabilitation Outcome Study (CROS-II) JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis. Design A systematic review and meta-analysis. Methods Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included. Resulte Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53-0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08-0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54-0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36-0.77; two out of 10 controlled cohort studies with neutral results). Conclusion CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation. KW - cardiac rehabilitation KW - cardiac rehabilitation delivery KW - acute coronary KW - syndrome KW - coronary bypass grafting KW - coronary artery disease KW - mortality Y1 - 2020 U6 - https://doi.org/10.1177/2047487320905719 SN - 2047-4873 SN - 2047-4881 VL - 27 IS - 16 SP - 1756 EP - 1774 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Schwaab, Bernhard A1 - Rauch, Bernhard A1 - Völler, Heinz A1 - Benzer, Werner A1 - Schmid, Jean-Paul T1 - Beyond randomised studies BT - recommendations for cardiac rehabilitation following repair of thoracic aortic aneurysm or dissection JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology Y1 - 2020 U6 - https://doi.org/10.1177/2047487320936782 SN - 2047-4873 SN - 2047-4881 VL - 28 IS - 17 SP - E17 EP - E19 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Böhm, Andreas A1 - Flößer, Anja A1 - Ermler, Swen A1 - Fender, Anke C. A1 - Lüth, Anja A1 - Kleuser, Burkhard A1 - Schrör, Karsten A1 - Rauch, Bernhard H. T1 - Factor-Xa-induced mitogenesis and migration require sphingosine kinase activity and S1P formation in human vascular smooth muscle cells JF - Cardiovascular research N2 - Sphingosine-1-phosphate (S1P) is a cellular signalling lipid generated by sphingosine kinase-1 (SPHK1). The aim of the study was to investigate whether the activated coagulation factor-X (FXa) regulates SPHK1 transcription and the formation of S1P and subsequent mitogenesis and migration of human vascular smooth muscle cells (SMC). FXa induced a time- (36 h) and concentration-dependent (330 nmol/L) increase of SPHK1 mRNA and protein expression in human aortic SMC, resulting in an increased synthesis of S1P. FXa-stimulated transcription of SPHK1 was mediated by the protease-activated receptor-1 (PAR-1) and PAR-2. In human carotid artery plaques, expression of SPHK1 was observed at SMC-rich sites and was co-localized with intraplaque FX/FXa content. FXa-induced SPHK1 transcription was attenuated by inhibitors of Rho kinase (Y27632) and by protein kinase C (PKC) isoforms (GF109203X). In addition, FXa rapidly induced the activation of the small GTPase Rho A. Inhibition of signalling pathways which regulate SPHK1 expression, inhibition of its activity or siRNA-mediated SPHK1 knockdown attenuated the mitogenic and chemotactic response of human SMC to FXa. These data suggest that FXa induces SPHK1 expression and increases S1P formation independent of thrombin and that this involves the activation of Rho A and PKC signalling. In addition to its key function in coagulation, this direct effect of FXa on human SMC may increase cell proliferation and migration at sites of vessel injury and thereby contribute to the progression of vascular lesions. KW - Factor-Xa KW - Atherosclerosis KW - Proliferation KW - Smooth muscle cells KW - Sphingosine kinase-1 Y1 - 2013 U6 - https://doi.org/10.1093/cvr/cvt112 SN - 0008-6363 VL - 99 IS - 3 SP - 505 EP - 513 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Hansen, Dominique A1 - Dendale, Paul A1 - Coninx, Karin A1 - Vanhees, Luc A1 - Piepoli, Massimo F. A1 - Niebauer, Josef A1 - Cornelissen, Veronique A1 - Pedretti, Roberto A1 - Geurts, Eva A1 - Ruiz, Gustavo R. A1 - Corra, Ugo A1 - Schmid, Jean-Paul A1 - Greco, Eugenio A1 - Davos, Constantinos H. A1 - Edelmann, Frank A1 - Abreu, Ana A1 - Rauch, Bernhard A1 - Ambrosetti, Marco A1 - Braga, Simona S. A1 - Barna, Olga A1 - Beckers, Paul A1 - Bussotti, Maurizio A1 - Fagard, Robert A1 - Faggiano, Pompilio A1 - Garcia-Porrero, Esteban A1 - Kouidi, Evangelia A1 - Lamotte, Michel A1 - Neunhaeuserer, Daniel A1 - Reibis, Rona Katharina A1 - Spruit, Martijn A. A1 - Stettler, Christoph A1 - Takken, Tim A1 - Tonoli, Cajsa A1 - Vigorito, Carlo A1 - Völler, Heinz A1 - Doherty, Patrick T1 - The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases. KW - Cardiovascular disease KW - rehabilitation KW - exercise training KW - training and decision support system Y1 - 2017 U6 - https://doi.org/10.1177/2047487317702042 SN - 2047-4873 SN - 2047-4881 VL - 24 SP - 1017 EP - 1031 PB - Sage Publ. CY - London ER -