title: Baseline subendocardial viability ratio influences left ventricular systolic improvement with cardiac rehabilitation.
abstract: OBJECTIVE
  Subendocardial viability ratio (SEVR), defined as diastolic to systolic pressure-time integral ratio, is a useful tool reflecting the balance between coronary perfusion and arterial load. Suboptimal SEVR creating a supply-demand imbalance may limit favorable cardiac response to cardiac rehabilitation (CR). To explore this hypothesis, we designed a study to analyze the relationship between baseline SEVR and response to CR in patients with coronary artery disease (CAD).
  
  
  METHODS
  In this prospectively study, after baseline arterial tonometry, echocardiography, and cardiopulmonary exercise tests (CPETs), patients undergone 20 sessions of CR. Post-CR echocardiographic and CPET measurements were obtained for comparison.
  
  
  RESULTS
  Final study population was comprised of fifty subjects. Study population was divided into two subgroups by median SEVR value (1.45, interquartile range 0.38). Although both groups showed significant improvements in peak VO2, significant improvements in oxygen pulse (πO2) (from 16.1±3.4 to 19.1±4.8 mL O2.kg-1.beat-1; p<0.001) and stroke volume index (from 31±5 to 35±6 mL; p=0.008) were observed in only the patients in the above-median subgroup. The change in πO2 was also significantly higher in the above-median SEVR subgroup (2.9±3.3 vs. 0.5±2.4; p=0.007).
  
  
  CONCLUSIONS
  Our study shows that baseline supply-demand imbalance may limit systolic improvement response to CR in patients with CAD.
authors.affiliation: Department of Cardiology, Yeditepe University Hospital; İstanbul-Turkey. mr_aslanger@hotmail.com.
authors.forename: Emre
authors.initials: E
authors.lastname: Aslanger
authors.affiliation: Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP); Paris-France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Assous
authors.affiliation: Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP); Paris-France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bihry
authors.affiliation: Department of Cardiology, UMR-S 942, Université Paris Diderot, DHU FIRE, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP); Paris-France.
authors.forename: Florence
authors.initials: F
authors.lastname: Beauvais
authors.affiliation: Department of Cardiology, UMR-S 942, Université Paris Diderot, DHU FIRE, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP); Paris-France.
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.affiliation: Department of Cardiology, UMR-S 942, Université Paris Diderot, DHU FIRE, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP); Paris-France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation; D003971:Diastole; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation*; D011446:Prospective Studies; D013599:Systole