Post aortic dissection: Gap between activity recommendation and real life patients aerobic capacities Pascal Delsart a, ⁎, Pauline Maldonado-Kauffmann a , Mathieu Bic a , Fanny Boudghene-Stambouli a , Jonathan Sobocinski a,c , Francis Juthier a,c , Olivia Domanski b , Augustin Coisne b,c , Richard Azzaoui a , Natacha Rousse a,c , George Fayad a , Thomas Modine a , Stephan Haulon a,c , Andre Vincentelli a,c , Claire Mounier-Vehier a,c , David Montaigne b,c a CHU Lille, Cardiology hospital, Bd Pr Leclercq, F-59000 Lille, France b CHU Lille, Echocardiography department, Bd Pr Leclercq, F-59000 Lille, France c University of Lille, CHU Lille, F-59000 Lille, France abstract article info Article history: Received 10 May 2016 Accepted 12 June 2016 Available online 15 June 2016 Back ground: Regular exercise at a safe level, i.e. 3–5 metabolic equivalents, is recommended to improve blood pressure control and quality of life even after aortic dissection, although aerobic exercise capacities in these pa- tients are unexplored yet. Methods: We prospectively collected data from 105 patients with a history of post aortic dissection referred for a cardiopulmonary exercise testing (CPX) aiming to guide exercise rehabilitation. Results: The population was composed of 76% of male, with a mean age of 57.9 ± 12.4 years. There were an equal distribution between the two type of dissection (47% of type A and 53% of type B aortic dissection). No cardiac event occurred during or after CPX. One third of patients have normal aerobic exercise capacity defined as peak oxygen uptake upper than 85% of their predicted capacity. Mean oxygen uptake peak was quite low 19.2 ± 5.2 ml/kg/min (5.5 ± 1.5 metabolic equivalents). Aerobic capacity was limited by cardiac chronotropic incompetence in 42% or peripheral deconditioning in 45%. Blood pressure remained in an acceptable range dur- ing the exercise. Systolic and diastolic blood pressures were respectively 151 ± 20 and 77 ± 13 mm Hg at first ventilatory threshold. Conclusions: CPX is a safe exploration in patients with post aortic dissection syndrome. Given the fact that most of these patients are faced with significant aerobic capacities, the recommended daily practice of moderate exercise at 3–5 METS should be adapted and personalized to each patient thanks to CPX. © 2016 Elsevier Ireland Ltd. All rights reserved. Keywords: Aortic dissection Exercise capacity Activity recommendation 1. Introduction Management of patients surviving aortic dissection is mainly focused on the blood pressure control thanks to intensive anti-hypertensive drug cocktails. Recent American recommendations encourage daily moderate activities, i.e. exercise at 3 to 5 metabolic equivalents (METS), for these patients to improve global cardiovascular health and blood pressure con- trol [1]. Data supporting this recommendation are however lacking and it remains difficult to define a safe range of exercise in a population in which the physician fears that too intense exercise might initiate or ag- gravate aortic expansion. To cope with this lack, we prospectively evalu- ated aerobic capacities with CPX in all stable post aortic dissection patients referred to our center. 2. Methods 2.1. Study population We collected data from patients referred for post aortic dissection follow-up between November 2012 and August 2015. Intramural aortic haematomas were considered to be aortic dissections with thrombosis of the false lumen. Patients with penetrating aortic ulcers, nor post trau- matic aortic dissection were excluded. Patients with type A aortic dis- section having undergone non-surgical treatment (e.g. medications only), because of severe comorbidities, were not included in the study. Patients with type A aortic dissection were hospitalized in one of two different cardiac surgery units. Patients with type B aortic dissection were hospitalized in a vascular medicine department or (in those re- quiring emergency treatment as a result of complications) a vascular surgery department. Clinical and morphological follow-up assessments were performed in the Vascular Medicine and Arterial Hypertension International Journal of Cardiology 219 (2016) 271–276 ⁎ Corresponding author at: Vascular medicine and Hypertension department, Cardiology hospital Universitary Hospital of Lille, F-59000 Lille, France. E-mail address: Pascal.DELSART@CHRU-LILLE.fr (P. Delsart). http://dx.doi.org/10.1016/j.ijcard.2016.06.026 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard