Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Digital technologies have the potential to address many of the challenges associated with the traditional center-based CR (CBCR), but the remote home-based cardiac rehabilitation(HBCR) model remains a challenge. Objective: This study is designed to investigate the feasibility, and efficacy of a smartwatch-facilitated HBCR model in patients with coronary heart disease (CHD). Methods: It was a single-center, randomized, non-blind, and parallel-controlled study. We recruited patients aged 18 years or older with coronary heart disease from a tertiary hospital in Jilin Province, China. The intervention group received a 3-month smartwatch-based HBCR program involving remotely delivered real-time feedback, supervision, and education. The control group received conventional HBCR. Adherence is the primary outcome of the trial, assessed by the Home-Based Cardiac Rehabilitation Exercise Adherence Scale. The secondary outcomes include cardiopulmonary function, measured by cardiopulmonary exercise testing, anxiety (General Anxiety Disorder-7), depression(Patient Health Questionnaire-9), and quality of life (36-Item Short Form Health Survey) at 3 months. Results: Between January 1, 2023, and December 30, 2023, 62 patients (mean age 59.93±10.06 years), of whom 33.3% were female and 66.% were male, were recruited and subsequently randomly assigned to the smartwatch group (n=32) or control group (n=30). No difference was detected in the baseline characteristics between the two groups. After the intervention, the subjects in the smartwatch group performed significantly better in peak VO2, home-based cardiac rehabilitation adherence, GAD-7, PHQ-9, and some other parameters than those in the control group. Conclusions: This feasibility study showed that the smartwatch device was well-accepted and effective in supporting a home-based cardiac rehabilitation model for patients with coronary heart disease (CHD). Clinical Trial: Clinical Trials Registry: ChiCTR2400088039; https://www.chictr.org.cn/bin/project/edit?pid=215602

Objective: Global longitudinal strain (GLS) is a sensitive and reproducible predictive factor in patients with ischemic heart disease (IHD), although its correlation with exercise tolerance is unknown. We aimed to identify the correlation between global longitudinal strain (GLS) and cardiopulmonary exercise testing (CPX) parameters and assess the prognostic implications and accuracy of GLS in predicting exercise intolerance in populations with ischemic heart disease (IHD) using CPET criteria. Methods: Prospectively, 108 patients with IHD underwent CPX and 2D speckle-tracking echocardiography. Correlation between GLS and multiple CPX variables was assessed using Spearman’s correlation analysis and univariate regression analysis. A receiver operating characteristic (ROC) curve analysis was performed on GLS to detect exercise intolerance. Results: GLS was correlated with peak oxygen uptake (peak VO₂; r = −0.438, p = 0.000), %PPeak VO₂ (−0.369, p = 0.000), peak metabolic equivalents (METs@peak; r = −0.438, p < 0.01), and the minute ventilation–carbon dioxide production (VE/VCO₂) slope (r = 0.257, p < 0.01). Weak-to-moderate correlations were also identified for the respiratory exchange rate at the anaerobic threshold (RER@AT), end-tidal carbon dioxide at the anaerobic threshold (PETCO₂@AT), oxygen consumption at the anaerobic threshold (VO₂@AT), carbon dioxide production at the anaerobic threshold (VCO₂@AT), and metabolic equivalents at the anaerobic threshold (METs@AT; p < 0.01). On multivariate analysis, the results showed that age, the BMI, and GLS are independent predictors for reduced exercise capacity in patients with IHD (p < 0.01). The area under the ROC curve value of GLS for identifying patients with a peak VO₂ of <14 mL/kg/min was 0.73 (p = 0.000). Conclusion: As a sensitive echocardiographic assessment of patients with ischemic heart disease, global longitudinal strain is an independent predictor of reduced exercise capacity and has a sensitivity of 74.2% and a specificity of 66.7% to detect exercise intolerance.

Background: Cardiorespiratory fitness (CRF) is a powerful predictor of cardiovascular morbidity and mortality. The cardiopulmonary exercise test (CPET) is considered a gold standard in assessing CRF. Patients with myocarditis are recommended to abstain from exercise because of the risk of sudden cardiac death (SCD). Therefore, the clinical benefit of exercise‐based cardiac rehabilitation (CR) has not been previously established in this population. Objective: The aim of this study is to assess the CRF of myocarditis and the safety and effectiveness of an exercise‐based CR program in these populations. Method: A total of 70 consecutive patients with a diagnosis of myocarditis admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between October 2021 and December 2024 were enrolled in the current study. CPET was performed within 3–6 months of hospital discharge. The exercise‐based CR program was performed for 3 months. The protocol included biomarker analysis, CPET, and standard‐of‐care echocardiography (including resting left ventricular ejection fraction and global longitudinal strain [GLS]). Data were collected at admission and 3 months after discharge. Results: A total of 70 patients with myocarditis were enrolled. Among them, 47 patients completed the rehabilitation program and had complete follow‐up assessments, including cardiopulmonary exercise testing, and were included in the final analysis. In comparison with NFM, patients with FM were more often female, and had higher levels of creatine kinase (CK), lactate dehydrogenase (LDH), urea nitrogen (UN), N‐terminus probrain natriuretic peptide (NT‐proBNP), fasting blood glucose (FBG), and white blood cell (WBC). For FM, echocardiography revealed more frequently signs of left ventricular (LV) dysfunction in the form of a reduced ejection fraction ( p < 0.01), and lower GLS ( p < 0.01) in contrast to NFM. CPET results showed that FM patients had markedly lower exercise capacity, impaired ventilatory efficiency, and pulmonary function ( p < 0.05). After the 3‐month exercise‐based CR program, both groups demonstrated significant improvements in peak VO ₂ , peak workload, and MVV. However, no significant between‐group differences were observed in the magnitude of improvement in CRF. Conclusion: CRF was substantially impaired in patients recovering from myocarditis, particularly among those with fulminant presentations. Participation in a structured 3‐month exercise‐based CR program was feasible and was associated with favorable changes in exercise capacity and cardiopulmonary performance. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2400088436

We report 8‐year follow‐up of a home‐based exercise rehabilitation program combined traditional Chinese medicine for a patient with triple vessel disease patient complicated with heart failure without invasive intervention. Improvements were observed in all outcomes.