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Pubblicazioni recenti - cardiopulmonary
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Real-time exercise reduces impaired cardiac function in breast cancer patients undergoing chemotherapy: a randomized controlled trial.
Ann Phys Rehabil Med2021 Jan;():101485. doi: S1877-0657(21)00003-8.
Chung Wei-Pang, Yang Hsin-Lun, Hsu Ya-Ting, Hung Ching-Hsia, Liu Ping-Yen, Liu Yen-Wen, Chan Shih-Hung, Tsai Kun-Ling,
Abstract
BACKGROUND:
Previous studies have reported that chemotherapy results in substantial long-term risk of heart failure. Exercise ameliorates exercise responses and exercise tolerance in patients receiving chemotherapy. The cardioprotective effect of real-time exercise in breast cancer is still unclear.
OBJECTIVES:
The aim of the present study was to determine the effect of real-time moderate-to-high-intensity exercise training in women with breast cancer undergoing chemotherapy and to follow up on parameters of cardiac function and exercise capacity at different times. We hypothesized that early moderate-to-high-intensity exercise training has beneficial effects on cardiac function in women with breast cancer undergoing chemotherapy.
METHODS:
This was a randomized controlled study that included 32 women randomly allocated into the control or exercise group. Exercise began with the first cycle of chemotherapy, and the training program was maintained during chemotherapy with 2 to 3 sessions per week for 3 months. Patients were instructed to perform moderate-to-high-intensity training with aerobic and resistance training. Outcome measurements were echocardiography and cardiopulmonary exercise test. The primary outcome was the change in left ventricle ejection fraction (LVEF). The secondary outcome was peak oxygen consumption (peak VO).
RESULTS:
The control group showed lower cardiac systolic function than the exercise group [mean (SD) LVEF 62% (2) and 70% (5), p < 0.05], reduced cardiac diastolic function, and cardiac hypertrophy at 3, 6 and 12 months after chemotherapy. At 6 months after chemotherapy, the exercise group exhibited relatively higher exercise capacity than controls [mean (SD) VO 12.1 (2.2) and 13.6 (2.2) mL/kg/min, p < 0.05]. The main effect size of the study based on echocardiography outcomes was 0.25 (95% confidence interval 0.23 to 0.27), a medium effect size.
CONCLUSIONS:
Moderate-to-high-intensity exercise training in breast cancer patients undergoing chemotherapy may prevent impaired cardiac function.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
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The impact of aerobic exercise on cardiopulmonary responses and predictors of change in individuals with Parkinson's disease.
Arch Phys Med Rehabil2021 Jan;():. doi: S0003-9993(21)00006-X.
Penko Amanda L, Zimmerman Nicole M, Crawford Michael, Linder Susan M, Alberts Jay L,
Abstract
OBJECTIVE:
To determine the impact of aerobic exercise on maximal and submaximal cardiopulmonary responses and predictors of change in individuals with Parkinson's disease (PD).
DESIGN:
Single-center, parallel-group, rater-blind study.
SETTING:
Research laboratory PARTICIPANTS: Individual's with mild to moderate PD (N=100) INTERVENTION: Participants were enrolled in a trial evaluating the impact of cycling on PD and randomized to either voluntary exercise (VE), forced exercise (FE), or a no exercise, control group. The exercise groups were time and intensity matched and exercised 3x/week for eight weeks on a stationary cycle.
MAIN OUTCOME MEASURE:
Cardiopulmonary responses were collected via gas analysis during a maximal graded exercise test at baseline and post intervention.
RESULTS:
Exercise attendance, was 97% and 93% for the FE and VE group respectively. Average exercise HR reserve was 67% ± 11% for FE and 70% ± 10% for VE. No significant difference was present for change in VO post intervention, even though the FE group had a 5% increase in VO. Both the FE and VE groups had significantly higher %VO at VT then the control group compared to baseline values (p=0.04). Mean (95% CI) VO at VT was 5% (0.1%, 11%) higher in FE patients (p=0.04) and 7% (2%, 12%) higher in VE groups compared to controls. A stepwise linear regression model revealed that lower age, high exercise cadence, and lower baseline VO were most predictive of improved VO. The overall model was found to be significant, (p< 0.01).
CONCLUSION:
Peak and submaximal cardiopulmonary function may improve after aerobic exercise in individuals with PD. Lower age, higher exercise cadence, and lower baseline VO were most predictive of improved VO in this exercise cohort. The improvements observed in aerobic capacity were gained after a relatively short aerobic cycling intervention.
Copyright © 2021. Published by Elsevier Inc.
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Femoral Stem Cementation in Hip Arthroplasty: The Know-How of a "Lost" Art.
Curr Rev Musculoskelet Med2021 Jan;():. doi: 10.1007/s12178-020-09681-5.
Emara Ahmed K, Ng Mitchell, Krebs Viktor E, Bloomfield Michael, Molloy Robert M, Piuzzi Nicolas S,
Abstract
PURPOSE OF REVIEW:
To describe the (1) indications, (2) preoperative precautions, and (3) stepwise technical details of modern femoral stem cemented fixation.
RECENT FINDINGS:
Femoral stem cementation provides excellent implant longevity with a low periprosthetic fracture rate among patients with compromised bone quality or aberrant anatomy. Unfamiliarity with the details of modern cementation techniques among trainees who may lack frequent exposure to cementing femoral stems may preclude them from offering this viable option to suitable patients in later stages of their careers. As such, maximizing benefit from cemented femoral stem fixation among suitable candidates is contingent upon the meticulous use of modern cementation techniques. In addition to proper patient selection, modern cementation techniques emphasize the use of (1) pulsatile lavage of the femoral canal, (2) utilization of epinephrine-soaked swabs, (3) vacuum cement mixing, (4) retrograde cement introduction, (5) cement pressurization, and (6) the use of stem centralizers. Furthermore, identifying and optimizing the preoperative status of at-risk patients with pre-existing cardiopulmonary compromise, in addition to intraoperative vigilance, are essential for mitigating the risk of developing bone cement implantation syndrome. Further research is required to assess the utility of cemented femoral stem fixation among younger patients.
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Exploring and reconciling discordance between documented and preferred resuscitation preferences for hospitalized patients: a quality improvement study.
Can J Anaesth2021 Jan;():. doi: 10.1007/s12630-020-01906-y.
Taneja Ravi, Sibbald Robert, Elliott Launa, Burke Elizabeth, Bishop Kristen A, Jones Philip M, Goldszmidt Mark,
Abstract
PURPOSE:
A discordance, predominantly towards overtreatment, exists between patients' expressed preferences for life-sustaining interventions and those documented at hospital admission. This quality improvement study sought to assess this discordance at our institution. Secondary objectives were to explore if internal medicine (IM) teams could identify patients who might benefit from further conversations and if the discordance can be reconciled in real-time.
METHODS:
Two registered nurses were incorporated into IM teams at a tertiary hospital to conduct resuscitation preference conversations with inpatients either specifically referred to them (group I, n = 165) or randomly selected (group II, n = 164) from 1 August 2016 to 31 August 2018. Resuscitation preferences were documented and communicated to teams prompting revised resuscitation orders where appropriate. Multivariable logistic regression was used to determine potential risk factors for discordance.
RESULTS:
Three hundred and twenty-nine patients were evaluated with a mean (standard deviation) age of 80 (12) and Charlson Comorbidity Index Score of 6.8 (2.6). Discordance was identified in 63/165 (38%) and 27/164 (16%) patients in groups I and II respectively. 42/194 patients (21%) did not want cardiopulmonary resuscitation (CPR) and 15/36 (41%) did not prefer intensive care unit (ICU) admission, despite these having been indicated in their initial preferences. 93% (84/90) of patients with discordance preferred de-escalation of care. Discordance was reconciled in 77% (69/90) of patients.
CONCLUSION:
Hospitalized patients may have preferences documented for CPR and ICU interventions contrary to their preferences. Trained nurses can identify inpatients who would benefit from further in-depth resuscitation preference conversations. Once identified, discordance can be reconciled during the index admission.
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Association between serum lactate level during cardiopulmonary resuscitation and survival in adult out-of-hospital cardiac arrest: a multicenter cohort study.
Sci Rep2021 Jan;11(1):1639. doi: 10.1038/s41598-020-80774-4.
Nishioka Norihiro, Kobayashi Daisuke, Izawa Junichi, Irisawa Taro, Yamada Tomoki, Yoshiya Kazuhisa, Park Changhwi, Nishimura Tetsuro, Ishibe Takuya, Yagi Yoshiki, Kiguchi Takeyuki, Kishimoto Masafumi, Inoue Toshiya, Hayashi Yasuyuki, Sogabe Taku, Morooka Takaya, Sakamoto Haruko, Suzuki Keitaro, Nakamura Fumiko, Matsuyama Tasuku, Okada Yohei, Matsui Satoshi, Hirayama Atsushi, Yoshimura Satoshi, Kimata Shunsuke, Shimazu Takeshi, Kitamura Tetsuhisa, Kawamura Takashi, Iwami Taku, ,
Abstract
We aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). From the database of a multicenter registry on OHCA patients, we included adult nontraumatic OHCA patients transported to the hospital with ongoing CPR. Based on the serum lactate levels during CPR, the patients were divided into four quartiles: Q1 (??10.6 mEq/L), Q2 (10.6-14.1 mEq/L), Q3 (14.1-18.0 mEq/L), and Q4 (>?18.0 mEq/L). The primary outcome was 1-month survival. Among 5226 eligible patients, the Q1 group had the highest 1-month survival (5.6% [74/1311]), followed by Q2 (3.6% [47/1316]), Q3 (1.7% [22/1292]), and Q4 (1.0% [13/1307]) groups. In the multivariable logistic regression analysis, the adjusted odds ratio of Q4 compared with Q1 for 1-month survival was 0.24 (95% CI 0.13-0.46). 1-month survival decreased in a stepwise manner as the quartiles increased (p for trend
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Clinical improvement of cardiac function in a patient with systemic lupus erythematosus and heart failure with preserved ejection fraction treated with belimumab.
BMJ Case Rep2021 Jan;14(1):. doi: e237549.
Baniaamam Milad, Voskuyl Alexandre E, Nurmohamed Michael T, Handoko M Louis,
Abstract
We present a 51-year-old Caucasian woman, with a medical history of systemic lupus erythematosus (SLE) who had dyspnoea at exertion. The SLE was clinically quiescent but serologically active. Echocardiography showed preserved left ventricular (LV) systolic function, pseudonormal mitral inflow pattern (diastolic dysfunction grade III), absence of wall motion abnormalities and elevated E/e' at exercise. An exercise right heart catheterisation was performed, confirming the diagnosis of heart failure with preserved ejection fraction (HFpEF). In the absence of other possible causes, we assumed that HFpEF was mediated by systemic inflammation secondary to SLE. Based on the Paulus' paradigm, that systemic inflammation may lead to diastolic dysfunction, we decided to add belimumab (a biological agent against soluble B-lymphocyte stimulator protein). After 16?weeks of treatment, patient reported an improved condition. Also, cardiopulmonary exercise test and echocardiography results improved, confirming resolution of the underlying LV diastolic dysfunction. This case supports the idea that targeting inflammation has therapeutic potential in a subset of HFpEF-patients.
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Esmolol in Cardiac Surgery: A Randomized Controlled Trial.
J Cardiothorac Vasc Anesth2021 Jan;():. doi: S1053-0770(20)31376-8.
Zangrillo Alberto, Bignami Elena, Noè Beatrice, Nardelli Pasquale, Licheri Margherita, Gerli Chiara, Crivellari Martina, Oriani Alessandro, Di Prima Ambra Licia, Fominskiy Evgeny, Di Tomasso Nora, Lembo Rosalba, Landoni Giovanni, Crescenzi Giuseppe, Monaco Fabrizio,
Abstract
OBJECTIVE:
To assess whether the administration of the ultra-short-acting ?-blocker esmolol in cardiac surgery could have a cardioprotective effect that translates into improved postoperative outcomes.
DESIGN:
Single-center, double-blinded, parallel-group randomized controlled trial.
SETTING:
A tertiary care referral center.
PARTICIPANTS:
Patients undergoing elective cardiac surgery with preoperative evidence of left ventricular end-diastolic diameter >60 mm and/or left ventricular ejection fraction <50%.
INTERVENTIONS:
Patients were assigned randomly to receive either esmolol (1 mg/kg as a bolus before aortic cross-clamping and 2 mg/kg mixed in the cardioplegia solution) or placebo in a 1:1 allocation ratio.
MEASUREMENTS AND MAIN RESULTS:
The primary composite endpoint of prolonged intensive care unit stay and/or in-hospital mortality occurred in 36/98 patients (36%) in the placebo group versus 27/102 patients (27%) in the esmolol group (p?=?0.13). In the esmolol group, a reduction in the maximum inotropic score during the first 24 postoperative hours was observed (10 [interquartile range 5-15] v 7 [interquartile range 5-10.5]; p?=?0.04), as well as a trend toward a reduction in postoperative low-cardiac-output syndrome (13/98 v 6/102; p?=?0.08) and the rate of hospital admission at one year (26/95 v 16/96; p?=?0.08). A trend toward an increase in the number of patients with ejection fraction ?60% at hospital discharge also was observed (4/95 v 11/92; p?=?0.06).
CONCLUSIONS:
In the present trial, esmolol as a cardioplegia adjuvant enhanced postoperative cardiac performance but did not reduce a composite endpoint of prolonged intensive care unit stay and/or mortality.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Influence of ADRB1, ADRB2, and COMT Genetic Polymorphisms on Postoperative Outcomes of Patients Undergoing Cardiac Valve Surgery.
Clin Ther2021 Jan;():. doi: S0149-2918(20)30559-2.
Dai Sisi, Ma Wenjuan, Qin Gang, Wang Lu, Wang E,
Abstract
PURPOSE:
The aim of this study is to prospectively investigate the influence of ADRB and COMT gene polymorphisms on postoperative outcomes of patients undergoing cardiac surgery.
METHODS:
This prospective cohort study included 223 patients undergoing elective cardiac valve surgery using cardiopulmonary bypass. Demographic information, intraoperative data, postoperative data, and blood samples were collected. Patients were genotyped for single-nucleotide polymorphisms (SNPs) of ADRB1 rs1801253, ADRB2 rs1042713, and COMT rs4680. Major adverse cardiovascular and cerebrovascular events (MACCEs) were used as the primary outcome to evaluate the postoperative prognosis of patients. Secondary outcomes included the duration of mechanical ventilatory support, intensive care unit stay, postoperative hospital stay, and postoperative need of inotropic or vasoactive agents.
FINDINGS:
The overall incidence of MACCEs was 15.2%. Among 3 SNP loci, only different genotyped carriers of ADRB2 rs1042713 had statistically significant differences in the incidence of MACCEs (P = 0.005), especially for acute kidney injury (P = 0.023). The proportions of postoperative norepinephrine demand of patients carrying the AA genotype of ADRB2 rs1042713 (P = 0.016) and the AG genotype of COMT rs4680 (P = 0.018) were low. The duration of mechanical ventilatory support (P = 0.034) and postoperative hospital stay (P = 0.045) of patients carrying the AG genotype of COMT rs4680 was shortest. After multiple logistic regression analysis, we found that the G allele carriers of ADRB2 rs1042713 had a higher risk of MACCEs (AG vs AA genotype: odds ratio [OR] = 4.348; 95% CI, 1.529-12.359, P = 0.006; GG vs AA genotype: OR = 3.722; 95% CI, 1.060-13.071; P = 0.040), in particular with acute kidney injury (AG vs AA genotype: OR = 5.273; 95% CI, 1.093-25.451; P = 0.038; GG vs AA genotype: OR = 7.533; 95% CI, 1.275-44.522; P = 0.026). There was no SNP-SNP interaction found among the 3 SNPs with multifactor dimensionality reduction analysis.
IMPLICATION:
The ADRB2 rs1042713 polymorphism might be related to prognosis of patients undergoing cardiac surgery. Patients carrying the G allele of ADRB2 rs1042713 had a higher risk of developing MACCEs, especially acute kidney injury. chictr.org.com identifier: ChiCTR1800015105.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Red blood cell exosome hemoglobin content increases after cardiopulmonary bypass and mediates acute kidney injury in an animal model.
J Thorac Cardiovasc Surg2020 Dec;():. doi: S0022-5223(20)33187-1.
Pat Betty, Oh Joo-Yeun, Masjoan Juncos Juan Xavier, Powell Pamela C, Collawn James F, Patel Rakesh P, Dell'Italia Louis J, ,
Abstract
OBJECTIVE:
Hemolysis, characterized by formation of free hemoglobin (Hb), occurs in patients undergoing cardiopulmonary bypass (CPB). However, there is no study of the dynamic changes in red blood cell (RBC)-derived exosomes (Exos) released during CPB, nor whether these particles mediate acute kidney injury (AKI).
METHODS:
This study is a comprehensive time-course analysis, at baseline, 30 minutes, to 24 hours post-crossclamp release (XCR) to determine (1) Exos Hb content; (2) free Hb/heme, haptoglobin, hemopexin; and (3) urinary markers of AKI over the same time period. In addition, we developed a model system in Sprague-Dawley rats to test for AKI after intravenous injection of Exos Hb released during CPB.
RESULTS:
In 30 patients undergoing CPB, there is a significant increase in plasma Hb-positive Exos but not microvesicles 30 minutes post-XCR versus other time points, with a simultaneous decrease in the haptoglobin/Hb ratio. These changes presage a significant increase in urine neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 at 24 hours. Intravenous injection of plasma Exos (10 particles obtained 30 minutes post-XCR) into rats causes AKI at 72 hours, manifested by multifocal degeneration of proximal tubular epithelium. At 21 days, there is persistent tubular injury and interstitial fibrosis. Intravenous injection of Exos from 35-day-old stored RBCs into rats results in glomerular-tubular injury, increased kidney ferritin and hemoxygenase-1 expression, and significant elevation of kidney injury molecule-1 and proteinuria at 72 hours.
CONCLUSIONS:
These combined studies raise the potential for RBC-derived Exos, released during CPB, to target the kidney and mediate AKI.
Published by Elsevier Inc.
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The impact of a cardiopulmonary resuscitation video on reducing surrogates' anxiety: A pilot randomized controlled trial.
J Crit Care2020 Dec;62():235-242. doi: S0883-9441(20)30756-5.
Ferrer Marrero Tirsa M, Barash Mark, Jaber Besma, Nothem Meghan, Shah Kumar, Weber Matthew W, Zellner Jones Stephanie, Kennedy Patrick, Graf Jeanette, Broaddrick Shannon, Garacci Zhuping, Banerjee Anjishnu, Kryworuchko Jennifer, Patel Jayshil,
Abstract
PURPOSE:
To test the primary hypothesis that a CPR video will reduce ICU patients' surrogates' anxiety when deciding code status, as measured by the Hamilton Anxiety Rating (HAM-A) Scale, as compared to the no video group.
MATERIALS AND METHODS:
This is a prospective randomized control trial. Twenty-seven ICU patients' surrogates were enrolled in the study after receiving an ICU team-led code status discussion. After the enrollment, twelve surrogates were randomized to the video group and fifteen to the no video group. The primary outcome of anxiety was quantified using the HAM-A Scale. Demographic information, clinical data, and patients' provenance information (Home vs. Not Home) were collected. The patients' severity of illness was calculated using the Sequential Organ Failure Assessment (SOFA) Score.
RESULTS:
The HAM-A score in the video group was 5.65 points lower than in the no video group ([? = -5.65, 95% CI -11.12 -0.18] P = 0.04). The statistically significant difference was maintained when adjusting for patients' SOFA Score and patients' provenance (P = 0.03).
CONCLUSION:
CPR video used to supplement ICU team-led code status discussions reduced surrogates' anxiety, as compared to no video.
TRIAL REGISTRATION:
ClinicalTrials.gov Identifier NCT03630965.
Copyright © 2020. Published by Elsevier Inc.
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Oxygen sensing, mitochondrial biology and experimental therapeutics for pulmonary hypertension and cancer.
Free Radic Biol Med2021 Jan;():. doi: S0891-5849(21)00001-0.
Wu Danchen, Dasgupta Asish, Read Austin D, Bentley Rachel E T, Motamed Mehras, Chen Kuang-Hueih, Al-Qazazi Ruaa, Mewburn Jeffrey D, Dunham-Snary Kimberly J, Alizadeh Elahe, Tian Lian, Archer Stephen L,
Abstract
The homeostatic oxygen sensing system (HOSS) optimizes systemic oxygen delivery. Specialized tissues utilize a conserved mitochondrial sensor, often involving NDUFS2 in complex I of the mitochondrial electron transport chain, as a site of pO-responsive production of reactive oxygen species (ROS). These ROS are converted to a diffusible signaling molecule, hydrogen peroxide (HO), by superoxide dismutase (SOD2). HO exits the mitochondria and regulates ion channels and enzymes, altering plasma membrane potential, intracellular Ca and Ca-sensitization and controlling acute, adaptive, responses to hypoxia that involve changes in ventilation, vascular tone and neurotransmitter release. Subversion of this O-sensing pathway creates a pseudohypoxic state that promotes disease progression in pulmonary arterial hypertension (PAH) and cancer. Pseudohypoxia is a state in which biochemical changes, normally associated with hypoxia, occur despite normal pO. Epigenetic silencing of SOD2 by DNA methylation alters HO production, activating hypoxia-inducible factor 1?, thereby disrupting mitochondrial metabolism and dynamics, accelerating cell proliferation and inhibiting apoptosis. Other epigenetic mechanisms, including dysregulation of microRNAs (miR), increase pyruvate dehydrogenase kinase and pyruvate kinase muscle isoform 2 expression in both diseases, favoring uncoupled aerobic glycolysis. This Warburg metabolic shift also accelerates cell proliferation and impairs apoptosis. Disordered mitochondrial dynamics, usually increased mitotic fission and impaired fusion, promotes disease progression in PAH and cancer. Epigenetic upregulation of dynamin-related protein 1 (Drp1) and its binding partners, MiD49 and MiD51, contributes to the pathogenesis of PAH and cancer. Finally, dysregulation of intramitochondrial Ca, resulting from impaired mitochondrial calcium uniporter complex (MCUC) function, links abnormal mitochondrial metabolism and dynamics. MiR-mediated decreases in MCUC function reduce intramitochondrial Ca, promoting Warburg metabolism, whilst increasing cytosolic Ca, promoting fission. Epigenetically disordered mitochondrial O-sensing, metabolism, dynamics, and Ca homeostasis offer new therapeutic targets for PAH and cancer. Promoting glucose oxidation, restoring the fission/fusion balance, and restoring mitochondrial calcium regulation are promising experimental therapeutic strategies.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Effect of self-tailored high-intensity interval training versus moderate-intensity continuous exercise on cardiorespiratory fitness after myocardial infarction: A randomized controlled trial.
Ann Phys Rehabil Med2021 Jan;():101490. doi: S1877-0657(21)00008-7.
Marcin Thimo, Trachsel Lukas D, Dysli Michelle, Schmid Jean Paul, Eser Prisca, Wilhelm Matthias,
Abstract
BACKGROUND:
Whether high-intensity interval training (HIIT) is more efficient than moderate-intensity continuous exercise (MICE) to increase cardiorespiratory fitness in patients with acute coronary syndrome at moderate-to-high cardiovascular risk is controversial. The best approach to guide training intensity remains to be determined.
OBJECTIVE:
We aimed to assess intensities achieved with self-tailored HIIT and MICE according to perceived exertion and to compare the effect on cardiorespiratory fitness in patients early after ST-elevation myocardial infarction (STEMI).
METHODS:
We included 69 males starting cardiac rehabilitation within 4 weeks after STEMI. After a 3-week run-in phase with MICE, 35 patients were randomized to 9 weeks of HIIT (2×HIIT and 1×MICE per week) and 34 patients to MICE (3×MICE). Training workload for MICE was initially set at the patients' first ventilatory threshold (VT). HIIT consisted of 4×4-min intervals with a workload above the second VT in high intervals. Training intensity was adjusted weekly to maintain the perceived exertion (Borg score 13-14 for MICE, ?15 for HIIT). Session duration was 38 min in both groups. Peak oxygen consumption (VO2) was measured by cardiopulmonary exercise testing pre- and post-intervention.
RESULTS:
Both groups improved peak VO2 (ml/kg/min) (HIIT +1.9, p<0.001; MICE +3.2, p<0.001, Cohen's d -0.4), but changes in VO2 were not significantly different between groups (p=0.104). Exercise regimes did not differ between groups in terms of energy expenditure or training time, but perceived exertion was higher with HIIT.
CONCLUSIONS:
Self-tailored HIIT was feasible in patients early after STEMI. It was more strenuous but not superior nor more time efficient than MICE in improving peak VO2.
Copyright © 2021. Published by Elsevier Masson SAS.
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Emerging benefits and drawbacks of alpha -adrenoceptor agonists in the management of sepsis and critical illness.
Br J Pharmacol2021 Jan;():. doi: 10.1111/bph.15363.
Lankadeva Yugeesh R, Shehabi Yahya, Deane Adam M, Plummer Mark P, Bellomo Rinaldo, May Clive N,
Abstract
Alpha -adrenoceptor agonists are increasingly being used for the provision of comfort, sedation and the management of delirium in critically ill patients with and without sepsis. In this context, increased sympathetic and inflammatory activity are common pathophysiological features linked to multi-organ dysfunction, particularly in patients with sepsis or those undergoing cardiac surgery requiring cardiopulmonary bypass. Experimental and clinical studies support the notion that the alpha -adrenoceptor agonists, dexmedetomidine and clonidine, mitigate sympathetic and inflammatory overactivity in sepsis and cardiac surgery requiring cardiopulmonary bypass. These effects can protect vital organs, including the cardiovascular system, kidneys and brain. We review the pharmacodynamic mechanisms by which alpha -adrenoceptor agonists might mitigate multi-organ dysfunction arising from pathophysiological conditions associated with excessive inflammatory and adrenergic stress in experimental studies. We also outline recent clinical trials that have examined the use of dexmedetomidine in critically ill patients with and without sepsis and in patients undergoing cardiac surgery.
This article is protected by copyright. All rights reserved.
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Profound bilateral deafness complicating aortic arch surgery.
Interact Cardiovasc Thorac Surg2020 Nov;():. doi: ivaa256.
Carré Fabienne, Mamelle Elisabeth, Ferrier Suzanne, Achouh Paul,
Abstract
Hearing loss is a rare complication of cardiac surgery; bilateral profound deafness has never been reported in this setting. A 45-year-old male presented with profound bilateral sudden deafness following arch surgery and frozen elephant trunk. Patient's presentation, surgery details and aetiological mechanisms are discussed.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Prognostic value of myocardial extracellular volume fraction evaluation based on cardiac magnetic resonance T1 mapping with T1 long and short in hypertrophic cardiomyopathy.
Eur Radiol2021 Jan;():. doi: 10.1007/s00330-020-07650-7.
Li Yuancheng, Liu Xiuming, Yang Fuyao, Wang Jie, Xu Yuanwei, Fang TingTing, Pu LuTong, Zhou XiaoYue, Han Yuchi, Chen Yucheng,
Abstract
OBJECTIVE:
To investigate the prognostic significance of T1 mapping using T1 long and short in hypertrophic cardiomyopathy (HCM) patients.
METHODS:
A total of 263 consecutive patients with HCM referred for cardiovascular magnetic resonance (CMR) imaging were enrolled in this study. The imaging protocol consisted of cine, late gadolinium enhancement (LGE), and T1 mapping with T1 long and short. All patients were followed up prospectively. Outcome events were divided into the primary and secondary endpoint events. Primary endpoint events included cardiac death, heart transplant, aborted sudden death, and cardiopulmonary resuscitation after syncope. The secondary endpoint event was defined as unplanned rehospitalization for heart failure.
RESULT:
The average follow-up duration was 28.3 ± 12.1 (range: 1-78) months. In all, 17 patients (7.0%) experienced a primary endpoint including 13 cardiovascular deaths, three aborted sudden deaths, and one resuscitation after syncope, and 34 patients experienced a secondary endpoint. Patients with primary endpoints showed a trend towards more extensive LGE (p < 0.001), significantly higher ECV (p < 0.001), and native T1 (p = 0.028) than those without events. In multivariate Cox regression analysis, ECV was independently associated with primary and secondary endpoints (p < 0.001 and p = 0.047, respectively). For every 3% increase, ECV portended a 1.374-fold increase risk of a primary endpoint occurring (p < 0.001). In the Kaplan-Meier survival analysis, the incidence of primary and secondary endpoint events was significantly higher in HCM with increased ECV (p < 0.001 and p = 0.009, respectively).
CONCLUSION:
In patients with HCM, ECV is a strong imaging marker for predicting adverse outcome.
KEY POINTS:
? ECV is a potent imaging index which has a strong correlation with LVEF and LVEDVI and can evaluate myocardial tissue structure and function. ? ECV and LGE can provide a prognostic value in patients with hypertrophic cardiomyopathy. ? ECV has stronger predictive effectiveness than LGE; even in the subgroup with LGE, ECV shows independent predictive significance for adverse events.
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A retrospective evaluation of the pulmonary function tests and quality of life assessment surveys of emphysema patients subject to coil treatment.
Tuberk Toraks2020 Dec;68(4):399-406. doi: 10.5578/tt.70358.
U?urlu Erhan, Çetin Nazl?, Yi?it Nilüfer, Aydo?mu? Ümit, Akbudak ?lknur Hatice, ?enol Hande, ?im?ek Fikri Selçuk, Alt?n???k Göksel,
Abstract
Introduction:
Bronchoscopic volume reduction treatments are among the important alternatives for selected emphysema patients with a dyspneic course despite optimal medical treatment. Our aim was to carry out a retrospective scan of the data for COPD patients subject to coil treatment at our center for assessing whether coil procedure has an impact on the respiratory symptom and pulmonary function tests in COPD patients.
Materials and Methods:
The data of 41 patients with severe emphysema and treated with coils between 2017-2020 were evaluated retrospectively. Cardiopulmonary rehabilitation programs were completed for all patients prior to the procedure and they were assessed with pulmonary function test (PFT), diffusing capacity for carbonmonoxide test (DLCO), body plethysmography, 6-minute walk test, ventilation/perfusion scintigraphy, St. George's Respiratory Questionnaire (SGRQ). Data acquired prior to the procedure and 3rd month control data after the procedure were recorded and SGRQ was applied via face-to-face interviews during the controls by doctors working on Pulmonary Diseases as was the case before the procedure.
Result:
SGRQ questionnaires of 32 patients were evaluated. Statistically significant changes were observed after the procedure in symptom, activity, impact score and total score which were calculated prior to the procedure. Pre and post procedure FEV1, FVC, FEV1/FVC, PEF, FEF25/75 parameters were used for the comparison made via SFT. Statistically significant changes were observed in FEV1, FVC, FEF25/75 when the pre and post-procedure SFT parameters of the 32 patients included in the study were compared.
Conclusions:
A statistically significant improvement was observed in the PFT parameters and quality of life questionnaires following the coil procedure which is a bronchoscopic volume reduction procedure.
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Perfusion strategy using axillary or femoral cannulation for minimally invasive cardiac surgery: experience in 270 patients with computed tomography-based criteria.
Eur J Cardiothorac Surg2021 Jan;():. doi: ezaa469.
Nakamura Yoshitsugu, Nishijima Shuhei, Kuroda Miho, Nakayama Taisuke, Tsuruta Ryo, Yoshiyama Daiki, Yasumoto Yuto, Ito Yujiro,
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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High-sensitivity troponin I for risk stratification in normotensive pulmonary embolism.
ERJ Open Res2020 Oct;6(4):. doi: 00625-2020.
Ebner Matthias, Guddat Niklas, Keller Karsten, Merten Marie Christine, Lerchbaumer Markus H, Hasenfuß Gerd, Konstantinides Stavros V, Lankeit Mareike,
Abstract
While numerous studies have confirmed the prognostic role of high-sensitivity troponin T (hsTnT) in pulmonary embolism (PE), high-sensitivity troponin I (hsTnI) is inappropriately studied. This study aimed to investigate the prognostic relevance of hsTnI in normotensive PE, establish the optimal cut-off value for risk stratification and to compare the prognostic performances of hsTnI and hsTnT. Based on data from 459 consecutive PE patients enrolled in a single-centre registry, receiver operating characteristic analysis was used to identify an optimal hsTnI cut-off value for prediction of in-hospital adverse outcomes (PE-related death, cardiopulmonary resuscitation or vasopressor treatment) and all-cause mortality. Patients who suffered an in-hospital adverse outcome (4.8%) had higher hsTnI concentrations compared with those with a favourable clinical course (57 (interquartile range (IQR) 22-197) 15 (IQR 10-86) pg·mL, p=0.03). A hsTnI cut-off value of 16?ng·mL provided optimal prognostic performance and predicted in-hospital adverse outcomes (OR 6.5, 95% CI 1.9-22.4) and all-cause mortality (OR 3.7, 95% CI 1.0-13.3). Between female and male patients, no relevant differences in hsTnI concentrations (17 (IQR 10-97) 17 (IQR 10-92) pg·mL, p=0.79) or optimised cut-off values were observed. Risk stratification according to the 2019 European Society of Cardiology algorithm revealed no differences if calculated based on either hsTnI or hsTnT (p=0.68). Our findings confirm the prognostic role of hsTnI in normotensive PE. HsTnI concentrations >16?pg·mL predicted in-hospital adverse outcome and all-cause mortality; sex-specific cut-off values do not seem necessary. Importantly, our results suggest that hsTnI and hsTnT can be used interchangeably for risk stratification.
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The risks of applying normative values in paediatric cardiopulmonary exercise testing: a case report.
ERJ Open Res2020 Oct;6(4):. doi: 00333-2020.
Waterfall Jessica L, Burns Paul, Shackell Dawn, Pepke-Zaba Joanna, Oates Katrina E, Sylvester Karl P,
Abstract
https://bit.ly/36WgOSO.
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Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients.
ERJ Open Res2020 Oct;6(4):. doi: 00589-2020.
Shiraishi Masashi, Higashimoto Yuji, Sugiya Ryuji, Mizusawa Hiroki, Takeda Yu, Fujita Shuhei, Nishiyama Osamu, Kudo Shintarou, Kimura Tamotsu, Chiba Yasutaka, Fukuda Kanji, Tohda Yuji,
Abstract
Background:
Although the pathophysiological mechanisms involved in the development of dyspnoea and poor exercise tolerance in patients with COPD are complex, dynamic lung hyperinflation (DLH) plays a central role. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. The objective of this study was to evaluate the effect of diaphragmatic excursions as assessed by US on exercise tolerance and DLH in patients with COPD.
Methods:
Patients with COPD (n=20) and age-matched control subjects (n=20) underwent US, which was used to determine the maximum level of diaphragmatic excursion (DE). Ventilation parameters, including the change in inspiratory capacity (?IC), were measured in the subjects during cardiopulmonary exercise testing (CPET). We examined the correlations between DE and the ventilation parameters.
Results:
The DE of patients with COPD was significantly lower than that of the controls (45.0±12.8?mm 64.6±6.3?mm, respectively; p<0.01). The perception of peak dyspnoea (Borg scale) was significantly negatively correlated with DE in patients with COPD. During CPET, oxygen uptake/weight (' /) and minute ventilation (') were significantly positively correlated with DE, while '/' and '/carbon dioxide output (' ) were significantly negatively correlated with DE in patients with COPD. DE was also significantly positively correlated with ?IC, reflecting DLH, and with ' /, reflecting exercise capacity.
Conclusion:
Reduced mobility of the diaphragm was related to decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patients.
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