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Pubblicazioni recenti - cardiorespiratory
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Do fit kids have fit parents?
Health Rep2021 Jan;32(1):3-12. doi: 10.25318/82-003-x202100100001-eng.
Colley Rachel C, Clarke Janine, Doyon Caroline Y, Janssen Ian, Lang Justin J, Timmons Brian W, Tremblay Mark S,
Abstract
BACKGROUND:
Physical fitness is an important indicator of current and future health status. This analysis examines the relationships among child-parent dyads in physical fitness measures.
DATA AND METHODS:
The analysis is based on biological child-parent dyads from three cycles of the Canadian Health Measures Survey (Cycle 1: 2007 to 2009, Cycle 2: 2009 to 2011, and Cycle 5: 2016 to 2017). Physical fitness components-cardiorespiratory (CRF) (n = 615), muscular strength (n = 1,319) and flexibility (n = 1,295)-were measured at mobile examination centres using standardized fitness tests. Descriptive, correlation and regression analyses were used to examine relationships among child-parent dyads.
RESULTS:
CRF (R = 0.12), muscular strength (R = 0.23) and flexibility (R = 0.22) measures were weakly correlated among child-parent dyads. Modest increases in the physical fitness levels of children were observed with increases in the fitness rating scores of their parents. According to unadjusted and adjusted regression models, CRF (p< 0.05), muscular strength (p< 0.001) and flexibility (p< 0.001) were positively associated among child-parent dyads. When examined by sex of parent and child, CRF was significantly associated in mother-son dyads only, grip strength was associated in all dyad types except father-son pairings, and flexibility was associated in mother-son and father-son pairings only.
DISCUSSION:
A significant and positive association was evident in measured physical fitness among parents and children. Some variation in the presence and strength of associations existed according to child and parent sex.
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Imaging coronary plaques using 3D motion-compensated [F]NaF PET/MR.
Eur J Nucl Med Mol Imaging2021 Jan;():. doi: 10.1007/s00259-020-05180-4.
Mayer Johannes, Wurster Thomas-Heinrich, Schaeffter Tobias, Landmesser Ulf, Morguet Andreas, Bigalke Boris, Hamm Bernd, Brenner Winfried, Makowski Marcus R, Kolbitsch Christoph,
Abstract
BACKGROUND:
Cardiac PET has recently found novel applications in coronary atherosclerosis imaging using [F]NaF as a radiotracer, highlighting vulnerable plaques. However, the resulting uptakes are relatively small, and cardiac motion and respiration-induced movement of the heart can impair the reconstructed images due to motion blurring and attenuation correction mismatches. This study aimed to apply an MR-based motion compensation framework to [F]NaF data yielding high-resolution motion-compensated PET and MR images.
METHODS:
Free-breathing 3-dimensional Dixon MR data were acquired, retrospectively binned into multiple respiratory and cardiac motion states, and split into fat and water fraction using a model-based reconstruction framework. From the dynamic MR reconstructions, both a non-rigid cardiorespiratory motion model and a motion-resolved attenuation map were generated and applied to the PET data to improve image quality. The approach was tested in 10 patients and focal tracer hotspots were evaluated concerning their target-to-background ratio, contrast-to-background ratio, and their diameter.
RESULTS:
MR-based motion models were successfully applied to compensate for physiological motion in both PET and MR. Target-to-background ratios of identified plaques improved by 7 ± 7%, contrast-to-background ratios by 26 ± 38%, and the plaque diameter decreased by -22 ± 18%. MR-based dynamic attenuation correction strongly reduced attenuation correction artefacts and was not affected by stent-related signal voids in the underlying MR reconstructions.
CONCLUSIONS:
The MR-based motion correction framework presented here can improve the target-to-background, contrast-to-background, and width of focal tracer hotspots in the coronary system. The dynamic attenuation correction could effectively mitigate the risk of attenuation correction artefacts in the coronaries at the lung-soft tissue boundary. In combination, this could enable a more reproducible and reliable plaque localisation.
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An integrative review of physical activity in adults with inflammatory bowel disease.
Intest Res2021 Jan;():. doi: 10.5217/ir.2020.00049.
Davis Suja P, Crane Patricia B, Bolin Linda P, Johnson Lee Ann,
Abstract
Adults with inflammatory bowel disease (IBD) search for self-management strategies to manage their symptoms and improve their quality of life (QOL). Physical activity (PA) is one of the self-management strategies widely adopted by adults with IBD. This integrative review aimed to synthesize the evidence on health outcomes of PA in adults with IBD as well as to identify the barriers to engaging in PA. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), published literature was searched to identify the articles that addressed PA in adults with IBD. Twenty-eight articles met the inclusion criteria. Many of the reviewed studies used the terms of PA and exercise interchangeably. Walking was the most common PA reported in the studies. The findings from the majority of the reviewed studies supported the benefits of moderate-intensity exercise/PA among adults with IBD. The reviewed studies noted the following positive health outcomes of PA: improvement in QOL, mental health, sleep quality, gastrointestinal symptoms, fatigue and cardiorespiratory fitness. More importantly, participation in PA reduced the risk for development of IBD and the risk for future active disease. The findings from the reviewed studies highlighted the following barriers to engage in PA: fatigue, joint pain, abdominal pain, bowel urgency, active disease and depression.
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Prevalence of Thrombotic Complications in ICU-Treated Patients With Coronavirus Disease 2019 Detected With Systematic CT Scanning.
Crit Care Med2021 Jan;():. doi: 10.1097/CCM.0000000000004890.
Mirsadraee Saeed, Gorog Diana A, Mahon Ciara F, Rawal Bhavin, Semple Thomas R, Nicol Edward D, Arachchillage Deepa R J, Devaraj Anand, Price Susanna, Desai Sujal R, Ridge Carole A, Singh Suveer, Padley Simon P G,
Abstract
OBJECTIVES:
Severe coronavirus disease 2019 is associated with an extensive pneumonitis and frequent coagulopathy. We sought the true prevalence of thrombotic complications in critically ill patients with severe coronavirus disease 2019 on the ICU, with or without extracorporeal membrane oxygenation.
DESIGN:
We undertook a single-center, retrospective analysis of 72 critically ill patients with coronavirus disease 2019-associated acute respiratory distress syndrome admitted to ICU. CT angiography of the thorax, abdomen, and pelvis were performed at admission as per routine institution protocols, with further imaging as clinically indicated. The prevalence of thrombotic complications and the relationship with coagulation parameters, other biomarkers, and survival were evaluated.
SETTING:
Coronavirus disease 2019 ICUs at a specialist cardiorespiratory center.
PATIENTS:
Seventy-two consecutive patients with coronavirus disease 2019 admitted to ICU during the study period (March 19, 2020, to June 23, 2020).
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
All but one patient received thromboprophylaxis or therapeutic anticoagulation. Among 72 patients (male:female = 74%; mean age: 52 ± 10; 35 on extracorporeal membrane oxygenation), there were 54 thrombotic complications in 42 patients (58%), comprising 34 pulmonary arterial (47%), 15 peripheral venous (21%), and five (7%) systemic arterial thromboses/end-organ embolic complications. In those with pulmonary arterial thromboses, 93% were identified incidentally on first screening CT with only 7% suspected clinically. Biomarkers of coagulation (e.g., D-dimer, fibrinogen level, and activated partial thromboplastin time) or inflammation (WBC count, C-reactive protein) did not discriminate between patients with or without thrombotic complications. Fifty-one patients (76%) survived to discharge; 17 (24%) patients died. Mortality was significantly greater in patients with detectable thrombus (33% vs 10%; p = 0.022).
CONCLUSIONS:
There is a high prevalence of thrombotic complications, mainly pulmonary, among coronavirus disease 2019 patients admitted to ICU, despite anticoagulation. Detection of thrombus was usually incidental, not predicted by coagulation or inflammatory biomarkers, and associated with increased risk of death. Systematic CT imaging at admission should be considered in all coronavirus disease 2019 patients requiring ICU.
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Precision in Cardiovascular Care Using Targeted Neonatal Echocardiography in Lethal Neonatal Disseminated Herpes Infection: A Case Series.
Pediatr Infect Dis J2021 Jan;():. doi: 10.1097/INF.0000000000003071.
Bhattacharya Soume, McNamara Patrick J, Giesinger Regan E,
Abstract
Neonates with disseminated neonatal herpes simplex virus infection often present with cardiorespiratory failure. The pathophysiological contributors to the disease phenotype, biologic mechanisms underlying the hemodynamic instability and optimal approach to cardiovascular treatment have not been well described. We describe clinical and echocardiography features of cardiovascular dysfunction, in a case series of neonates with disseminated herpes simplex virus, and response to physiology-based hemodynamic management. The biologic phenotype includes low systemic vascular resistance state, hypovolemia secondary to third space losses, myocardial dysfunction and pulmonary hypertension. Early targeted neonatal echocardiography provided hemodynamic insights on blood flow, shunt characterization, vascular resistance and cardiac function, that were difficult to gauge clinically (eg, differentiating parenchymal from pulmonary vascular disease) thereby positively impacted clinical care. All patients were stabilized hemodynamically without utilizing extracorporeal membrane oxygenation, although all patients died of multiorgan failure.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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The V?E/V?CO2 Slope During Maximal Treadmill Cardiopulmonary Exercise Testing: REFERENCE STANDARDS FROM FRIEND (FITNESS REGISTRY AND THE IMPORTANCE OF EXERCISE: A NATIONAL DATABASE).
J Cardiopulm Rehabil Prev2021 Jan;():. doi: 10.1097/HCR.0000000000000566.
Arena Ross, Myers Jonathan, Harber Mathew, Phillips Shane A, Severin Richard, Ozemek Cemal, Peterman James E, Kaminsky Leonard A,
Abstract
PURPOSE:
Cardiopulmonary exercise testing (CPX) is the gold standard approach for the assessment of cardiorespiratory fitness (CRF). The primary aim of the current study was to determine reference standards for the minute ventilation/carbon dioxide production (V?E/V?CO2) slope in a cohort from the "Fitness Registry and the Importance of Exercise: A National Database" (FRIEND) Registry.
METHODS:
The current analysis included 2512 tests from 10 CPX laboratories in the United States. Inclusion criteria included CPX data on apparently healthy men and women: (1) age ?20 yr; and (2) with a symptom-limited exercise test performed on a treadmill. Ventilation and V?CO2 data, from the initiation of exercise to peak, were used to calculate the V?E/V?CO2 slope via least-squares linear regression. Reference values were determined for men and women by decade of life.
RESULTS:
On average, V?E/V?CO2 slope values were lower in men and increased with age independent of sex. Fiftieth percentile values increased from 27.1 in the second decade to 33.9 in the eighth decade in men and from 28.5 in the second decade to 33.7 in the eighth decade in women. In the overall group, correlations with baseline characteristics and the V?E/V?CO2 slope were statistically significant (P < .05) although generally weak, particularly for age and body mass index.
CONCLUSION:
The results of the current study establish reference values for the V?E/V?CO2 slope when treadmill testing is performed, and all exercise data are used for the slope calculation. These results may prove useful in enhancing the interpretation of CPX results when assessing CRF.
Copyright © Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Contralateral Muscle Imbalances and Physiological Profile of Recreational Aerial Athletes.
J Funct Morphol Kinesiol2019 Jul;4(3):. doi: E49.
Ruggieri Rachel M, Costa Pablo B,
Abstract
BACKGROUND:
Aerial fitness is quickly gaining popularity; however, little is known regarding the physiological demands of aerial athletes. The purpose of the study was to examine contralateral muscle imbalances, compare dominant versus non-dominant hamstrings-to-quadriceps (H:Q) ratios, and to establish a physiological profile of recreational aerial athletes.
METHODS:
Thirteen aerialist women visited a local aerial studio to participate in a data collection session to examine isometric levels of upper and lower body strength, muscle endurance, flexibility, balance, and cardiovascular fitness.
RESULTS:
No significant differences were found between dominant and non-dominant hand grip strength ( = 0.077), dominant and non-dominant isometric knee flexion ( = 0.483), dominant and non-dominant isometric knee extension ( = 0.152), or dominant and non-dominant isometric H:Q ratios ( = 0.102). In addition, no significant difference was found between isometric dominant H:Q ratio and the widely-used value of 0.60 ( = 0.139). However, isometric non-dominant H:Q ratio was significantly lower than the 0.60 criterion ( = 0.004). Aerial athletes demonstrated to have excellent flexibility, balance, cardiorespiratory fitness, and average strength.
CONCLUSIONS:
Aerial fitness may be another recreational activity that could be used to maintain higher levels of flexibility, balance, cardiorespiratory fitness, and strength. Aerialists may want to consider focusing on strengthening the lower body and balancing the hamstrings and quadriceps muscle strength.
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Validation of Cardiorespiratory Fitness Measurements in Adolescents.
J Funct Morphol Kinesiol2019 Jul;4(3):. doi: E44.
Migliano Pedro, Kabiri Laura S, Cross Megan, Butcher Allison, Frugé Amy, Brewer Wayne, Ortiz Alexis,
Abstract
Cardiorespiratory fitness (CRF) is an important indicator of adolescent cardiovascular well-being and future cardiometabolic health but not always feasible to measure. The purpose of this study was to estimate the concurrent validity of the non-exercise test (NET) for adolescents against the Progressive Aerobic Capacity Endurance Run (PACER) and direct measures of VO as well as to examine the concurrent validity of the PACER with a portable metabolic system (K4b). Forty-six adolescents (12-17 years) completed the NET prior to performing the PACER while wearing the K4b. The obtained VO values were compared using linear regression, intra-class correlation (ICC), and Bland-Altman plots, and ? was set at 0.05. The VO acquired directly from the K4b was significantly correlated to the VO indirectly estimated from the NET ( = 0.73, < 0.001, = 0.53, ICC = 0.67). PACER results were significantly related to the VO estimates from the NET ( = 0.81, < 0.001, = 0.65, ICC = 0.72). Direct measures from the K4b were significantly correlated to the VO estimates from the PACER ( = 0.87, < 0.001, = 0.75, ICC = 0.93). The NET is a valid measure of CRF in adolescents and can be used when an exercise test is not feasible.
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Organized Sports and Physical Activities as Sole Influencers of Fitness: The Homeschool Population.
J Funct Morphol Kinesiol2019 Jan;4(1):. doi: E13.
Kabiri Laura S, Rodriguez Augusto X, Perkins-Ball Amanda M, Diep Cassandra S,
Abstract
Homeschool children may rely solely on organized sports and physical activities to achieve recommended levels of physical activity and fitness. The purpose of this study was to investigate differences in fitness levels between homeschool children who did, and did not, participate in organized sports or physical activities, and then examine relationships between hours per week in sports or physical activities and cardiorespiratory fitness as measured by portions of the FitnessGram test battery. Organized sports/physical activity participation information was gathered on 100 children ages 10-17 years who completed tests of upper, abdominal, and cardiorespiratory fitness. The current investigation revealed that participation alone was not associated with higher levels of physical fitness as assessed by the 90° push-up test or curl-up test nor was time in participation related to cardiorespiratory fitness as assessed by the Progressive Aerobic Capacity Endurance Run (PACER). These activities alone may be insufficient for meeting physical activity recommendations and improving physical fitness. Therefore, children and adolescents educated at home may need additional opportunities to participate in unstructured daily physical activity.
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School-Based Intervention on Cardiorespiratory Fitness in Brazilian Students: A Nonrandomized Controlled Trial.
J Funct Morphol Kinesiol2019 Jan;4(1):. doi: E10.
Minatto Giseli, Petroski Edio Luiz, Silva Kelly Samara da, Duncan Michael J,
Abstract
BACKGROUND:
In response to the worldwide increasing prevalence of low cardiorespiratory fitness (CRF), several interventions have been developed. The aim of this study was to examine the effect of a school-based intervention on CRF in Brazilian students.
METHODS:
A nonrandomised controlled design tested 432 students (intervention group: = 247) from 6th to 9th grade recruited from two public secondary schools in Florianopolis, in 2015. The intervention entitled "" (move yourself), applied over 13 weeks, included four components: (1) increases in physical activity during Physical Education classes; (2) active recess; (3) educational sessions; and (4) educational materials. CRF (20-m shuttle run test) was the primary outcome.
RESULTS:
The effect size of the intervention on CRF was 0.15 (CI 95% = -0.04; 0.34). In the within-group comparisons, VO2max decreased significantly from baseline to follow-up in the control group but remained constant in the intervention group. After adjustment variables, differences between intervention and control group were not statistically significant ( > 0.05).
CONCLUSION:
The "" intervention did not have an effect on adolescents' CRF. However, maintenance of VO2max in intervention group and a reduction within control group demonstrates that this intervention may be beneficial for long-term CRF and, possibly, the increased intervention time could result in a better effect.
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Fatigability and Cardiorespiratory Impairments in Parkinson's Disease: Potential Non-Motor Barriers to Activity Performance.
J Funct Morphol Kinesiol2020 Oct;5(4):. doi: E78.
Pechstein Andrew E, Gollie Jared M, Guccione Andrew A,
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative condition after Alzheimer's disease, affecting an estimated 160 per 100,000 people 65 years of age or older. Fatigue is a debilitating non-motor symptom frequently reported in PD, often manifesting prior to disease diagnosis, persisting over time, and negatively affecting quality of life. Fatigability, on the other hand, is distinct from fatigue and describes the magnitude or rate of change over time in the performance of activity (i.e., performance fatigability) and sensations regulating the integrity of the performer (i.e., perceived fatigability). While fatigability has been relatively understudied in PD as compared to fatigue, it has been hypothesized that the presence of elevated levels of fatigability in PD results from the interactions of homeostatic, psychological, and central factors. Evidence from exercise studies supports the premise that greater disturbances in metabolic homeostasis may underly elevated levels of fatigability in people with PD when engaging in physical activity. Cardiorespiratory impairments constraining oxygen delivery and utilization may contribute to the metabolic alterations and excessive fatigability experienced in individuals with PD. Cardiorespiratory fitness is often reduced in people with PD, likely due to the combined effects of biological aging and impairments specific to the disease. Decreases in oxygen delivery (e.g., reduced cardiac output and impaired blood pressure responses) and oxygen utilization (e.g., reduced skeletal muscle oxidative capacity) compromise skeletal muscle respiration, forcing increased reliance on anaerobic metabolism. Thus, the assessment of fatigability in people with PD may provide valuable information regarding the functional status of people with PD not obtained with measures of fatigue. Moreover, interventions that target cardiorespiratory fitness may improve fatigability, movement performance, and health outcomes in this patient population.
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Testing the Motor Competence and Health-Related Variable Conceptual Model: A Path Analysis.
J Funct Morphol Kinesiol2018 Nov;3(4):. doi: E61.
Burns Ryan Donald, Fu You,
Abstract
The purpose of this study was to empirically test a comprehensive conceptual model linking gross motor skills, school day physical activity and health-related variables in a sample of sixth graders. Participants were a convenience sample of 84 sixth grade students (Mean age = 11.6 ± 0.6 years). Gross motor skills were assessed using the Test of Gross Motor Development-3rd Edition (TGMD-3), school day physical activity was assessed using pedometers, health-related fitness was assessed using Progressive Aerobic Cardiovascular Endurance Run (PACER) laps, perceived competence assessed using a validated questionnaire and the health-related outcome was assessed using Body Mass Index (BMI). The relationship between school day step counts and TGMD-3 scores was mediated through both perceived competence and PACER laps ( = 0.015) and the direct path coefficient between TGMD-3 scores and BMI was statistically significant ( = -0.22 kg/m, < 0.001). Overall there was good model fit with all indices meeting acceptable criteria ( = 3.7, = 0.293; Root Mean Square Error of Approximation (RMSEA) = 0.062, 90% Confidence Interval (C.I.): 0.00-0.23; Comparative Fit Index (CFI) = 0.98; Tucker-Lewis Index (TLI) = 0.96; Standardized Root Mean Square Residual (SRMR) = 0.052). The comprehensive conceptual model explaining the inter-relationships among motor competence and health-related variables was empirically validated with the relationship between physical activity and gross motor skills mediated through both perceived competence and cardiorespiratory endurance in a sample of sixth graders.
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The "Hub and Spoke" (HandS) ECMO for "Resuscitating" Neonates with Respiratory Life-Threatening Conditions.
Children (Basel)2021 Jan;8(1):. doi: E24.
Padalino Massimo A, Doglioni Nicoletta, Nardo Daniel, Baraldi Eugenio, Vida Vladimiro L, Trevisanuto Daniele,
Abstract
BACKGROUND:
Extracorporeal membrane oxygenation (ECMO) implantation for neonates with severe cardiorespiratory life-threatening conditions is highly effective. However, since ECMO is a high-risk and complex therapy, this treatment is usually performed in centers with proven expertise.
METHODS:
A retrospective review of neonates, from January 2014 to January 2020, presenting with life-threatening conditions and treated by means of Hub and Spoke (HandS) ECMO in peripheral (spoke) hospitals. Data were retrieved from our internal ECMO registry. Protocols and checklists were revised and shared with all spoke hospitals located in North-Eastern Italy.
RESULTS:
Eleven neonates receiving maximal respiratory and cardiovascular support at a spoke hospital underwent HandS ECMO management. All but three patients were affected by life-threatening meconium aspiration syndrome (MAS). The median ECMO support duration and hospitalization were four (range 2-32) and 30 days (range 8-50), respectively. All but two patients (with congenital diaphragmatic hernia), were weaned off ECMO and discharged home. At a mean follow up of 33.7 ± 29.2 months, all survivors were alive and well, without medications, and normal somatic growth. All but one had normal neuropsychological development.
CONCLUSION:
HandS ECMO model for neonates with life-threatening conditions is effective and successful. A specialized multidisciplinary team and close cooperation between Hub and Spoke centers are essential for success.
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Cardiorespiratory arrest after iso-osmolar iodinated contrast injection: A case report of contrast-induced encephalopathy following contrast-enhanced computed-tomography.
Medicine (Baltimore)2021 Jan;100(2):e24035. doi: 10.1097/MD.0000000000024035.
Yao Li-Ding, Zhu Xiu-Liang, Yang Run-Lin, Zhang Min-Ming,
Abstract
RATIONALE:
Contrast-induced encephalopathy (CIE) is a rare complication caused by administration of intravascular contrast media and characterized by acute reversible neurological disturbance. Most of the CIE cases are reported after arterial administration of contrast media such as during cerebral or coronary angiographies, yet only a few articles have reported CIE secondary to intravenous contrast. A case of CIE secondary to intravenous contrast administration is reported here.
PATIENT CONCERNS:
A 68-year-old man was admitted to our hospital for contrast-enhanced chest computed-tomography (CT) examination due to suspected pulmonary nodules. After CT examination, the patient lost consciousness and experienced a cardiorespiratory arrest. An emergency plain brain CT was done immediately which showed abnormal cortical contrast enhancement and cerebral sulci hyperdensity.
DIAGNOSES:
After excluding other differential diagnoses such as electrolytes imbalance, hypo/hyperglycemia, cardiogenic pathologies and other neurological emergencies such as cerebral hemorrhage, cerebral infarction, the final diagnosis of CIE was made.
INTERVENTIONS:
The patient was admitted to the intensive care unit for further management. A series of supportive treatments were arranged.
OUTCOMES:
Follow-up visits at the outpatient clinic showed no lasting neurological deficits.
LESSONS:
CIE should be considered as 1 of the differential diagnoses for a patient with acute neurologic symptoms after iodinate contrast administration. Neuroradiological imaging examinations are essential to rule out other etiologies such as acute cerebral infarction or intracranial hemorrhage.
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
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Assessments of Onset and Duration of Drug Effects and Pharmacokinetics by Dose Level of HSK3486, a New Sedative-Hypnotic Agent, in Healthy Female/Male Subjects: A Phase I Multiarm Randomized Controlled Clinical Trial.
Anesth Analg2021 Jan;():. doi: 10.1213/ANE.0000000000005343.
Ludbrook Guy, Li Fangqiong, Sleigh Jamie, Liang Yong,
Abstract
BACKGROUND:
Onset and duration of effects and pharmacokinetics of the novel anesthesia medication HSK3486 were examined after a single intravenous injection to evaluate its usefulness as a potential alternative to propofol.
METHODS:
Phase Ia (male-only, blinded) and Ib (female-only, open-label) trials were both prospective randomized, dose escalation trials of a single intravenous injection of HSK3486 or either placebo or propofol. The primary aim of this first-in-human trial was safety through measurements of dose-related effects on cardiorespiratory functions, the central nervous system, laboratory parameters, and reported adverse events. The secondary aims were to determine initial pharmacokinetic parameters and to establish a dose regimen for sedation and general anesthesia for subsequent later-phase clinical trials.
RESULTS:
A total of 50 healthy male subjects were enrolled in the phase Ia trial and 30 healthy female subjects in the phase Ib trial. No significant difference was found in the overall pattern of anesthetic effects between HSK3486 and propofol (all P > .05), but the sample size was not sufficiently large to make a confident assessment. Rapid onset and offset of dose-dependent sedation or general anesthesia after HSK3486 administration was found in male and female subjects with median central nervous system equilibrium half-life times of 1.3 and 1.8 minutes across cohorts in phases Ia and Ib and accompanied by mild hypotension and respiratory depression. Pharmacokinetics profiles revealed that there was no evidence that the groups were different (all P > .05), with a high clearance and distribution volume. In the phase Ia trial, the median terminal half-life (t1/2) for HSK3486 doses of 128, 192, 288, 432, 540, 648, and 810 ?g/kg were 68.8, 64.7, 207.0, 210.7, 313.5, 293.5, and 245.7 minutes, respectively. In the phase Ib trial, the median t1/2 for HSK3486 doses of 288, 432, 540, 648, and 810 ?g/kg were 68.5, 159.7, 122.7, 281.5, and 245.3 minutes, respectively. Treatment emergent adverse events (TEAEs) were reported in 50% and 53% of subjects in the phase Ia and Ib trials but were mostly related to minor events (eg, arterial catheter irritation). HSK3486 was well tolerated at dose levels up to 810 ?g/kg in all subjects compared with propofol (odds ratio in phases Ia and Ib: 0.71 and 6.00; 95% confidence interval [CI], 0.09-4.85 and 0.47-314.71, respectively; all P > .05) and placebo (odds ratio in phase Ia: 0.95; 95% CI, 0.01-78.45; P > .05).
CONCLUSIONS:
HSK3486 has potential clinical application for intravenous administration for the induction and maintenance of sedation and general anesthesia.
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society.
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Attenuated heart rate recovery is associated with higher arrhythmia recurrence and mortality following atrial fibrillation ablation.
Europace2021 Jan;():. doi: euaa419.
Donnellan Eoin, Wazni Oussama M, Chung Mina K, Elshazly Mohamed B, Chung Roy, Taigen Tyler, Niebauer Mark, Kochar Arshneel, Hussain Muzna, Patel Divyang R, Il'Giovine Zachary, Harb Serge, Cantillon Daniel J, Kanj Mohamed, Saliba Walid, Jaber Wael,
Abstract
AIMS:
Heart rate recovery (HRR), the decrease in heart rate occurring immediately after exercise, is caused by the increase in vagal activity and sympathetic withdrawal occurring after exercise and is a powerful predictor of cardiovascular events and mortality. The extent to which it impacts outcomes of atrial fibrillation (AF) ablation has not previously been studied. The aim of this study is to investigate the association between attenuated HRR and outcomes following AF ablation.
METHODS AND RESULTS:
We studied 475 patients who underwent EST within 12?months of AF ablation. Patients were categorized into normal (>12?b.p.m.) and attenuated (?12?b.p.m.) HRR groups. Our main outcomes of interest included arrhythmia recurrence and all-cause mortality. During a mean follow-up of 33?months, 43% of our study population experienced arrhythmia recurrence, 74% of those with an attenuated HRR, and 30% of those with a normal HRR (P?
CONCLUSION:
Heart rate recovery provides additional valuable prognostic information beyond CRF. An impaired HRR is associated with significantly higher rates of arrhythmia recurrence and death following AF ablation.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
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Resting Heartbeat Complexity Predicts All-Cause and Cardiorespiratory Mortality in Middle- to Older-Aged Adults From the UK Biobank.
J Am Heart Assoc2021 Jan;():e018483. doi: 10.1161/JAHA.120.018483.
Gao Lei, Gaba Arlen, Cui Longchang, Yang Hui-Wen, Saxena Richa, Scheer Frank A J L, Akeju Oluwaseun, Rutter Martin K, Lo Men-Tzung, Hu Kun, Li Peng,
Abstract
Background Spontaneous heart rate fluctuations contain rich information related to health and illness in terms of physiological complexity, an accepted indicator of plasticity and adaptability. However, it is challenging to make inferences on complexity from shorter, more practical epochs of data. Distribution entropy (DistEn) is a recently introduced complexity measure that is designed specifically for shorter duration heartbeat recordings. We hypothesized that reduced DistEn predicted increased mortality in a large population cohort. Method and Results The prognostic value of DistEn was examined in 7631 middle-older-aged UK Biobank participants who had 2-minute resting ECGs conducted (mean age, 59.5 years; 60.4% women). During a median follow-up period of 7.8 years, 451 (5.9%) participants died. In Cox proportional hazards models with adjustment for demographics, lifestyle factors, physical activity, cardiovascular risks, and comorbidities, for each 1-SD decrease in DistEn, the risk increased by 36%, 56%, and 73% for all-cause, cardiovascular, and respiratory disease-related mortality, respectively. These effect sizes were equivalent to the risk of death from being >5 years older, having been a former smoker, or having diabetes mellitus. Lower DistEn was most predictive of death in those <55 years with a prior myocardial infarction, representing an additional 56% risk for mortality compared with older participants without prior myocardial infarction. These observations remained after controlling for traditional mortality predictors, resting heart rate, and heart rate variability. Conclusions Resting heartbeat complexity from short, resting ECGs was independently associated with mortality in middle- to older-aged adults. These risks appear most pronounced in middle-aged participants with prior MI, and may uniquely contribute to mortality risk screening.
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Cardiopulmonary Function Abnormalities in Cohort of Adults following Bronchopulmonary Dysplasia as Preterm Infants.
Am J Perinatol2021 Jan;():. doi: 10.1055/s-0040-1722604.
Lasry Ariane, Kavabushi Patrick, Canakis Anne-Marie, Luu Thuy M, Nuyt Anne-Monique, Perreault Thérèse, Simoneau Jessica, Landry Jennifer, Altit Gabriel,
Abstract
OBJECTIVE:
?This study was aimed to describe the cardiopulmonary profiles of adult patients with bronchopulmonary dysplasia (BPD), comparing them to normative adult values.
STUDY DESIGN:
?This study presents a retrospective chart review of all BPD patients followed in the adult BPD clinic, identified from institutional and archive databases, born preterm at ?33 weeks estimated gestational age (EGA) between January 1980 and December 2000.
RESULTS:
?Forty-four patients with BPD (26.4?±?2.7 weeks of EGA) were included. Average age at follow-up was 19 years. Majority (61.4%) of the patients had a diagnosis of asthma. Mean spirometry values were: first second of forced expiration (FEV1) 74.1%, forced vital capacity (FVC) 80.7%, and FEV1/FVC 82.5%. Echocardiography (ECHO) images were reviewed, left ventricular (LV) structure and performance did not differ between obstructive and nonobstructive pulmonary function test (PFT) groups, but values of LV longitudinal strain were 4.8% lower than expected normal for adults. Patients with obstructive PFT had additional decreased right ventricular (RV) function by ECHO.
CONCLUSION:
?BPD patients in this study were found to have a burden of cardiorespiratory alterations that persisted into adulthood, with RV performance abnormalities found among patients with obstructive PFT.
KEY POINTS:
· BPD patients born at extremes of prematurity have cardiorespiratory alterations in adulthood.. · Among patients with obstructive lung function, subtle cardiac performance abnormalities were found.. · Future directions should include systematic follow-up of premature newborns with BPD..
Thieme. All rights reserved.
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The thermal acclimation potential of maximum heart rate and cardiac heat tolerance in Arctic char (Salvelinus alpinus), a northern cold-water specialist.
J Therm Biol2021 Jan;95():102816. doi: S0306-4565(20)30587-8.
Gilbert Matthew J H, Farrell Anthony P,
Abstract
Increasing heart rate (?) is a central, if not primary mechanism used by fishes to support their elevated tissue oxygen consumption during acute warming. Thermal acclimation can adjust this acute response to improve cardiac performance and heat tolerance under the prevailing temperatures. We predict that such acclimation will be particularly important in regions undergoing rapid environmental change such as the Arctic. Therefore, we acclimated Arctic char (Salvelinus alpinus), a high latitude, cold-adapted salmonid, to ecologically relevant temperatures (2, 6, 10, 14 and 18 °C) and examined how thermal acclimation influenced their cardiac heat tolerance by measuring the maximum heart rate (?) response to acute warming. As expected, acute warming increased ? in all Arctic char before ? reached a peak and then became arrhythmic. The peak ?, and the temperature at which peak ? (T) and that at which arrhythmia first occurred (T) all increased progressively (+33%, 49% and 35%, respectively) with acclimation temperature from 2 to 14 °C. When compared at the same test temperature ? also decreased by as much as 29% with increasing acclimation temperature, indicating significant thermal compensation. The upper temperature at which fish first lost their equilibrium (critical thermal maximum: CT) also increased with acclimation temperature, albeit to a lesser extent (+11%). Importantly, Arctic char experienced mortality after several weeks of acclimation at 18 °C and survivors did not have elevated cardiac thermal tolerance. Collectively, these findings suggest that if wild Arctic char have access to suitable temperatures (<18 °C) for a sufficient duration, warm acclimation can potentially mitigate some of the cardiorespiratory impairments previously documented during acute heat exposure.
Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.
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Cardiorespiratory fitness is not associated with fracture risk in middle-aged men.
Eur J Clin Invest2020 Dec;50(12):e13360. doi: 10.1111/eci.13360.
Kunutsor Setor K, Mäkikallio Timo H, Voutilainen Ari, Blom Ashley W, Savonen Kai, Laukkanen Jari A,
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