Ageing and endurance training effects on quantity and quality of pulmonary vascular bed in healthy men

International audienceIt has recently been demonstrated that in healthy individuals, peak oxygen consumption is associated with a greater pulmonary capillary blood volume and a more distensible pulmonary circulation. Our cross-sectional study suggests that, in healthy men aged 20 to 60 years (n = 63), endurance sport practice (vigorous-intensity domain of the International Physical Activity Questionnaire) is associated with better quantity (pulmonary capillary blood volume) and quality (slope of increase in lung diffusion for carbon monoxide on exercise) of the pulmonary vascular bed, partly counterbalancing the deleterious effects of ageing, which remains to be demonstrated in a prospective longitudinal design

Endurance-training in healthy men is associated with lesser exertional breathlessness that correlates with circulatory-muscular conditioning markers in a cross-sectional design.

International audienceWhether exertional dyspnoea can be attributed to poor circulatory-muscular conditioning is a difficult clinical issue. Because criteria of poor conditioning such as low oxygen pulse, low ventilatory threshold or high heart rate/oxygen consumption slope can be observed in heart or lung diseases and are not specific to conditioning, we assessed the relationships between physical exercise, conditioning and exertional breathlessness in healthy subjects, in whom the aforementioned criteria can confidently be interpreted as reflecting conditioning. To this end, healthy males with either low (inactive men, n = 31) or high (endurance-trained men, n = 31) physical activity evaluated using the International Physical Activity Questionnaire (IPAQ) underwent spirometry and incremental exercise testing with breathlessness assessment using Borg scale. No significant breathlessness was reported before the ventilatory threshold in the two groups. Peak breathlessness was highly variable, did not differ between the two groups, was not related to any conditioning criterion, but correlated with peak respiratory rate. Nevertheless, endurance-trained subjects reported lower breathlessness at the same ventilation levels in comparison with inactive subjects. Significant but weak associations were observed between isoventilation breathlessness and physical activity indices (Borg at 60 L/min and total IPAQ scores, rho = -0.31, p = 0.020), which were mainly attributable to the vigorous domain of physical activity, as well as with conditioning indices (Borg score at 60 L.min(-1) and peak oxygen pulse or heart rate/oxygen consumption slope, rho = -0.31, p = 0.021 and rho = 0.31, p = 0.020; respectively). In conclusion, our data support a weak relationship between exertional breathlessness and circulatory-muscular conditioning, the later being primarily related to vigorous physical activity

The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study

Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p  30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality

Get with the guidelines: management of chronic obstructive pulmonary disease in emergency departments in Europe and Australasia is sub‐optimal

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