ROLE OF OSCILLATORY BREATHING DURING CARDIOPULMONARY EXERCISE TEST FOR PROGNOSTIC STRATIFICATION OF ELDERLY PATIENTS WITH CHRONIC HEART FAILURE

We sought to determine the prognostic role of EOB compared with other ventilatory parameters in risk stratification of elderly CHF patients capable to perform a maximal exercise test

A case for assessment of oscillatory breathing during cardiopulmonary exercise test in risk stratification of elderly patients with chronic heart failure

The prognostic value of exercise oscillatory breathing (EOB) during cardiopulmonary test (CPX) has been described in young chronic heart failure (HF) patients. We assessed the prognostic role of EOB vs other clinical and ventilatory parameters in elderly HF patients performing a maximal CPX. Methods and results: We prospectively followed-up 370 HF outpatients >= 65 years after a symptom limited CPX. We tested the predictive value of clinical and ventilatory parameters for all-cause mortality and a composite of all-cause mortality and HF hospitalizations. Median age was 74 years, 51% had ischemic heart disease, 25% NYHA class III; ejection fraction was 41% [34-50]. Peak oxygen consumption (PVO2) was 11.9 [9.9-14] mL/kg/min, the slope of the regression line relating ventilation to CO2 output, (VE/VCO2 slope) was 33.9 [29.8-39.2]. EOB was found in 58% of patients. At follow-up, 84 patients died and overall 158, using a time-to-first event approach, met the composite end-point. Independent predictors of all-cause mortality were CPX EOB and the ratio of VE/VCO2 slope to peak VO2, hemoglobin, creatinine and body mass index. The area under the ROC curve (AUC) of the Cox multivariable model was 0.80 (95% CI 0.73 to 0.87). Independent predictors of the composite end-point were EOB, VE/VCO2 slope, hemoglobin and HF admissions in the previous year (Model AUC 0.75) (95% CI 0.69 to 0.81). Conclusions: Among elderly HF patients, EOB prevalence is higher than middle-aged cohorts. EOB and the ratio of VE/VCO2 slope to peak VO2 resulted the strongest ventilatory predictor of all-cause mortality, independent of ventricular function

[Winging effect in interatrial defect after transseptal mitral valvuloplasty: an anatomical study].

In the balloon catheters the redundancy of the deflated balloon produces 2 or 3 sort of thin wings. The presence of wings can reduce the catheter "pushability" or, in certain conditions, can determine tissue lesion (winging effect). Simulating a transeptal valvuloplasty of the mitral valve by technique of the 2 balloon in human fresh heart, we studied the winging effect over the interatrial septum in 12 hearts; in the first 6 the atrial septum was dilated with a 6 mm balloon (Group A), in the second 6 the atrial septum was dilated with a 10 mm balloon (Group B). The procedure was completed introducing consecutively 2 bigger balloons (15 + 20 mm). We suppose that the winging effect of the 2 bigger balloons (15 + 20 mm) could counter balance the theoretical advantage of a small balloon (6 mm). The atrial septal defect (ASD) after septal dilatation was 5.0 +/- 0.59 mm x 1.56 +/- 0.25 mm (long axis x short axis) in Group A and 6.53 +/- 0.35 x 2.16 +/- 0.39 mm in Group B (p less than 0.01). The final ASD (after introducing the 2 bigger balloons) was 7.04 +/- 1.06 x 2.36 +/- 0.57 mm in Group A and 7.03 +/- 0.18 x 2.16 +/- 0.32 mm in Group B (NS). Our data show that the winging effect can determine biological negative effects

[Effects of slow-release isosorbide-5-mononitrate on ergometric parameters and cardiac output in stable effort angina pectoris: a double-blind randomized placebo study]

Abstract The effects of a single oral dose of 60 mg of sustained release (R) isosorbide-5-mononitrate (ISM) administered in 9 male patients (mean age: 53 +/- 7 years) with stable exercise-induced angina pectoris were studied in a randomized, double blind, cross-over study. The effectiveness of the drug was evaluated by concomitant ergometer exercise stress test and cardiac output determination (bioimpedance method, Bomed Med-Ltd) performed 1 hour before and 1, 4, 10 and 24 hours after acute administration of placebo (P) and ISM-R. After P, all patients showed a positive exercise test, whereas 3 patients during ISM-R treatment had a negative exercise stress test 1 and 4 hours after ISM-R administration. Compared with P, ISM-R produced a statistically significant improvement of exercise stress test parameters at peak exercise (maximum work load, heart rate, systolic and diastolic blood pressures and double product) up to 10 hours after drug administration. On the other hand, cardiac output did not significantly differ at any time after ISM-R compared with both control conditions and P treatment. Moreover, no side effect was detected in any patient during the study. In conclusion, a single oral dose of 60 mg of sustained-release ISM-R seems to be an effective drug in the treatment of effort angina, its effectiveness lasting more than 10 hours without side effects

[Effects of slow-release isosorbide-5-mononitrate on ergometric parameters and cardiac output in stable effort angina pectoris: a double-blind randomized placebo study]

Abstract The effects of a single oral dose of 60 mg of sustained release (R) isosorbide-5-mononitrate (ISM) administered in 9 male patients (mean age: 53 +/- 7 years) with stable exercise-induced angina pectoris were studied in a randomized, double blind, cross-over study. The effectiveness of the drug was evaluated by concomitant ergometer exercise stress test and cardiac output determination (bioimpedance method, Bomed Med-Ltd) performed 1 hour before and 1, 4, 10 and 24 hours after acute administration of placebo (P) and ISM-R. After P, all patients showed a positive exercise test, whereas 3 patients during ISM-R treatment had a negative exercise stress test 1 and 4 hours after ISM-R administration. Compared with P, ISM-R produced a statistically significant improvement of exercise stress test parameters at peak exercise (maximum work load, heart rate, systolic and diastolic blood pressures and double product) up to 10 hours after drug administration. On the other hand, cardiac output did not significantly differ at any time after ISM-R compared with both control conditions and P treatment. Moreover, no side effect was detected in any patient during the study. In conclusion, a single oral dose of 60 mg of sustained-release ISM-R seems to be an effective drug in the treatment of effort angina, its effectiveness lasting more than 10 hours without side effects

Evaluation of neutrophil CD64 expression and procalcitonin as useful markers in early diagnosis of sepsis

Quantitation of neutrophil CD64 expression and procalcitonin (PCT) levels in blood samples have been recently proposed as useful tools for early detection of sepsis. To determine the usefulness of these tests, we analyzed blood samples of 112 patients, admitted to an intensive care unit (ICU), presenting clinical symptoms of sepsis, as well as of 50 healthy controls. At the end of the study, a retrospective analysis showed that only 52 of the 112 ICU-patients presented a real sepsis (positive blood culture). The results obtained indicated that of the 52 patients with sepsis, 50 and 49 presented levels of neutrophil CD64 expression >= 2398 molecules per cell (cut-off determined by receiver operator characteristic analysis) and PCT levels > 0.5 ng/ml (cut-off suggested by the manufacturer), respectively. However, the neutrophil CD64 test showed higher specificity in detecting sepsis since 5 out of the 60 ICU-patients without sepsis (negative blood culture), presented CD64 expression levels >= 2398 molecules per cell, PCT levels >= 0.5 ng/ml were shown in 27 patients. Moreover, while none of the 50 healthy controls presented a neutrophil CD64 level higher than the cut-off value, 5 patients presented PCT levels >= 0.5 ng/ml. In conclusion, our data seem to indicate that the quantitation of CD64 expression could be taken into consideration as a sensitive and specific test for early diagnosis of sepsis

Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation

BACKGROUND: Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO2AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. DESIGN: We tested the prognostic role of VO2AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. METHODS: Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). RESULTS: The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p = 0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO2) showed a prognostic capacity (C-index) similar to that obtained including VO2AT (0.76 vs 0.72). Also, left ventricular ejection fraction, ventilation vs carbon dioxide production slope, β-blocker and digoxin therapy proved to be significant prognostic indexes. The receiver-operating characteristic (ROC) curves analysis showed that the best predictive VO2AT cut-off for the SR group was 11.7 ml/kg/min, while it was 12.8 ml/kg/min for the AF group. CONCLUSIONS: VO2AT, a submaximal CPET-derived parameter, is reliable for long-term cardiovascular mortality prognostication in stable systolic HF. However, different VO2AT cut-off values between SR and AF HF patients should be adopted.BACKGROUND: Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO2AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. DESIGN: We tested the prognostic role of VO2AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. METHODS: Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). RESULTS: The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p = 0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO2) showed a prognostic capacity (C-index) similar to that obtained including VO2AT (0.76 vs 0.72). Also, left ventricular ejection fraction, ventilation vs carbon dioxide production slope, β-blocker and digoxin therapy proved to be significant prognostic indexes. The receiver-operating characteristic (ROC) curves analysis showed that the best predictive VO2AT cut-off for the SR group was 11.7 ml/kg/min, while it was 12.8 ml/kg/min for the AF group. CONCLUSIONS: VO2AT, a submaximal CPET-derived parameter, is reliable for long-term cardiovascular mortality prognostication in stable systolic HF. However, different VO2AT cut-off values between SR and AF HF patients should be adopte