Oxygen Kinetics and Heart Rate Response during Early Recovery from Exercise in Patients with Heart Failure

Background. The purpose of this study was to assess the post-exercise O2 uptake and heart rate response in patients with heart failure (HF) in comparison to healthy individuals. Methods and Results. Exercise testing of all subjects was conducted according to the RITE-protocol. The study subjects were classified according to their peak oxygen uptake (peak VO2) in four groups: healthy individuals with a peak VO2 >22 mL/kg/min (group 1, : 50), and patients with HF and a peak VO2 of 18–22 mL/kg/min, (group 2, : 48), 14–18 mL/kg/min (group 3, : 57), and <14 mL/kg/min (group 4, : 31). Both peak VO2 and HR declined more slowly in the patients with HF than in the normal subjects. Recovery of VO2 and HR followed monoexponential kinetics in the early post-recovery phase. This enabled the determination of a time constant for both HR and VO2 (TC VO2 and TC HR). From group 1 to 4 there was a prolongation of the time constant for VO2 and HR: TC VO2 (group 1: 110±34, group 2: 197±43, group 3: 238±80, and group 4: 278±50 sec), and TC HR (group 1: 148±82, group 2: 290±65, group 3: 320±58, and group 4: 376±55 sec). Conclusion. The rate of decline of VO2 and HR in the early post-exercise phase is inversely related to the peak VO2. The time constant for oxygen uptake (TC VO2) and heart rate (TC HR) might prove a useful parameter for more precise monitoring and grading of HF

Narrow QRS complex tachycardia with long RP-interval: what is the mechanism?

No anstrac

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all &gt;0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Rotational angiography and three-dimensional reconstruction of the left atrium as intraprocedural imaging for ablative treatment of atrial fibrillation

Die Rotationsangiographie (RTA) stellt ein neues Verfahren zur intraprozeduralen Darstellung der linken Vorhofs, Pulmonalvenen und anderer für die Vorhofflimmerablation relevanter Strukturen dar. Die Durchführung der RTA während direkter KM-injektion in den linken Vorhof und nach Adenosin- induzierter Asystolie bzw. während schneller ventrikulärer Stimulation kann mit Sicherheit durchgeführt werden und ermöglicht die Darstellung des linken Vorhofs und der Pulmonalvenen in mehreren angiographischen Projektionen. Zusätzlich, können anatomische Variationen wie gemeinsame Pulmonalvenenostien oder akzessorische Pulmonalvenen sehr genau dargestellt werden. Die daraus entstehende dreidimensionale atriale Rekonstruktion (3D-ATG) zeigt eine gute qualitative und quantitative Übereinstimmung mit der kardialen Computertomographie und kann als einzige Navigation für die Vorhofflimmerablation angewandt werden. Der entscheidende Vorteil dieses Verfahrens liegt in der Schnelligkeit der Durchführung, der geringen Strahlungsbelastung und der Möglichkeit der intraprozeduralen Darstellung aller relevanter Strukturen unmittelbar vor Beginn der Vorhofflimmerablation.Rotational angiography (RTA) is a new intraprocedural imaging modality of the left atrium, pulmonary veins and other anatomical structures that are relevant for atrial fibrillation ablation. RTA can be performed by direct injection of contrast medium in the left atrium and during either an adenosine-induced ventricular asystole or during rapid ventricular pacing. RTA is safe and enables imaging of the left atrium and pulmonary veins in multiple angiographic projections. Additionally, anatomical variations like common pulmonary veins ostia and accessory pulmonary veins can be visualized. The angiographic data set of RTA can be used for three-dimansional reconstruction of the left atrium and pulmonary veins (so called three-dimensional atriography, 3D-ATG). 3D-ATG showes a very good correlation with cardiac computed tomography both in qualitative and quantitative terms and can be used as a single navigation toll for atrial fibrillation ablation. The main advantage of 3D-ATG is the short time needed to perform it, the low radiation exposure for the patient and the ability to intraprocedurally visualize all the anatomical structures that are relevant for atrial fibrillation ablation