An inspiratory load enhances the antihypertensive effects of home-based training with slow deep breathing: a randomised trial

QuestionCan adding an inspiratory load enhance the antihypertensive effects of slow breathing training performed at home?DesignRandomised trial with concealed allocation.ParticipantsThirty patients with essential hypertension Stage I or II.InterventionExperimental groups performed slow deep breathing at home, either unloaded or breathing against a load of 20 cmH2O using a threshold-loaded breathing device. Participants trained for 30 min, twice daily for 8 weeks. A control group continued with normal activities.Outcome measuresResting blood pressure and heart rate were measured at home and in the laboratory before and after the training period.ResultsCompared to the control group, systolic and diastolic blood pressure decreased significantly with unloaded breathing by means of 7.0 mmHg (95% CI 5.5 to 8.5) and 13.5 mmHg (95% CI 11.3 to 15.7), respectively (laboratory measures). With loaded breathing, the reductions were greater at 18.8 mmHg (95% CI 16.1 to 21.5) and 8.6 mmHg (95% CI 6.8 to 10.4), respectively. The improvement in systolic blood pressure was 5.3 mmHg (95% CI 1.0 to 9.6) greater than with unloaded breathing. Heart rate declined by 8 beats/min (95% CI 6.5 to 10.3) with unloaded breathing, and 9 beats/min (95% CI 5.6 to 12.2) with loaded breathing. Very similar measures of blood pressure and heart rate were obtained by the patients at home.ConclusionHome-based training with a simple device is well tolerated by patients and produces clinically valuable reductions in blood pressure. Adding an inspiratory load of 20 cmH2O enhanced the decrease in systolic blood pressure.Trial registrationNCT007919689

Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis.

Background Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6-month mortality in IE. Methods and Results Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]-Prospective Cohort Study [PCS], 2000-2006, n=4049), a model to predict 6-month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE-PLUS, 2008-2012, n=1197). The 6-month mortality was 971 of 4049 (24.0%) in the ICE-PCS cohort and 342 of 1197 (28.6%) in the ICE-PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left-sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6-month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62-0.89). A simplified risk model was developed by weight adjustment of these variables. Conclusions Six-month mortality after IE is 25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in I

First Case of Tricuspid Valve Endocarditis Caused by Gemella bergeri

Gemella bergeri is a Gram-positive cocci species arranged in pairs and composes the normal flora of oral cavity, digestive and urinary tract. Several species of Gemella are known to cause endocarditis. Here, we report the first case in Thailand of G. bergeri endocarditis whose blood culture was negative using routine methods but was positive by PCR identification of bacteria in the affected valve. A 37-year-old male presented with prolonged fever, weight loss, and dyspnea on exertion. By transthoracic echocardiography, he was suspected of having infective endocarditis of the tricuspid valve. The patient underwent tricuspid valve repair and vegetectomy. Routine hospital blood cultures were negative but G. bergeri was identified by PCR/sequencing of the heart valve tissue

Human Endocarditis: Echocardiographic Features and Clinical Outcome

Background Human Streptococcus suis endocarditis occurs infrequently and continues to be a serious illness with high mortality. However, knowledge of the echocardiographic features and clinical outcome of this disease remains unclear. Methods One hundred and fourteen patients were identified in a prospective study, and hospitalized at Queen Sirikit Heart Center and Srinagarind Hospital, Khon Kaen University. Echocardiography was routinely performed in all patients. Results Between January 2010 and December 2011, three cases of S. suis endocarditis were diagnosed. All cases were male and aged 27-53 years. The most common risk factor for contracting S. suis infection was eating undercooked pork. Three patients presented with congestive heart failure. Transthoracic echocardiography demonstrated large, highly mobile vegetations and severe valvular damage. Aortic valve involvement was documented in two patients, and mitral valve involvement in one. One patient presented with embolic stroke and one with arterial occlusion. All patients underwent urgent valve replacement with a good clinical outcome. Conclusion The echocardiographic features of S. suis endocarditis show destructive, extensive valvular damage and early embolization with a fulminant course, needing early surgical intervention with a good clinical outcome

Prospective comparison of infective endocarditis in khon kaen, Thailand and rennes, france

International audienceProspectively collected, contemporary data are lacking on how the features of infective endocarditis (IE) vary according to region. We, therefore, compared IE in Rennes, France and Khon Kaen, Thailand. Fifty-eight patients with confirmed IE were enrolled at each site during 2011 and 2012 using a common protocol. Compared with French patients, Thais had a lower median age (47 versus 70 years old; P \textless 0.001) and reported more animal contact (86% versus 21%; P \textless 0.001). There were more zoonotic infections among Thai than France patients (6 and 1 cases; P = 0.017) and fewer staphylococcal infections (4 versus 15 cases; P = 0.011). Underlying rheumatic heart disease was more prevalent in Thai than in French patients (31% and 4%; P = 0.001), whereas prosthetic heart valves were less prevalent (9% and 35%; P = 0.001). Our data strengthen previous observations that IE in the tropics has distinctive demographic characteristics, risk factors, and etiologies and underscore the need for improved prevention and control strategies

The first reported case of Bartonella endocarditis in Thailand

Bartonella species have been shown to cause acute, undifferentiated fever in Thailand. A study to identify causes of endocarditis that were blood culture-negative using routine methods led to the first reported case in Thailand of Bartonella endocarditis A 57 year-old male with underlying rheumatic heart disease presented with severe congestive heart failure and suspected infective endocarditis. The patient underwent aortic and mitral valve replacement. Routine hospital blood cultures were negative but B. henselae was identified by serology, PCR, immunohistochemistry and specific culture techniques

The First Reported Cases of Q Fever Endocarditis in Thailand

We describe the first two reported cases of Q fever endocarditis in Thailand. Both patients were male, had pre-existing heart valve damage and had contact with cattle. Heightened awareness of Q fever could improve diagnosis and case management and stimulate efforts to identify risk factors and preventive measures