Τα χαρακτηριστικά της περιοδικής αναπνοής ανάλογα με τη βαρύτητα ασθενών με καρδιακή ανεπάρκεια

ΕΙΣΑΓΩΓΗ: Η περιοδική αναπνοή κατά την άσκηση (ΠΑασκ) είναι μια παράμετρος της καρδιοαναπνευστικής δοκιμασίας κόπωσης (ΚΑΔΚ) που εμφανίζεται σε ασθενείς με χρόνια καρδιακή ανεπάρκεια (ΧΚΑ) με μειωμένο (HFrEF) ή διατηρημένο (HFpEF) κλάσμα εξώθησης της αριστερής κοιλίας (ΚΕ) και σχετίζεται με αυξημένη θνησιμότητα. Πρόσφατα εντοπίστηκε και στη ΧΚΑ με ενδιάμεση τιμή ΚΕ (HFmrEF). Τα χαρακτηριστικά της ΠΑασκ σε ασθενείς με ΧΚΑ διαφορετικής βαρύτητας δεν έχουν διερευνηθεί πλήρως. ΣΚΟΠΟΣ: Η σύγκριση ασθενών με ΧΚΑ διαφορετικής βαρύτητας που εμφανίζουν ΠΑασκ ως προς τα χαρακτηριστικά της και τη λειτουργική τους ικανότητα. ΜΕΘΟΔΟΛΟΓΙΑ: Μελετήθηκαν 427 διαδοχικοί ασθενείς με σταθερή ΧΚΑ (ηλικία:54±13 έτη, VO2peak:17.8±6.7 ml.kg-1.min-1) υποβαλλόμενοι σε μέγιστη ΚΑΔΚ. Οι ασθενείς ταξινομήθηκαν σε 3 ομάδες ανάλογα με το ΚΕ: HFrEF (ΑΠΟΤΕΛΕΣΜΑΤΑ: Ο επιπολασμός της ΠΑασκ ήταν 56% στους HFrEF, 57% στους HFmrEF και 33% στους HFpEF (p0.05), ενώ παρατηρήθηκαν σημαντικές διαφορές για το λ και h% (p0.05). ΣΥΜΠΕΡΑΣΜΑΤΑ: Η ΠΑασκ εμφανίστηκε σε όλες τις ομάδες ως προς το ΚΕ. Οι ασθενείς με HFrEF που εμφaνίζουν ΠΑασκ φαίνεται να παρουσιάζουν μειωμένη λειτουργική ικανότητα και συνεπώς αυξημένη βαρύτητα σε σχέση με τους αντίστοιχους HFmrEF και HFpEF. Το μήκος και πλάτος της ΠΑασκ ήταν αυξημένα στους HFrEF, το οποίο πιθανόν αντανακλά σε μεγαλύτερες διαταραχές στον έλεγχο του αερισμού. Τα ευρήματα χρήζουν περαιτέρω διερεύνησης σε μεγαλύτερους πληθυσμούς.INTRODUCTION: Exercise oscillatory ventilation (EOV) is a non-invasive parameter, which has been detected during cardiopulmonary exercise testing (CPET) in chronic heart failure (CHF) patients with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) and is associated with increased mortality. EOV has been also detected in CHF patients with mid-range LVEF (HFmrEF). EOV characteristics have not been fully investigated among CHF patients of different severity. PURPOSE: To compare EOV derivative measures and functional capacity in different CHF severity patients stratified by LVEF. METHODOLOGY: Four hundred twenty-seven consecutive patients with stable CHF (age: 54±13 years, VO2peak: 17.8±6.7 ml.kg-1.min-1) underwent maximum CPET. Patients were categorised in three groups according to LVEF: HFrEF (RESULTS: The prevalence of EOV was 56% in HFrEF, 57% in HFmrEF, 33% in HFpEF (p0.05). Significant differences were observed for λ and h% (p 0.05). CONCLUSIONS: EOV was detected in all LVEF groups. HFrEF patients presenting EOV had diminished functional ability and consequently greater CHF severity than HFmrEF and HFpEF. EOV length and amplitude were increased in HFrEF, possibly reflecting greater ventilatory control abnormalities. These findings warrant further investigation in larger populations

Diagnosis and Treatment of Inappropriate Sinus Tachycardia

Inappropriate sinus tachycardia (IST) is a syndrome of cardiac and extracardiac symptoms characterized by rapid sinus heart rate at rest (>100 bpm) or with minimal activity and disproportionate to the physiologic demands. Patients with this unique and puzzling arrhythmia may require restriction from physical activity. The responsible mechanisms for IST are not completely understood. IST and postural orthostatic tachycardia syndrome (POTS) are the 2 sides of the same coin. It is important to distinguish IST from so-called appropriate sinus tachycardia and from POTS, with which an overlap may occur. As the long-term outcome seems to be benign, treatment may be unnecessary, or may be as simple as physical training. However, for patients with intolerable symptoms, therapeutic measures are warranted. Beta-adrenergic blockers, considered a first-line therapy, are usually ineffective even at high doses; the same applies for most other medical therapies. Ivabradine seems to be more effective than beta-blockers especially in the non- hypertensive patients. In rare instances, catheter- or surgically- based right atrial or sinus node modification may be helpful, but even this is fraught with limited efficacy and potential complications. Overtreatment, in an attempt to reduce symptoms, can be difficult to avoid, but is discouraged. In this report, we will be review IST, explore its mechanisms and evaluate possible management strategies

Effects of exercise training on diastolic and systolic dysfunction in patients with chronic heart failure

BACKGROUND Chronic heart failure (CHF) is a complex syndrome characterized by a progressive reduction of the left ventricular (LV) contractility, low exercise tolerance, and increased mortality and morbidity. Diastolic dysfunction (DD) of the LV, is a keystone in the pathophysiology of CHF and plays a major role in the progression of most cardiac diseases. Also, it is well estimated that exercise training induces several beneficial effects on patients with CHF. AIM To evaluate the impact of a cardiac rehabilitation program on the DD and LV ejection fraction (EF) in patients with CHF. METHODS Thirty-two stable patients with CHF (age: 56 +/- 10 years, EF: 32% +/- 8%, 88% men) participated in an exercise rehabilitation program. They were randomly assigned statement: to aerobic exercise (AER) or combined aerobic and strength training (COM), based on age and peak oxygen uptake, as stratified randomization criteria. Before and after the program, they underwent a symptom-limited maximal cardiopulmonary exercise testing (CPET) and serial echocardiography evaluation to evaluate peak oxygen uptake (VO2peak), peak workload (W-peak), DD grade, right ventricular systolic pressure (RVSP), and EF. RESULTS The whole cohort improved VO2peak, and W-peak, as well as DD grade (P < 0.05). Overall, 9 patients (28.1%) improved DD grade, while 23 (71.9%) remained at the same DD grade; this was a significant difference, considering DD grade at baseline (P < 0.05). In addition, the whole cohort improved RVSP and EF (P < 0.05). Not any between-group differences were observed in the variables assessed (P > 0.05). CONCLUSION Exercise rehabilitation improves indices of diastolic and systolic dysfunction. Exercise protocol was not observed to affect outcomes. These results need to be further investigated in larger samples

International Validation of Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) Score in Heart Failure

Background: Current European heart failure (HF) Guidelines suggests the use of risk score: among them, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has demonstrated to be one of the most accurate. However, the risk scores are still poorly implemented in clinical practice, also due to lack of strong evidence regarding their external validation in different populations. Thus, the current study was designed as an external validation test of the MECKI score in an international multicentre setting. Methods: The study cohort consisted of patients diagnosed with HF with reduced ejection fraction (HFrEF) across international centres (not Italian), retrospectively recruited. Collected data included demographics, HF aetiology, laboratory testing, ECG, echocardiographic findings, cardiopulmonary exercise testing (CPET) results as described in the original MECKI score publication. Results: 1042 patients across 8 international centres (7 European and 1 Asian) were included and followed up from 1998 till 2019. Patients were divided according to the calculated MECKI scores into 3 subgroups: (i) MECKI score <10%; (ii) 10-20%; (iii) ≥20%. Survival analysis comparison among the 3 MECKI score subgroups showed a worse prognosis in patients with higher MECKI score value: median event-free survival times were 4396 days for MECKI score <10%; 3457 days for 10-20%; 1022 days for ≥20% (p<0.0001). ROC curves and the AUC curves were like those reported in the original internal validation studies. Conclusion: In patients diagnosed with HFrEF, the power of the MECKI score was confirmed in terms of prognosis and risk stratification, supporting its implementation as advised by the HF Guidelines