Cardiopulmonary Exercise Test in Advanced Heart Failure Among Heart Transplantation Candidates

Cardiopulmonary exercise test has been raised through recent decades as a brilliant prognostic tool in a wide field of diseases and clinical conditions which makes it valuable to be used in prognostic assessment during the current study among chronic heart failure (CHF) patients. This study recruited 71 patients with severe CHF who were candidates for heart transplantation. Bicycle-protocol Cardiopulmonary Exercise Test was done, and several parameters were measured and compared between four groups of patients based on their VO2/kg to show four grades of the disease from G1 to G4. Total 71 CHF subjects from 18 to 46 year of age enrolled in the study. Statistically significant correlations were determined between HRR, VE/VCO2, VE/VO2, BR and the severity of CHF. VO2max, HRR, VE/VO2, VE/VCO2, BR, and AT were the most prominent factors of CPET which showed their validity and reliability in terms of prognosis of CHF. It seems that combination of CPET and other cardiac prognostic tools like echocardiography and measurement of the pressure in cardiac chambers can improve the prognosis in CHF

Sarcopenia and Sarcopenic Obesity in Chronic Obstructive Pulmonary Disease Patients with Different Levels of Severity

Background: Sarcopenia is defined as loss of muscle mass with attendant loss of muscle strength and physical function and is associated with advancing age. Inflammatory condition of chronic disease leads to more rapid progression of this syndrome, which may adversely affect quality of life. The aim of this study was to determine the relationship between chronic obstructive pulmonary disease (COPD) and sarcopenia.Methods: This study included 108 COPD patients who were treated in the pulmonary clinic at Masih Daneshvari Hospital. Patients were categorized into three groups based on Global Initiative for Obstructive Lung Disease criteria. Sarcopenic parameters including muscle mass, muscle strength, and physical performance were measured by Bioimpedance Analysis, hand grip dynamometer, and the Short Physical Performance Battery test, respectively. According to the European Working Group on Sarcopenia in Older People cutoff points and the definition of sarcopenic obesity, sarcopenic patients were diagnosed and categorized based on different COPD severity scores.Results: The relationship between sarcopenia and COPD grading, which was assessed using multiple regression models with adjustment of confounding factors, including age, chronic diseases, and smoking, was statistically insignificant. However, by using forced expiratory volume in 1 second (FEV1) or ratio of FEV1 to forced vital capacity in this model, the results were significant (P = 0.026). A positive linear correlation was observed between skeletal muscle index (SMI) and spirometric data, which was assessed by Spearman’s correlation test. By exploring the association between sarcopenia and obesity with the one-way analysis of variance test, sarcopenic patients represented to have the minimal spirometric measures. However, this difference was only significant for actual measurements.Conclusion: This study showed that sarcopenic COPD patients had smaller spirometric measurements and that sarcopenia and magnitude of SMI were positively correlated with obstruction severity

Effectiveness of mechanical insufflation-exsufflation device in pediatric patients with cystic fibrosis

Introduction: Coughing is the body’s defense mechanism to clear the airways from the foreign bodies and secretions. In patients with neuromuscular disorders or other diseases affecting the airways such as cystic fibrosis (CF), the effectiveness of this defense mechanism is often reduced due to respiratory exhaustion. The aim of our study was to evaluate the effectiveness of mechanical insufflation-exsufflation device (MI-E) in pediatric patients with CF. Materials and Methods: In this study, we randomized 31 patient’s whit CF admitted to the pediatric pulmonary ward of Masih Daneshvari hospital (Tehran – Iran) into two groups of routine physiotherapy (including an active cycle of breathing technique, pursed-lips breathing, diaphragmatic/abdominal breathing, huffing, and coughing) or, routine physiotherapy plus 10 sessions of MI-E, each for 20 minutes. MI-E pressure was set +5 to +30 cmH2O for inspiration and -8 to -33 for expiration, for 1-3 and 3-5 seconds, respectively. Two groups were then compared regarding the results of the 6-minute walk test (distance), spirometry, echocardiography, and arterial blood gases.Results: The mean age of the patients was 16.4± 4.6 years and 16 (23.6%) were male. Results of the analysis demonstrated that there were no significant differences between the two groups. Our results demonstrated similar efficacy for conventional physiotherapy versus physiotherapy and MI-E regarding the improvement of pulmonary function and airway clearance in CF patients.   &nbsp

Effect of rehabilitation with or without noninvasive ventilation on pulmonary function and COPD assessment test results in COPD patients

Background: Chronic obstructive pulmonary disease (COPD) is a serious and prevalent health condition, with many patients ultimately requiring ventilation support. Noninvasive ventilation (NIV) has been suggested as a therapeutic option for improving pulmonary function in these patients. This study aimed to evaluate the effectiveness of NIV for improving pulmonary function. Methods: Fifty hemodynamically stable patients with stage 3 or 4 COPD presenting to our center were randomly assigned into two groups of rehabilitation with (n=25) or without NIV (n=25). NIV was administered using I=12 and E=4 with BiPAP settings. Echocardiography, spirometry, six-minute walk test (6MWT), COPD Assessment Test (CAT), and venous blood gas (VBG) analysis were performed at baseline and after 4 weeks of rehabilitation and compared using appropriate statistical tests. Results:  The mean age of the participants was 60.8±10.6 years and 84% were males. The two groups were similar regarding baseline variables, except for the higher number of stage 4 patients in the NIV group. The mean ejection fraction and pulmonary artery pressure were 53.6±4.3% and 37.2±9.6 mmHg, respectively, with no significant difference between the study groups (P>0.05). All pulmonary function indices by spirometry, 6MWT, and VBG values improved significantly after rehabilitation in each group (P<0.05), but NIV patients showed no advantage over the control group. However, NIV significantly increased the CAT scores after rehabilitation: 29.32 vs. 25.04, in the NIV and control groups, respectively (P<0.05). Conclusion: Despite having multiple health benefits in COPD patients including decreasing the mortality rate and the need for invasive ventilation, NIV showed superiority compared with rehabilitation alone only in improving the CAT score. &nbsp