The present study aimed to evaluate forced expiration based on transverse abdominis (TrA) stiffness by identifying the relationship between TrA stiffness and peak expiratory flow (PEF) in both younger and older adults. We also assessed the relationship between diaphragm thickness and PEF. A total of 31 younger (21.24 ± 2.73 years) and 34 older (71.35 ± 5.26 years) adults were included in the present study. TrA muscle stiffness was measured at rest and during abdominal bracing using shear wave elastography. Diaphragm thickness was measured during deep inspiration and expiration using B-mode ultrasound, and respiratory function was assessed by measuring PEF using a spirometer. We found that TrA stiffness during bracing was significantly lower in older than younger adults (p < 0.05). Similarly, the difference in absolute stiffness of the TrA when bracing versus at rest was significantly lower in older than younger adults (p < 0.05). Additionally, TrA stiffness during bracing was positively associated with PEF in the younger group (r = 0.483), while a very weak correlation was found in the older group (r = 0.172). Similarly, PEF was moderately correlated with diaphragm thickness during expiration as well as during changes between inspiration and expiration in the younger group (r = 0.405 and r = 0.403); however, no significant correlation was found in the older group. These findings of the present study indicate that the variations in PEF between younger and older adults may be due to age-associated changes in the musculoskeletal structure and muscle fibre type.
{"title":"Association between abdominal muscle stiffness, diaphragm thickness and peak expiratory flow in younger versus older adults","authors":"Youngeun Lim, Yerim Do, Haneul Lee","doi":"10.1111/cpf.12850","DOIUrl":"10.1111/cpf.12850","url":null,"abstract":"<p>The present study aimed to evaluate forced expiration based on transverse abdominis (TrA) stiffness by identifying the relationship between TrA stiffness and peak expiratory flow (PEF) in both younger and older adults. We also assessed the relationship between diaphragm thickness and PEF. A total of 31 younger (21.24 ± 2.73 years) and 34 older (71.35 ± 5.26 years) adults were included in the present study. TrA muscle stiffness was measured at rest and during abdominal bracing using shear wave elastography. Diaphragm thickness was measured during deep inspiration and expiration using B-mode ultrasound, and respiratory function was assessed by measuring PEF using a spirometer. We found that TrA stiffness during bracing was significantly lower in older than younger adults (<i>p</i> < 0.05). Similarly, the difference in absolute stiffness of the TrA when bracing versus at rest was significantly lower in older than younger adults (<i>p</i> < 0.05). Additionally, TrA stiffness during bracing was positively associated with PEF in the younger group (<i>r</i> = 0.483), while a very weak correlation was found in the older group (<i>r</i> = 0.172). Similarly, PEF was moderately correlated with diaphragm thickness during expiration as well as during changes between inspiration and expiration in the younger group (<i>r</i> = 0.405 and <i>r</i> = 0.403); however, no significant correlation was found in the older group. These findings of the present study indicate that the variations in PEF between younger and older adults may be due to age-associated changes in the musculoskeletal structure and muscle fibre type.</p>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9911060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kritika Subramanian, Brett Muench, Eugene Shostak, Amanda Coffey, Lady Sawoszczyk, Fei Gao, Adam Leep, Ramya Rajaram, John Hornung, Elisabeth O'Dwyer
Background
Endobronchial valve placement is a minimally invasive option for treatment of patients with severe emphysema, by reducing lung volumes in lobes with both poor ventilation and perfusion; ventilation is determined by emphysematous scores and perfusion by quantitative lung perfusion imaging. CT-based fissure identifying artificial intelligence algorithms have recently demonstrated enhanced quantification of the perfusion in a 5-lobar analysis. We hypothesized that this newly developed algorithm may offer greater utility in determining target treatment lobes by supplementing the radiographic risk stratification initiated by the conventional emphysematous scores alone.
Methods
Quantification images of 43 deidentified individuals underwent perfusion SPECT/CT with Tc99m Macro-Aggregated Albumin (4mCi/148MBq intravenous) using both conventional zonal anatomy and AI augmented 5-lobar analysis.
Analysis
Images were reviewed to demonstrate that the new algorithm was not inferior to standard of care imaging with zonal segmentation. A pilot subcohort analysis of 4 patients with severe emphysema who had pre-endobronchial valve placement imaging demonstrated that an emphysema-perfusion ratio greater than 3 was indicative of a potential target lobe.
Discussion
We conclude that 5-lobar analysis in not inferior to conventional zonal analysis and allows the determination of emphysema-to-perfusion ratio. Preliminary review of a small subcohort suggests an emphysema-to-perfusion ratio greater than 3 for a lobe may clinically benefit in endobronchial valve placement. Further evaluation with prospective studies and larger sample sizes are recommended before clinical implementation.
{"title":"Lobar quantification of pulmonary perfusion prior to minimally invasive lung reduction improves prediction of postprocedure outcomes: A pilot study","authors":"Kritika Subramanian, Brett Muench, Eugene Shostak, Amanda Coffey, Lady Sawoszczyk, Fei Gao, Adam Leep, Ramya Rajaram, John Hornung, Elisabeth O'Dwyer","doi":"10.1111/cpf.12847","DOIUrl":"10.1111/cpf.12847","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endobronchial valve placement is a minimally invasive option for treatment of patients with severe emphysema, by reducing lung volumes in lobes with both poor ventilation and perfusion; ventilation is determined by emphysematous scores and perfusion by quantitative lung perfusion imaging. CT-based fissure identifying artificial intelligence algorithms have recently demonstrated enhanced quantification of the perfusion in a 5-lobar analysis. We hypothesized that this newly developed algorithm may offer greater utility in determining target treatment lobes by supplementing the radiographic risk stratification initiated by the conventional emphysematous scores alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Quantification images of 43 deidentified individuals underwent perfusion SPECT/CT with Tc99m Macro-Aggregated Albumin (4mCi/148MBq intravenous) using both conventional zonal anatomy and AI augmented 5-lobar analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Analysis</h3>\u0000 \u0000 <p>Images were reviewed to demonstrate that the new algorithm was not inferior to standard of care imaging with zonal segmentation. A pilot subcohort analysis of 4 patients with severe emphysema who had pre-endobronchial valve placement imaging demonstrated that an emphysema-perfusion ratio greater than 3 was indicative of a potential target lobe.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>We conclude that 5-lobar analysis in not inferior to conventional zonal analysis and allows the determination of emphysema-to-perfusion ratio. Preliminary review of a small subcohort suggests an emphysema-to-perfusion ratio greater than 3 for a lobe may clinically benefit in endobronchial valve placement. Further evaluation with prospective studies and larger sample sizes are recommended before clinical implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eero Juntunen, Olli Suomalainen, Sorjo Mätzke, Tiina Heliö, Antti Loimaala, Valtteri Uusitalo
Cardiac transthyretin amyloidosis (ATTR) is a possible incidental finding on bone scintigraphy imaged due to prostate cancer. We investigated its significance in 1426 elderly prostate cancer patients (>70 years) who underwent bone scintigraphy in three nuclear medicine departments in Finland. Patients with Perugini grade two or three uptakes were considered positive for cardiac uptake. Heart failure diagnoses and pacemaker implantations were collected from the hospital's records. Mortality data were gathered from the Finnish national statistical service (Statistics Finland). The Median follow-up time was 4 years (interquartile range: 2−5 years). Cardiac uptake was detected in 37 individuals (2.6%), and it was associated with an elevated risk of both overall and cardiovascular death in univariable analysis. However, cardiac uptake did not predict overall mortality in the multivariable analysis when adjusted to age, bone metastases or the diagnosis of heart failure (p > 0.05). The risk of heart failure was higher in patients with cardiac uptake (47% vs. 15%, p < 0.001), while the risk of pacemaker implantations was not elevated (5% vs. 5%, p = 0.89). In conclusion, cardiac uptake on bone scintigraphy imaged due to prostate cancer is associated with an elevated risk of heart failure and both overall and cardiovascular death. However, cardiac uptake was not independently associated with overall mortality when adjusted to age, bone metastasis or heart failure. Therefore, they are essential to consider when incidental cardiac uptake is detected on bone scintigraphy. The need for pacemaker implantation was not elevated in patients with cardiac uptake.
心脏转甲状腺蛋白淀粉样变(ATTR)可能是前列腺癌骨显像的偶然发现。我们调查了芬兰三个核医学科室1426例老年前列腺癌患者(>70岁)骨显像的意义。Perugini 2级或3级摄取的患者被认为是心脏摄取阳性。从医院的记录中收集心力衰竭诊断和心脏起搏器植入。死亡率数据是从芬兰国家统计局(芬兰统计局)收集的。中位随访时间为4年(四分位数间距:2-5年)。在单变量分析中，37人(2.6%)检测到心脏摄取，并与总体和心血管死亡风险升高相关。然而，在多变量分析中，当调整到年龄、骨转移或心力衰竭诊断时，心脏摄取并不能预测总死亡率(p > 0.05)。心脏摄取患者发生心力衰竭的风险更高(47% vs. 15%， p
{"title":"Cardiac morbidity and the cause of death in elderly patients with prostate cancer and incidental cardiac uptake on bone scintigraphy","authors":"Eero Juntunen, Olli Suomalainen, Sorjo Mätzke, Tiina Heliö, Antti Loimaala, Valtteri Uusitalo","doi":"10.1111/cpf.12848","DOIUrl":"10.1111/cpf.12848","url":null,"abstract":"<p>Cardiac transthyretin amyloidosis (ATTR) is a possible incidental finding on bone scintigraphy imaged due to prostate cancer. We investigated its significance in 1426 elderly prostate cancer patients (>70 years) who underwent bone scintigraphy in three nuclear medicine departments in Finland. Patients with Perugini grade two or three uptakes were considered positive for cardiac uptake. Heart failure diagnoses and pacemaker implantations were collected from the hospital's records. Mortality data were gathered from the Finnish national statistical service (Statistics Finland). The Median follow-up time was 4 years (interquartile range: 2−5 years). Cardiac uptake was detected in 37 individuals (2.6%), and it was associated with an elevated risk of both overall and cardiovascular death in univariable analysis. However, cardiac uptake did not predict overall mortality in the multivariable analysis when adjusted to age, bone metastases or the diagnosis of heart failure (<i>p</i> > 0.05). The risk of heart failure was higher in patients with cardiac uptake (47% vs. 15%, <i>p</i> < 0.001), while the risk of pacemaker implantations was not elevated (5% vs. 5%, <i>p</i> = 0.89). In conclusion, cardiac uptake on bone scintigraphy imaged due to prostate cancer is associated with an elevated risk of heart failure and both overall and cardiovascular death. However, cardiac uptake was not independently associated with overall mortality when adjusted to age, bone metastasis or heart failure. Therefore, they are essential to consider when incidental cardiac uptake is detected on bone scintigraphy. The need for pacemaker implantation was not elevated in patients with cardiac uptake.</p>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12848","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The study examines global and regional systolic shortening of the left (LV) and right ventricle (RV) in 1266 individuals without evidence of heart disease in the third wave of the HUNT study. Regional mitral annular systolic displacement (mitral annular plane systolic excursion [MAPSE]) was 1.5 cm in the septum and anterior walls, 1.6 cm in the lateral wall and 1.7 cm in the inferior wall, global mean 1.6 cm. Peak systolic velocity S' was 8.0, 8.3, 8.8 and 8.6 cm/s in the same walls (global mean 8.7 cm/s). All measures of LV longitudinal shortening correlated, mean MAPSE and S' also correlated with stroke volume (SV) and ejection fraction (EF). Global longitudinal strain by either method correlated with MAPSE, S' and EF, but not with SV, reflecting a systematic difference. S' and MAPSE correlated with early annular diastolic velocity (e'), reflecting that e' is the recoil from systole. Mean displacement was 2.8 (0.5) cm in the tricuspid annulus (tricuspid annular plane systolic excursion [TAPSE]). Normal values by age and sex are provided. Both TAPSE and S' were lower in women, where body size explained the sex difference. Normalisation of MAPSE and S' for wall length reduced intra-individual variation of displacement and velocity by 80%–90%, showing regional MAPSE to be related to LV wall length, and that longitudinal wall strain was relatively uniform. Displacement and S' were lowest in the septum and highest in the left and right free walls, shows systolic bending of the AV-plane into a U-shape, relating to the total cardiac volume changes during the heart cycle.
{"title":"Regional motion of the AV-plane is related to the cardiac anatomy and deformation of the AV-plane. Data from the HUNT study","authors":"Asbjørn Støylen, Harald E. Mølmen, Håvard Dalen","doi":"10.1111/cpf.12845","DOIUrl":"10.1111/cpf.12845","url":null,"abstract":"<p>The study examines global and regional systolic shortening of the left (LV) and right ventricle (RV) in 1266 individuals without evidence of heart disease in the third wave of the HUNT study. Regional mitral annular systolic displacement (mitral annular plane systolic excursion [MAPSE]) was 1.5 cm in the septum and anterior walls, 1.6 cm in the lateral wall and 1.7 cm in the inferior wall, global mean 1.6 cm. Peak systolic velocity S' was 8.0, 8.3, 8.8 and 8.6 cm/s in the same walls (global mean 8.7 cm/s). All measures of LV longitudinal shortening correlated, mean MAPSE and S' also correlated with stroke volume (SV) and ejection fraction (EF). Global longitudinal strain by either method correlated with MAPSE, S' and EF, but not with SV, reflecting a systematic difference. S' and MAPSE correlated with early annular diastolic velocity (e'), reflecting that e' is the recoil from systole. Mean displacement was 2.8 (0.5) cm in the tricuspid annulus (tricuspid annular plane systolic excursion [TAPSE]). Normal values by age and sex are provided. Both TAPSE and S' were lower in women, where body size explained the sex difference. Normalisation of MAPSE and S' for wall length reduced intra-individual variation of displacement and velocity by 80%–90%, showing regional MAPSE to be related to LV wall length, and that longitudinal wall strain was relatively uniform. Displacement and S' were lowest in the septum and highest in the left and right free walls, shows systolic bending of the AV-plane into a U-shape, relating to the total cardiac volume changes during the heart cycle.</p>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12845","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9766359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atrial linear scars in Cox‐Maze IV procedures are achieved using Cryothermy (Cryo) or radiofrequency (RF) techniques. The subsequent postoperative left atrial (LA) reverse remodelling is unclear. We used 2‐ and 3‐dimensional echocardiography (2‐3DE) to compare the impact of Cryo and RF procedures on LA size and function 1 year after Cox‐maze IV ablation concomitant with Mitral valve (MV) surgery.
{"title":"Effect of cryothermic and radiofrequency Cox-Maze IV ablation on atrial size and function assessed by 2D and 3D echocardiography, a randomized trial. To freeze or to burn","authors":"Gabriella Boano, Farkas Vánky, Meriam Åström Aneq","doi":"10.1111/cpf.12841","DOIUrl":"10.1111/cpf.12841","url":null,"abstract":"Atrial linear scars in Cox‐Maze IV procedures are achieved using Cryothermy (Cryo) or radiofrequency (RF) techniques. The subsequent postoperative left atrial (LA) reverse remodelling is unclear. We used 2‐ and 3‐dimensional echocardiography (2‐3DE) to compare the impact of Cryo and RF procedures on LA size and function 1 year after Cox‐maze IV ablation concomitant with Mitral valve (MV) surgery.","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9745578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
During hyperthermia, the perturbations in mean arterial blood pressure (MAP) produced by the Valsalva manoeuvre (VM) are more severe. However, whether these more severe VM-induced changes in MAP are translated to the cerebral circulation during hyperthermia is unclear.
Methods
Healthy participants (n = 12, 1 female, mean ± SD: age 24 ± 3 years) completed a 30 mmHg (mouth pressure) VM for 15 s whilst supine during normothermia and mild hyperthermia. Hyperthermia was induced passively using a liquid conditioning garment with core temperature measured via ingested temperature sensor. Middle cerebral artery blood velocity (MCAv) and MAP were recorded continuously during and post-VM. Tieck's autoregulatory index was calculated from the VM responses, with pulsatility index, an index of pulse velocity (pulse time) and mean MCAv (MCAvmean) also calculated.
Results
Passive heating significantly raised core temperature from baseline (37.9 ± 0.2 vs. 37.1 ± 0.1°C at rest, p < 0.01). MAP during phases I through III of the VM was lower during hyperthermia (interaction effect p < 0.01). Although an interaction effect was observed for MCAvmean (p = 0.02), post-hoc differences indicated only phase IIa was lower during hyperthermia (55 ± 12 vs. 49.3 ± 8 cm s−1 for normothermia and hyperthermia, respectively, p = 0.03). Pulsatility index was increased 1-min post-VM in both conditions (0.71 ± 0.11 vs. 0.76 ± 0.11 for pre- and post-VM during normothermia, respectively, p = 0.02, and 0.86 ± 0.11 vs. 0.99 ± 0.09 for hyperthermia p < 0.01), although for pulse time only main effects of time (p < 0.01), and condition (p < 0.01) were apparent.
Conclusion
These data indicate that the cerebrovascular response to the VM is largely unchanged by mild hyperthermia.
{"title":"Cerebrovascular and cardiovascular responses to the Valsalva manoeuvre during hyperthermia","authors":"Blake G. Perry, Stephanie Korad, Toby Mündel","doi":"10.1111/cpf.12843","DOIUrl":"10.1111/cpf.12843","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>During hyperthermia, the perturbations in mean arterial blood pressure (MAP) produced by the Valsalva manoeuvre (VM) are more severe. However, whether these more severe VM-induced changes in MAP are translated to the cerebral circulation during hyperthermia is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Healthy participants (<i>n</i> = 12, 1 female, mean ± SD: age 24 ± 3 years) completed a 30 mmHg (mouth pressure) VM for 15 s whilst supine during normothermia and mild hyperthermia. Hyperthermia was induced passively using a liquid conditioning garment with core temperature measured via ingested temperature sensor. Middle cerebral artery blood velocity (MCAv) and MAP were recorded continuously during and post-VM. Tieck's autoregulatory index was calculated from the VM responses, with pulsatility index, an index of pulse velocity (pulse time) and mean MCAv (MCAv<sub>mean</sub>) also calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Passive heating significantly raised core temperature from baseline (37.9 ± 0.2 vs. 37.1 ± 0.1°C at rest, <i>p</i> < 0.01). MAP during phases I through III of the VM was lower during hyperthermia (interaction effect <i>p</i> < 0.01). Although an interaction effect was observed for MCAv<sub>mean</sub> (<i>p</i> = 0.02), post-hoc differences indicated only phase IIa was lower during hyperthermia (55 ± 12 vs. 49.3 ± 8 cm s<sup>−</sup><sup>1</sup> for normothermia and hyperthermia, respectively, <i>p</i> = 0.03). Pulsatility index was increased 1-min post-VM in both conditions (0.71 ± 0.11 vs. 0.76 ± 0.11 for pre- and post-VM during normothermia, respectively, <i>p</i> = 0.02, and 0.86 ± 0.11 vs. 0.99 ± 0.09 for hyperthermia <i>p</i> < 0.01), although for pulse time only main effects of time (<i>p</i> < 0.01), and condition (<i>p</i> < 0.01) were apparent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These data indicate that the cerebrovascular response to the VM is largely unchanged by mild hyperthermia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9684218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicholas Cauwenberghs, Josephine Sente, František Sabovčik, Evangelos Ntalianis, Kristofer Hedman, Jomme Claes, Kaatje Goetschalckx, Véronique Cornelissen, Tatiana Kuznetsova
Background
Interpretation of cardiopulmonary exercise testing (CPET) results requires thorough understanding of test confounders such as anthropometrics, comorbidities and medication. Here, we comprehensively assessed the clinical determinants of cardiorespiratory fitness and its components in a heterogeneous patient sample.
Methods
We retrospectively collected medical and CPET data from 2320 patients (48.2% females) referred for cycle ergometry at the University Hospital Leuven, Belgium. We assessed clinical determinants of peak CPET indexes of cardiorespiratory fitness (CRF) and its hemodynamic and ventilatory components using stepwise regression and quantified multivariable-adjusted differences in indexes between cases and references.
Results
Lower peak load and peak O2 uptake were related to: higher age, female sex, lower body height and weight, and higher heart rate; to the intake of beta blockers, analgesics, thyroid hormone replacement and benzodiazepines; and to diabetes mellitus, chronic kidney disease, non-ST elevation myocardial infarction and atrial fibrillation (p < 0.05 for all). Lower peak load also correlated with obstructive pulmonary diseases. Stepwise regression revealed associations of hemodynamic and ventilatory indexes (including heart rate, O2 pulse, systolic blood pressure and ventilation at peak exercise and ventilatory efficiency) with age, sex, body composition and aforementioned diseases and medications. Multivariable-adjusted differences in CPET metrics between cases and controls confirmed the associations observed.
Conclusion
We described known and novel associations of CRF components with demographics, anthropometrics, cardiometabolic and pulmonary diseases and medication intake in a large patient sample. The clinical implications of long-term noncardiovascular drug intake for CPET results require further investigation.
{"title":"Cardiorespiratory fitness components in relation to clinical characteristics, disease state and medication intake: A patient registry study","authors":"Nicholas Cauwenberghs, Josephine Sente, František Sabovčik, Evangelos Ntalianis, Kristofer Hedman, Jomme Claes, Kaatje Goetschalckx, Véronique Cornelissen, Tatiana Kuznetsova","doi":"10.1111/cpf.12842","DOIUrl":"10.1111/cpf.12842","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Interpretation of cardiopulmonary exercise testing (CPET) results requires thorough understanding of test confounders such as anthropometrics, comorbidities and medication. Here, we comprehensively assessed the clinical determinants of cardiorespiratory fitness and its components in a heterogeneous patient sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively collected medical and CPET data from 2320 patients (48.2% females) referred for cycle ergometry at the University Hospital Leuven, Belgium. We assessed clinical determinants of peak CPET indexes of cardiorespiratory fitness (CRF) and its hemodynamic and ventilatory components using stepwise regression and quantified multivariable-adjusted differences in indexes between cases and references.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Lower peak load and peak O<sub>2</sub> uptake were related to: higher age, female sex, lower body height and weight, and higher heart rate; to the intake of beta blockers, analgesics, thyroid hormone replacement and benzodiazepines; and to diabetes mellitus, chronic kidney disease, non-ST elevation myocardial infarction and atrial fibrillation (<i>p</i> < 0.05 for all). Lower peak load also correlated with obstructive pulmonary diseases. Stepwise regression revealed associations of hemodynamic and ventilatory indexes (including heart rate, O<sub>2</sub> pulse, systolic blood pressure and ventilation at peak exercise and ventilatory efficiency) with age, sex, body composition and aforementioned diseases and medications. Multivariable-adjusted differences in CPET metrics between cases and controls confirmed the associations observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We described known and novel associations of CRF components with demographics, anthropometrics, cardiometabolic and pulmonary diseases and medication intake in a large patient sample. The clinical implications of long-term noncardiovascular drug intake for CPET results require further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10032613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Walid El-Saadi, Jan Engvall, Jan-Erik Karlsson, Eva Maret
Introduction
Adverse left ventricular remodelling (AR) develops over time in approximately 30% of patients with a history of coronary artery disease. AR manifests as a structural change in the left ventricle (LV) in terms of increased volumes and reduced left ventricular ejection fraction (LVEF). Manganese dipyridoxyl diphosphate (mangafodipir) has demonstrated interesting cardioprotective features in acute myocardial ischaemia. Pharmacological postconditioning (PP) with mangafodipir as an adjunct to primary percutaneous coronary intervention may possibly reduce the development of AR over time in ST-elevation myocardial infarction (STEMI). The aim of this 4–7-year follow-up study is to investigate the potential benefits of PP with mangafodipir in STEMI patients.
Method
Thirteen out of the initial 20 patients that were included in the primary study of Karlsson et al. were followed up between April and June 2017. The study group underwent review of the hospital records, a clinical examination with ECG and blood sample analysis before cardiac magnetic resonance examination of the patient. LVEF, left ventricular diastolic volume, left ventricular end systolic volume, LV mass and myocardial strain in all directions were computed.
Results
The PP group showed a decrease in LV volume, mass and higher LVEF at follow-up (p < 0.05) while the individual response of the placebo group showed features that are seen in AR. Although there was no difference in myocardial strain, measurement for the PP-group was higher in absolute terms.
Conclusion
Pharmacological postconditioning with mangafodipir in STEMI demonstrated cardioprotective features compared to the placebo group at follow-up. This article is protected by copyright. All rights reserved.
{"title":"Four- to seven-year follow-up of pharmacological postconditioning with mangafodipir as an adjunct to primary PCI in ST-segment elevation myocardial infarction","authors":"Walid El-Saadi, Jan Engvall, Jan-Erik Karlsson, Eva Maret","doi":"10.1111/cpf.12839","DOIUrl":"10.1111/cpf.12839","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adverse left ventricular remodelling (AR) develops over time in approximately 30% of patients with a history of coronary artery disease. AR manifests as a structural change in the left ventricle (LV) in terms of increased volumes and reduced left ventricular ejection fraction (LVEF). Manganese dipyridoxyl diphosphate (mangafodipir) has demonstrated interesting cardioprotective features in acute myocardial ischaemia. Pharmacological postconditioning (PP) with mangafodipir as an adjunct to primary percutaneous coronary intervention may possibly reduce the development of AR over time in ST-elevation myocardial infarction (STEMI). The aim of this 4–7-year follow-up study is to investigate the potential benefits of PP with mangafodipir in STEMI patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Thirteen out of the initial 20 patients that were included in the primary study of Karlsson et al. were followed up between April and June 2017. The study group underwent review of the hospital records, a clinical examination with ECG and blood sample analysis before cardiac magnetic resonance examination of the patient. LVEF, left ventricular diastolic volume, left ventricular end systolic volume, LV mass and myocardial strain in all directions were computed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PP group showed a decrease in LV volume, mass and higher LVEF at follow-up (<i>p</i> < 0.05) while the individual response of the placebo group showed features that are seen in AR. Although there was no difference in myocardial strain, measurement for the PP-group was higher in absolute terms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pharmacological postconditioning with mangafodipir in STEMI demonstrated cardioprotective features compared to the placebo group at follow-up. This article is protected by copyright. All rights reserved.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12839","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9652132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiopulmonary exercise testing (CPET) variables represent central and peripheral factors and combined factors in the pathology of patients with cardiac disease. The difference in end-tidal oxygen partial pressure from resting to anaerobic threshold (ΔPETO2) may represent predominantly peripheral factors. This study aimed to verify the prognostic significance of ΔPETO2 for major adverse cardiac and cerebrovascular events (MACCE) in cardiac patients, including comparison with the minute ventilation–carbon dioxide production relationship (VE/VCO2 slope), and peak oxygen uptake (VO2).
Methods
In total, 185 patients with cardiac disease who underwent CPET were consecutively enroled in this retrospective study. The primary endpoint was 3-year MACCE. The ability of ΔPETO2, VE/VCO2 slope, and peak VO2 to predict MACCE was examined.
Results
Optimal cut-off values for predicting MACCE were 2.0 mmHg for ΔPETO2 (area under the curve [AUC]: 0.829), 29.8 for VE/VCO2 slope (AUC: 0.734), and 19.0 mL/min/kg for peak VO2 (AUC: 0.755). The AUC of ΔPETO2 was higher than those of VE/VCO2 slope and peak VO2. The MACCE-free survival rate was significantly lower in the ΔPETO2 ≤ 2.0 group versus the ΔPETO2 > 2.0 group (44.4% vs. 91.2%, p < 0.001). ΔPETO2 ≤ 2.0 was an independent predictor of MACCE after adjustment for age and VE/VCO2 slope (hazard ratio [HR], 7.28; p < 0.001) and after adjustment for age and peak VO2 (HR, 6.52; p < 0.001).
Conclusion
ΔPETO2 was a strong predictor of MACCE independent of and superior to VE/VCO2 slope and peak VO2 in patients with cardiac disease.
{"title":"End-tidal oxygen partial pressure is a strong prognostic predictive factor in patients with cardiac disease","authors":"Asami Ogura, Kazuhiro P. Izawa, Hideto Tawa, Masaaki Wada, Masashi Kanai, Ikko Kubo, Ayano Makihara, Ryohei Yoshikawa, Yuichi Matsuda","doi":"10.1111/cpf.12838","DOIUrl":"10.1111/cpf.12838","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiopulmonary exercise testing (CPET) variables represent central and peripheral factors and combined factors in the pathology of patients with cardiac disease. The difference in end-tidal oxygen partial pressure from resting to anaerobic threshold (ΔPETO<sub>2</sub>) may represent predominantly peripheral factors. This study aimed to verify the prognostic significance of ΔPETO<sub>2</sub> for major adverse cardiac and cerebrovascular events (MACCE) in cardiac patients, including comparison with the minute ventilation–carbon dioxide production relationship (VE/VCO<sub>2</sub> slope), and peak oxygen uptake (VO<sub>2</sub>).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In total, 185 patients with cardiac disease who underwent CPET were consecutively enroled in this retrospective study. The primary endpoint was 3-year MACCE. The ability of ΔPETO<sub>2</sub>, VE/VCO<sub>2</sub> slope, and peak VO<sub>2</sub> to predict MACCE was examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Optimal cut-off values for predicting MACCE were 2.0 mmHg for ΔPETO<sub>2</sub> (area under the curve [AUC]: 0.829), 29.8 for VE/VCO<sub>2</sub> slope (AUC: 0.734), and 19.0 mL/min/kg for peak VO<sub>2</sub> (AUC: 0.755). The AUC of ΔPETO<sub>2</sub> was higher than those of VE/VCO<sub>2</sub> slope and peak VO<sub>2</sub>. The MACCE-free survival rate was significantly lower in the ΔPETO<sub>2</sub> ≤ 2.0 group versus the ΔPETO<sub>2</sub> > 2.0 group (44.4% vs. 91.2%, <i>p</i> < 0.001). ΔPETO<sub>2</sub> ≤ 2.0 was an independent predictor of MACCE after adjustment for age and VE/VCO<sub>2</sub> slope (hazard ratio [HR], 7.28; <i>p</i> < 0.001) and after adjustment for age and peak VO<sub>2</sub> (HR, 6.52; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ΔPETO<sub>2</sub> was a strong predictor of MACCE independent of and superior to VE/VCO<sub>2</sub> slope and peak VO<sub>2</sub> in patients with cardiac disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10028728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alaa I. Alyahya, Sarah J. Charman, Nduka C. Okwose, Amy S. Fuller, Christopher Eggett, Peter Luke, Kristian Bailey, Guy A. MacGowan, Djordje G. Jakovljevic
Objectives
Heart rate variability (HRV) is a measure of cardiac autonomic function. This study: (1) evaluated the differences in HRV and haemodynamic function between individuals with hypertrophic cardiomyopathy (HCM) and healthy controls, and (2) determined the relationship between HRV and haemodynamic variables in individuals with HCM.
Methods
Twenty-eight individuals with HCM (n = 7, females; age 54 ± 15 years; body mass index: 29 ± 5 kg/m2) and 28 matched healthy individuals (n = 7 females; age 54 ± 16 years; body mass index: 29 ± 5 kg/m2) completed 5-min HRV and haemodynamic measurements under resting (supine) conditions using bioimpedance technology. Frequency domain HRV measures (absolute and normalized low-frequency power (LF), high-frequency power (HF) and LF/HF ratio) and RR interval were recorded.
Results
Individuals with HCM demonstrated higher vagal activity (i.e., absolute unit of HF power (7.40 ± 2.50 vs. 6.03 ± 1.35 ms2, p = 0.01) but lower RR interval (914 ± 178 vs. 1014 ± 168 ms, p = 0.03) compared to controls. Stroke volume (SV) index and cardiac index were lower in HCM compared with healthy individuals (SV, 33 ± 9 vs. 43 ± 7 ml/beat/m², p < 0.01; cardiac index,2.33 ± 0.42 vs. 3.57 ± 0.82 L/min/m2, p < 0.01), but total peripheral resistance (TPR) was higher in HCM (3468 ± 1027 vs. 2953 ± 1050 dyn·s·m2cm−5, p = 0.03). HF power was significantly related to SV (r = −0.46, p < 0.01) and TPR (r = 0.28, p < 0.05) in HCM.
Conclusions
Short-term frequency domain indices of HRV provide a feasible approach to assess autonomic function in individuals with HCM. Vagal activity, represented by HF power, is increased, and associated with peripheral resistance in individuals with HCM.
{"title":"Heart rate variability and haemodynamic function in individuals with hypertrophic cardiomyopathy","authors":"Alaa I. Alyahya, Sarah J. Charman, Nduka C. Okwose, Amy S. Fuller, Christopher Eggett, Peter Luke, Kristian Bailey, Guy A. MacGowan, Djordje G. Jakovljevic","doi":"10.1111/cpf.12840","DOIUrl":"10.1111/cpf.12840","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Heart rate variability (HRV) is a measure of cardiac autonomic function. This study: (1) evaluated the differences in HRV and haemodynamic function between individuals with hypertrophic cardiomyopathy (HCM) and healthy controls, and (2) determined the relationship between HRV and haemodynamic variables in individuals with HCM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-eight individuals with HCM (<i>n</i> = 7, females; age 54 ± 15 years; body mass index: 29 ± 5 kg/m<sup>2</sup>) and 28 matched healthy individuals (<i>n</i> = 7 females; age 54 ± 16 years; body mass index: 29 ± 5 kg/m<sup>2</sup>) completed 5-min HRV and haemodynamic measurements under resting (supine) conditions using bioimpedance technology. Frequency domain HRV measures (absolute and normalized low-frequency power (LF), high-frequency power (HF) and LF/HF ratio) and RR interval were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Individuals with HCM demonstrated higher vagal activity (i.e., absolute unit of HF power (7.40 ± 2.50 vs. 6.03 ± 1.35 ms<sup>2</sup>, <i>p</i> = 0.01) but lower RR interval (914 ± 178 vs. 1014 ± 168 ms, <i>p</i> = 0.03) compared to controls. Stroke volume (SV) index and cardiac index were lower in HCM compared with healthy individuals (SV, 33 ± 9 vs. 43 ± 7 ml/beat/m², <i>p</i> < 0.01; cardiac index,2.33 ± 0.42 vs. 3.57 ± 0.82 L/min/m<sup>2</sup>, <i>p</i> < 0.01), but total peripheral resistance (TPR) was higher in HCM (3468 ± 1027 vs. 2953 ± 1050 dyn·s<i>·m</i><sup><i>2</i></sup>cm<sup><i>−</i>5</sup>, <i>p</i> = 0.03). HF power was significantly related to SV (<i>r</i> = −0.46, <i>p</i> < 0.01) and TPR (<i>r</i> = 0.28, <i>p</i> < 0.05) in HCM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Short-term frequency domain indices of HRV provide a feasible approach to assess autonomic function in individuals with HCM. Vagal activity, represented by HF power, is increased, and associated with peripheral resistance in individuals with HCM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10045998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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