101 research outputs found
A Study on Comprehensibility of Concept Descriptions
No full textA transformation of descriptions of concepts without a change of meaning makes sense under a heterogeneous space of concepts, like Explanation-Based Learning (EBL) under the operational criterion. Under finite awareness the heterogeneousness is necessary, because agents have to select certain finite sets of concepts under criterion. Comprehensibility seems to come from the finite awareness, and it should be realized by such a transformation of descriptions. In this paper, we discuss comprehensibility of descriptions using a formalism of first order logic with finite awareness, and a couple of characterisations. Methods to transform descriptions in a sense of goodness discussed in the paper. The address is temporary. After March 1996, author's address will be: Department of Intelligence and Computer Science, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya 466, Japan. E-mail: [email protected] 1 INTRODUCTION We sometimes find it difficult to comprehend descriptio..
Abnormal lung function in adults with congenital heart disease: prevalence, relation to cardiac anatomy, and association with survival
No full textBACKGROUND: Restrictive lung defects are associated with higher mortality in patients with acquired chronic heart failure. We investigated the prevalence of abnormal lung function, its relation to severity of underlying cardiac defect, its surgical history, and its impact on outcome across the spectrum of adult congenital heart disease. METHODS AND RESULTS: A total of 1188 patients with adult congenital heart disease (age, 33.1+/-13.1 years) undergoing lung function testing between 2000 and 2009 were included. Patients were classified according to the severity of lung dysfunction based on predicted values of forced vital capacity. Lung function was normal in 53% of patients with adult congenital heart disease, mildly impaired in 17%, and moderately to severely impaired in the remainder (30%). Moderate to severe impairment of lung function related to complexity of underlying cardiac defect, enlarged cardiothoracic ratio, previous thoracotomy/ies, body mass index, scoliosis, and diaphragm palsy. Over a median follow-up period of 6.7 years, 106 patients died. Moderate to severe impairment of lung function was an independent predictor of survival in this cohort. Patients with reduced force vital capacity of at least moderate severity had a 1.6-fold increased risk of death compared with patients with normal lung function (P=0.04). CONCLUSIONS: A reduced forced vital capacity is prevalent in patients with adult congenital heart disease; its severity relates to the complexity of the underlying heart defect, surgical history, and scoliosis. Moderate to severe impairment of lung function is an independent predictor of mortality in contemporary patients with adult congenital heart disease
Response to letter regarding article, comprehensive use of cardiopulmonary exercise testing identifies adults with congenital heart disease at increased mortality risk in the medium term
No full textPeak oxygen uptake correlates with disease severity and predicts outcome in adult patients with Ebstein's anomaly of the tricuspid valve
No full textComprehensive use of cardiopulmonary exercise testing identifies adults with congenital heart disease at increased mortality risk in the medium term
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Background—
Parameters of cardiopulmonary exercise testing were recently identified as strong predictors of mortality in adults with congenital heart disease. We hypothesized that combinations of cardiopulmonary exercise testing parameters may provide optimal prognostic information on midterm survival in this population.
Methods and Results—
A total of 1375 consecutive adult patients with congenital heart disease (age, 33±13 years) underwent cardiopulmonary exercise testing at a single center over a period of 10 years. Peak oxygen consumption (peak V̇
o
2
), ventilation per unit of carbon dioxide production (V̇
e
/V̇
co
2
slope), and heart rate reserve were measured. During a median follow-up of 5.8 years, 117 patients died. Peak V̇
o
2
, heart rate reserve, and V̇
e
/V̇
co
2
slope were related to midterm survival in adult patients with congenital heart disease. Risk of death increased with lower peak V̇
o
2
and heart rate reserve. A higher V̇
e
/V̇
co
2
slope was also related to increased risk of death in noncyanotic patients, whereas the V̇
e
/V̇
co
2
slope was not predictive of mortality in cyanotic patients. The combination of peak V̇
o
2
and heart rate reserve provided the greatest predictive information after adjustment for clinical parameters such as negative chronotropic agents, age, and presence of cyanosis. However, the incremental value of these exercise parameters was reduced in patients with peak respiratory exchange ratio <1.0.
Conclusions—
Cardiopulmonary exercise testing provides strong prognostic information in adult patients with congenital heart disease. Prognostication should be approached differently, depending on the presence of cyanosis, use of rate-lowering medications, and achieved level of exercise. We provide 5-year survival prospects based on cardiopulmonary exercise testing parameters in this growing population.
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Detrimental impact of socioeconomic status on exercise capacity in adults with congenital heart disease
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