1,720,983 research outputs found
Novel strategies: challenge loop diuretics and sodium management in heart failure--part II.
No full textExercise training in patients with chronic heart failure: A new challenge for Cardiac Rehabilitation Community.
No full textExercise training (ET) is strongly recommended in patients with
chronic stable heart failure (HF). Moderate-intensity aerobic continuous
ET is the best-established training modality in HF patients. In the
last decade, however, high-intensity interval exercise training (HIIT)
has aroused considerable interest in cardiac rehabilitation community.
In HF patients, HIIT exerts larger improvements in exercise capacity
compared to moderate-continuous ET. Since better functional capacity
translates into symptoms relief and improvement in quality of life in
patients with HF, this training modality is collecting growing interest
and consensus, not revealing major safety issues. HIIT should not replace
other training modalities in HF but should rather complement
them. Inspiratory muscle training, another promising training modality
in patients with HF, exerts beneficial effect on inspiratory muscle
strength and inspiratory endurance, on exercise capacity and quality of
life. In conclusion, taking into consideration the complecity of HF syndrome,
combining and tailoring different ET modalities according to
each patient’s baseline clinical characteristics (i.e., exercise capacity,
comorbidity, frailty status, personal needs, preferences and goals)
seem the wiliest approach for exercise prescription. The present review
aims at discussing the rececent evidences on the effects of exercise
training in patients with chronic HF (with both reduced and preserved
left ventricular function)
Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure.
No full textNormal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend?
No full textThe aim of the present study was to evaluate the effects of a normal-sodium (120 mmol sodium) diet compared with a low-sodium diet (80 mmol sodium) on readmissions for CHF (congestive heart failure) during 180 days of follow-up in compensated patients with CHF. A total of 232 compensated CHF patients (88 female and 144 male; New York Heart Association class II–IV; 55–83 years of age, ejection fraction <35% and serum creatinine <2 mg/dl) were randomized into two groups: group 1 contained 118 patients (45 females and 73 males) receiving a normal-sodium diet plus oral furosemide [250–500 mg, b.i.d. (twice a day)]; and group 2 contained 114 patients (43 females and 71 males) receiving a low-sodium diet plus oral furosemide (250–500 mg, b.i.d.). The treatment was given at 30 days after discharge and for 180 days, in association with a fluid intake of 1000 ml per day. Signs of CHF, body weight, blood pressure, heart rate, laboratory parameters, ECG, echocardiogram, levels of BNP (brain natriuretic peptide) and aldosterone levels, and PRA (plasma renin activity) were examined at baseline (30 days after discharge) and after 180 days. The normal-sodium group had a significant reduction (P<0.05) in readmissions. BNP values were lower in the normal-sodium group compared with the low sodium group (685±255 compared with 425±125 pg/ml respectively; P<0.0001). Significant (P<0.0001) increases in aldosterone and PRA were observed in the low-sodium group during follow-up, whereas the normal-sodium group had a small significant reduction (P=0.039) in aldosterone levels and no significant difference in PRA. After 180 days of follow-up, aldosterone levels and PRA were significantly (P<0.0001) higher in the low-sodium group. The normal-sodium group had a lower incidence of rehospitalization during follow-up and a significant decrease in plasma BNP and aldosterone levels, and PRA. The results of the present study show that a normal-sodium diet improves outcome, and sodium depletion has detrimental renal and neurohormonal effects with worse clinical outcome in compensated CHF patients. Further studies are required to determine if this is due to a high dose of diuretic or the low-sodium diet
Safety and feasibility of atropine added in patients with sub-maximal heart rate during exercise myocardial perfusion SPECT.
No full textBackground Failure to reach 80% of maximal predicted heart rate (HR) during exercise may render a myocardial perfusion single photon emission computed tomography (SPECT) study non-diagnostic for ischemia detection. We sought to investigate the injection of atropine in patients who fail to achieve 80% of age-predicted HR during exercise performed for myocardial perfusion SPECT (MPS), defining its safety and efficacy to raise HR to adequate levels as well as its effect on MPS interpretation
Prognostic Value of the 6-Min Walk Test After Open-Heart Valve Surgery: EXPERIENCE OF A CARDIOVASCULAR REHABILITATION PROGRAM
No full textPURPOSE:
This single-center retrospective analysis aimed to evaluate the prognostic relevance of 6-min walk test (6MWT) in patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery.
METHODS:
One hundred one patients able to perform a 6MWT within the first week of admission (time after surgery: 16 ± 8 d) were included (age 68 ± 11 y; 55% female; median left ventricular ejection fraction 55% [interquartile range: 50-60]; 51% after aortic valve surgery). Study endpoints were cardiovascular death and the combined outcome of cardiovascular death/cardiac hospitalization. Univariate and multivariate analyses were performed to analyze predictive value of the 6MWT.
RESULTS:
After a median follow-up of 27 mo, cardiovascular mortality was 9.9% while combined endpoint occurrence was 33%. Patients experiencing study endpoints had lower left ventricular ejection fraction, higher N-terminal prohormone of brain natriuretic peptide serum levels, and longer in-hospital stay (all P < .05). The 6MWT distance was a significant predictor of cardiovascular death (hazard ratio [HR] = 0.89, 95% CI: 0.81-0.97, P = .007) and cardiac hospitalizations (HR = 0.95, 95% CI: 0.90-0.99, P = .02). Even after adjusting for the relevant confounding variables of cardiovascular death and cardiac hospitalization, the adjusted HR = 0.88, 95% CI: 0.75-0.98, P = .028 and adjusted HR = 0.95, 95% CI: 0.90-0.99, P = .05, respectively.
CONCLUSIONS:
In patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery, 6MWT proved to be an independent prognostic tool, potentially allowing identification of high-risk patients for whom a more intensive and tailored in-hospital cardiovascular rehabilitation program should be designed and implemented in order to avoid unfavorable cardiovascular events
Has something changed in the smoking attitudes of parents in the household in the last 15 years? Epidemiological survey among the students of the city of Agrigento [È cambiato qualcosa nelle abitudini dei genitori fumatori in ambito domestico negli ultimi 15 anni? Indagine epidemiologica tra gli alunni della città di Agrigento]
No full textBACKGROUND:
Exposure of children to passive tobacco smoking in the household setting has been demonstrated to cause respiratory diseases. Early atherosclerosis has also been demonstrated in young people previously exposed to passive tobacco smoking. Functional damage can initiate at the fetal age due to maternal smoking, with a tendency towards over-time progress. To date only scant data are available about indoor parental smoking attitudes and their changes after campaigns against smoke and risk factors in exposed youths. Questionnaires are useful tools in order to search for information on cigarette smoking and parental household lifestyle. In this study, we asked pupils of primary schools for providing information on their relatives' every 5 years throughout the period 1994-2009.
METHODS:
A multiple-choice answer questionnaire about sharing household parental smoking was administered to all primary school children (mean age 10.5 ± 0.5 years) of the city of Agrigento (Sicily, Italy).
RESULTS:
A total of 2221 questionnaires were collected from 637 children in 1994, 687 in 1999, 516 in 2004, and 381 in 2009. Important findings show a significant reduction in both smoking parents and exposure to passive tobacco smoking (from 64% in 1994 to 45% in 2009, p<0.00001). In 2009, 22% of mothers and 39% of fathers resulted to be smokers in the household setting yet.
CONCLUSIONS:
In agreement with the 2011 Italian DOXA survey on the general population, the present study demonstrates a negative trend in the prevalence of household smoker parents (predominantly mothers) and exposure of children to passive tobacco smoking. These results likely reflect such a greater awareness about smoke-related risks in children, and the effectiveness of medical campaigns against cardiovascular risk factors as well
Effect of intravenous iron replacement therapy on exercise capacity in iron deficient anemic patients after cardiac surgery
No full textIron deficiency (ID) is recognized as an important comorbidity in patients undergoing cardiac surgery; however, it still remains under-diagnosed and
under-treated in clinical practice. This study aims at comparing efficacy and the effects on exercise capacity of intravenous ferric carboxymaltose (FCM) versus ferric gluconate (FG) in patients with ID anemia (IDA) resulting from cardiac surgery. We retrospectively analyzed data from our records of in-hospital patients with IDA after cardiac surgery undergoing cardiac rehabilitation. Group I was treated with FG, group II with FCM. Efficacy measures included changes (baseline vs discharge) in hemoglobin (Hb) and in distance traveled at six-minutes walking test (6MWT). Data from 74 in-patients (mean age 67.5±10.4 years, 43% women) were analyzed. At discharge, patients treated with FCM showed higher levels of Hb (11.1±1.2g/dl vs 10.2±1.1 g/dl; p=0.001), greater distance traveled at 6MWT (279.2±108.8 meters vs 236.3±72.7 meters; p=0.048), and lower in-hospital rehabilitation length of stay (20.3±7 vs 25.3±11.7 days; p=0.043) as compared to FG group. At multivariate analysis, the most powerful predictors of Hb increase >1 g/dl at discharge were transferrin levels (p=0.019) and treatment with FCM (p100 meters) at discharge (p=0.13 and p=0.003, respectively). In patients with IDA following cardiac surgery, intravenous FCM is effective in restoring Hb levels and in improving exercise capacity after cardiac surgery
Changes in Brain Natriuretic Peptide Levels and Bioelectrical Impedance Measurements After Treatment With High-Dose Furosemide and Hypertonic Saline Solution Versus High-Dose Furosemide Alone in Refractory Congestive Heart Failure A Double-Blind Study
No full textOBJECTIVES: The aim of this study was to evaluate the effect of a new treatment for refractory congestive heart failure (CHF) on brain natriuretic peptide (BNP) plasma levels and hydration station.
BACKGROUND: The study was aimed at evaluating the effects of the combination of high-dose furosemide and small-volume hypertonic saline solution (HSS) in refractory CHF patients.
METHODS: A total of 94 patients (34 women/60 men) with refractory CHF (age 55 to 80 years) were enrolled. They had to have an ejection fraction <35%, serum creatinine <2 mg/dl, blood urea nitrogen <60 mg/dl, a reduced urinary volume, and a low natriuresis (<500 ml/24 h and <60 mEq/24 h, respectively). Patients were divided (double-blind) into two groups: group 1 (18 women/30 men) received an intravenous furosemide (500 to 1,000 mg) plus HSS twice a day in 30 min. Group 2 (16 women/30 men) received an intravenous bolus of furosemide (500 to 1,000 mg/twice a day) alone, for four to six days. At entry, body weight, blood pressure, heart rate, and laboratory parameters were checked during hospitalization; BNP levels were measured on admission, 6 and 30 days after discharge, while on admission and 6 days after, impedance plethysmography was performed. The HSS group received 120 mmol of Na intake versus 80 mmol in non-HSS group. Fluid intake of 1,000 was given to both groups.
RESULTS: The groups were similar for clinical characteristics. A significant increase in daily diuresis and natriuresis was observed in HSS group, p < 0.05. The BNP values showed significant intragroup and intergroup differences, 6 and 30 days after treatment. The patients from the HSS group reached a better hydration state than the non-HSS group after six days. In addition, the HSS group showed a significant reduction in hospitalization time and readmission rate.
CONCLUSIONS: Our data show that the HSS group reached dry weight more rapidly, a significantly faster reduction in BNP levels, shorter hospitalization stay, and lower incidence in readmissions in the 30-day study period
Impact of "Off-Label" Use of Ivabradine on Exercise Capacity, Gas Exchange, Functional Class, Quality of Life, and Neurohormonal Modulation in Patients With Ischemic Chronic Heart Failure
No full textBackground: Epidemiologic studies indicate that elevated heart rate (HR) is an independent risk factor for mortality and morbidity in patients (pts) with chronic heart failure (CHF). Clinical trials with b-blockers suggest that HR reduction is an important mechanism of their benefit in pts with stable CHF. Pharmacologic inhibition of the If current now provides the opportunity of pure HR reduction. The purpose of this study was to evaluate the impact of ‘‘Off-Label’’ use of ivabradine on exercise capacity, gas exchange, functional class, quality of life, and neurohormonal modulation in pts with ischemic CHF. Methods: Between January 2008 and June 2008, a graded maximal exercise test with respiratory gas analysis and an endurance test with constant workload corresponding to 85% of the peak VO2 at the baseline and after 3 months were performed, and at the same times, N-terminal probrain natriuretic peptide (NT-proBNP) levels were also measured, in 60 pts (45 M, 15 F, mean age 52.7 + 5.3 years), with stable ischemic CHF, New York Heart Association (NYHA) functional classes II (n 1⁄4 35)–III (n 1⁄4 25),
with left ventricular ejection fraction (LVEF) 40%, randomized to a ‘‘off-label’’ ivabradine use (n 1⁄4 30) and a control group
(n 1⁄4 30). Results: The exercise capacity increased from 14.8 + 2.5 to 28.2 + 3.5 min (P < .0001) and the peak oxygen
consumption tended to improve from 13.5 + 1.3 to 17.9 + 2.4 mL/kg per minute (P < .0001) in ivabradine group. Oxygen
consumption at the anaerobic threshold (AT) increased from 11.9 + 1.4 to 15.3 + 1.4 mL/kg per minute (P < .0001). NTproBNP levels decreased from 2356 + 2113 pg/mL to 1434 + 1273 pg/mL (P 1⁄4 .045). No significant differences were found
in control group at 3 months. The positive ivabradine effects were also associated with an improvement in the NYHA functional
class and quality of life. Conclusion: The ‘‘Off-Label’’ use of ivabradine significantly improves the exercise capacity, gas exchange, functional heart failure class, quality of life, and neurohormonal modulation in pts with ischemic CHF.
Epidemiologic studies indicate that elevated heart rate (HR) is an independent risk factor for mortality and morbidity in patients (pts) with chronic heart failure (CHF). Clinical trials with β-blockers suggest that HR reduction is an important mechanism of their benefit in pts with stable CHF. Pharmacologic inhibition of the I(f) current now provides the opportunity of pure HR reduction. The purpose of this study was to evaluate the impact of ''Off-Label'' use of ivabradine on exercise capacity, gas exchange, functional class, quality of life, and neurohormonal modulation in pts with ischemic CHF.
METHODS: between January 2008 and June 2008, a graded maximal exercise test with respiratory gas analysis and an endurance test with constant workload corresponding to 85% of the peak VO(2) at the baseline and after 3 months were performed, and at the same times, N-terminal probrain natriuretic peptide (NT-proBNP) levels were also measured, in 60 pts (45 M, 15 F, mean age 52.7 ± 5.3 years), with stable ischemic CHF, New York Heart Association (NYHA) functional classes II (n = 35)-III (n = 25), with left ventricular ejection fraction (LVEF) ≤ 40%, randomized to a ''off-label'' ivabradine use (n = 30) and a control group (n = 30).
RESULTS: the exercise capacity increased from 14.8 ± 2.5 to 28.2 ± 3.5 min (P < .0001) and the peak oxygen consumption tended to improve from 13.5 ± 1.3 to 17.9 ± 2.4 mL/kg per minute (P < .0001) in ivabradine group. Oxygen consumption at the anaerobic threshold (AT) increased from 11.9 ± 1.4 to 15.3 ± 1.4 mL/kg per minute (P < .0001). NTproBNP levels decreased from 2356 ± 2113 pg/mL to 1434 ± 1273 pg/mL (P = .045). No significant differences were found in control group at 3 months. The positive ivabradine effects were also associated with an improvement in the NYHA functional class and quality of life.
CONCLUSION: the ''Off-Label'' use of ivabradine significantly improves the exercise capacity, gas exchange, functional heart failure class, quality of life, and neurohormonal modulation in pts with ischemic CHF
- …
