HIV testing after implementation of name-based reporting.
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AIDS Serodiagnosis↗
Biomedical subjects
J Myers
Publications and source records attributed to J Myers.
Effect of betaxolol on the hemodynamic, gas exchange, and cardiac output response to exercise in chronic atrial fibrillation.
BACKGROUND: beta-blockade controls the ventricular response to exercise in chronic atrial fibrillation (AF), but the effects of beta-blockers on exercise capacity in AF have been debated. METHODS: Twelve men with AF (65+/-8 years) participated in a randomized, double-blind, placebo-controlled study of betaxolol (20 mg daily). Patients underwent maximal exercise testing with ventilatory gas exchange analysis, and a separate, submaximal test (50% of maximum) during which cardiac output was measured by a CO2 rebreathing technique. RESULTS: After betaxolol therapy, heart rate was reduced both at rest (92+/-27 vs 62+/-12 beats/min; p < 0.001) and at peak exercise (173+/-22 vs 116+/-24 beats/min; p < 0.001). Maximal oxygen uptake (VO2) was reduced by 19% after betaxolol (21.8+/-5.3 with placebo vs 17.6+/-5.1 mL/kg/min with betaxolol; p < 0.05), with similar reductions observed for maximal exercise time, minute ventilation, and CO2 production. VO2 was reduced by a similar extent (19%) at the ventilatory threshold. Submaximal cardiac output was reduced by 15% during betaxolol therapy (12.9+/-2.3 vs 10.9+/-1.3 L/min; p < 0.05), and stroke volume was higher (88.0+/-21 vs 105.6+/-19 mL/beat; p < 0.05). CONCLUSION: Betaxolol therapy in patients with AF effectively controlled the ventricular rate at rest and during exercise, but also caused considerable reductions in maximal VO2 and cardiac output during exercise. The observed increase in stroke volume could not adequately compensate for reduced heart rate to maintain VO2 during exercise.
Adrenergic beta-Antagonists↗
Clinical, hemodynamic, and cardiopulmonary exercise test determinants of survival in patients referred for evaluation of heart failure.
BACKGROUND: Accurate prognosis in chronic heart failure has become increasingly important in assessing the efficacy of treatment and in appropriately allocating scarce resources for transplantation. Previous studies of severe heart failure have been limited by short follow-up periods and few deaths. OBJECTIVE: To establish clinical, hemodynamic, and cardiopulmonary exercise test determinants of survival in patients with heart failure. DESIGN: Retrospective study. SETTING: Hospital-based outpatient heart failure clinic. PARTICIPANTS: 644 patients referred for evaluation of heart failure over 10 years. MEASUREMENTS: Age, cause of heart failure, body surface area, cardiac index, ejection fraction, pulmonary capillary wedge pressure, left ventricular dimensions, watts achieved during exercise, heart rate, maximum systolic blood pressure, and oxygen uptake (VO2) at the ventilatory threshold and at peak exercise were measured at baseline. Univariate and multivariate analyses were done for clinical, hemodynamic, and exercise test predictors of death. A Cox hazards model was developed for time of death. RESULTS: During a mean follow-up period of 4 years, 187 patients (29%) died and 101 underwent transplantation. Actuarial 1-year and 5-year survival rates were 90.5% and 73.4%, respectively. Resting systolic blood pressure, watts achieved, peak VO2, VO2 at the ventilatory threshold, and peak heart rate were greater among survivors than among nonsurvivors. Cause of heart failure (coronary artery disease or cardiomyopathy) was a strong determinant of death (relative risk for coronary artery disease, 1.73; P< 0.01). By multivariate analysis, only peak VO2 was a significant predictor of death. Stratification of peak VO2 above and below 12, 14, and 16 mL/kg per minute demonstrated significant differences in risk for death, but each cut-point predicted risk to a similar degree. CONCLUSIONS: Peak VO2 outperforms clinical variables, right-heart catheterization data, exercise time, and other exercise test variables in predicting outcome in severe chronic heart failure. Direct measurement of VO2 should be included when clinical or surgical decisions are being made in patients referred for evaluation of heart failure or those considered for transplantation.
Adult↗
The electrocardiographic exercise test in a population with reduced workup bias: diagnostic performance, computerized interpretation, and multivariable prediction. Veterans Affairs Cooperative Study in Health Services #016 (QUEXTA) Study Group. Quantitative Exercise Testing and Angiography.
BACKGROUND: Empirical scores, computerized ST-segment measurements, and equations have been proposed as tools for improving the diagnostic performance of the exercise test. OBJECTIVE: To compare the diagnostic utility of these scores, measurements, and equations with that of visual ST-segment measurements in patients with reduced workup bias. DESIGN: Prospective analysis. SETTING: 12 university-affiliated Veterans Affairs Medical Centers. PATIENTS: 814 consecutive patients who presented with angina pectoris and agreed to undergo both exercise testing and coronary angiography. MEASUREMENTS: Digital electrocardiographic recorders and angiographic calipers were used for testing at each site, and test results were sent to core laboratories. RESULTS: Although 25% of patients had previously had testing, workup bias was reduced, as shown by comparison with a pilot study group. This reduction resulted in a sensitivity of 45% and a specificity of 85% for visual analysis. Computerized measurements and visual analysis had similar diagnostic power. Equations incorporating nonelectrocardiographic variables and either visual or computerized ST-segment measurement had similar discrimination and were superior to single ST-segment measurements. These equations correctly classified 5 more patients of every 100 tested (areas under the receiver-operating characteristic curve, 0.80 for equations and 0.68 for visual analysis; P < 0.001) in this population with a 50% prevalence of disease. CONCLUSIONS: Standard exercise tests had lower sensitivity but higher specificity in this population with reduced work-up bias than in previous studies. Computerized ST-segment measurements were similar to visual ST-segment measurements made by cardiologists. Considering more than ST-segment measurements can enhance the diagnostic power of the exercise test.
Adult↗
Serial exercise testing and prognosis in selected patients considered for cardiac transplantation.
OBJECTIVES: This study sought to examine the predictive value of variables obtained from serial maximal exercise testing, echocardiography, and ejection fraction in patients referred as potential heart transplant candidates. BACKGROUND: Variables such as peak VO2, left ventricular dimensions, ejection fraction, and hemodynamic measurements are known to predict prognosis in heart failure, but there are few data on the impact of serial measurements of these variables on subsequent mortality. METHODS AND RESULTS: Two hundred sixty-three ambulatory patients with severe heart failure referred as potential candidates for heart transplantation who underwent two exercise tests (mean 7.8 months apart) after optimal medical treatment were identified. At the same two time points, echocardiography was performed in 106 (37%) and ejection fraction was measured in 84 (30%). During a mean follow-up period of 3.9+/-0.1 years, 70 (25%) died and 45 (19%) underwent heart transplantation. Exercise capacity, peak exercise heart rate, and peak exercise systolic blood pressure achieved were all significantly higher among survivors compared with nonsurvivors. Among the survivors a slight increase in peak VO2 and ejection fraction were observed, but there were no significant differences in the changes of any of the measured variables between survivors and nonsurvivors. There were no significant differences in survival between patients with increased versus those with decreased peak VO2, left ventricular dimensions, or ejection fraction. CONCLUSION: Although peak VO2, left ventricular dimensions, and ejection fraction predict survival, changes in these parameters do not add any prognostic information in patients with severe heart failure who have been stabilized with optimal medical treatment. Routine use of these procedures therefore does not seem to be warranted and should be performed only in the context of a specific clinical situation. Serial measurements of these parameters do not appear to be useful in the risk stratification of patients referred for heart transplantation.
Case-Control Studies↗
Effects of exercise training on limb blood flow in patients with reduced ventricular function.
BACKGROUND: Among the factors that contribute to limiting exercise tolerance in chronic heart failure are reduced peripheral blood flow and impaired vasodilatory capacity. Exercise training improves vasodilatory capacity in normal subjects, but controlled studies of exercise training evaluating upper and lower limb blood flow rates have not been performed in patients with reduced ventricular function. Improved vasodilatory capacity could help explain how training increases exercise capacity in these patients. METHODS: Twenty patients (mean age 55 +/- 6 years) with reduced left ventricular function (mean ejection fraction 32% +/- 6%) after a myocardial infarction were randomized to a 2-month high-intensity residential rehabilitation program or to a control group and were monitored over the subsequent year. Both groups were treated according to current practice with angiotensin-converting enzyme inhibition therapy. Training began 1 month after myocardial infarction. Baseline and postischemic flow rates were measured by plethysmography in both the upper and lower limbs 1 month, 3 months, and 1 year after the infarction. Peak oxygen uptake (VO2) and cardiac output were measured before and after training, and peak VO2 was determined again after 1 year. RESULTS: After 2 months of training peak VO2 increased 25%, VO2 at the lactate threshold increased 40%, and maximal cardiac output increased from 12.1 +/- 1.6 L/min to 13.9 +/- 2.4 L/min in the exercise group (all p < 0.05), whereas no differences were observed in the control group. At the 1-year follow-up no further increases in peak VO2 were noted in either group, but the higher value persisted in the trained group. However, changes in limb flow rates were poorly related to changes in both peak VO2 and maximal cardiac output. Improvements in baseline and postischemic flow rates occurred mainly in the lower limbs and were observed in the two groups to a similar degree. CONCLUSION: Exercise training is highly effective in improving exercise capacity in patients with reduced ventricular function after myocardial infarction. These improvements parallel an increase in maximal cardiac output, but they are unrelated to vasodilatory capacity. In patients with reduced ventricular function after myocardial infarction, lower limb vasodilatory capacity improves gradually over the subsequent year, and these improvements occur irrespective of exercise training.
Adult↗
Can computerization of the exercise test replace the cardiologist?
BACKGROUND: The type of practitioners who use the standard exercise test is changing. Once a tool of the cardiologist, the standard exercise test is now being performed by internists and other noncardiologists. Because this change could be facilitated by computerization similar to the computerized interpretation programs available for the resting electrocardiograph (ECG), we performed this analysis. A secondary aim was to demonstrate the effects of medication status and resting ECG abnormalities on test diagnostic characteristics because these factors affect utility of the exercise test by the generalist. METHODS AND RESULTS: A retrospective analysis was performed of consecutive patients referred at 2 university-affiliated Veteran's Affairs Medical Centers and a Hungarian Hospital for evaluation of chest pain and possible ischemic heart disease. There were 1384 consecutive male patients without a prior myocardial infarction with complete data who had exercise tests and coronary angiography between 1987 and 1997. Measurements included clinical, exercise test data, and visual interpretation of the ECG recordings as well as more than 100 computed measurements from the digitized ECG recordings and compilation of angiographic data from clinical reports. The computer measurements had similar diagnostic power compared with visual interpretation. Computerized measurements from maximal exercise or recovery were equivalent or superior to all other measurements. Prediction equations applied by computer were superior to single ECG measurements. Beta-blockers had no effect on test characteristics, whereas resting ST depression was associated with decreased specificity and increased sensitivity. CONCLUSIONS: Computerized exercise ST measurements are comparable to visual ST measurements by a cardiologist; computerized scores that included clinical and exercise test results exhibited the greatest diagnostic power. Applying scores with a computer allows the practicing physician to improve the diagnostic characteristics of the standard exercise test. This approach is successful even when there is resting ST depression, thus lessening the need for more expensive nuclear or imaging studies.
Adult↗
Influence of exercise training on blood viscosity in patients with coronary artery disease and impaired left ventricular function.
Exercise training has recently become an accepted therapeutic modality in chronic heart failure after myocardial infarction. Because the therapeutic mechanism behind it is controversial and not well understood, we analyzed the influence of exercise training on blood viscosity. Twenty-five patients with chronic heart failure (ejection fraction < 40%) after myocardial infarction were randomly assigned to either an 8-week intensive exercise program at a residential rehabilitation center or 8 weeks of sedentary life at home. Exercise consisted of two 1-hour walking sessions per day and four intensive bicycle ergometer training sessions of 40 minutes at 70% to 80% peak exercise capacity per week. Whole blood viscosity, viscosity at standardized hematocrit of 45% (P45) at high and low shear rates, and plasma viscosity were measured in a Couette-type viscometer before, during, and at the end of the study period. Exercise training, which significantly increased maximal cardiac output and oxygen uptake, did not change plasma viscosity, whole blood viscosity, and P45 significantly. Sedentary controls, however, had a higher whole blood viscosity and P45 after 8 weeks. No statistical difference was found, however, between the two groups. We conclude that blood rheology remains unaffected by exercise training in patients with chronic heart failure. The improvement of blood viscosity remains an interesting therapeutic option for the symptoms of these patients, which must be achieved by methods other than exercise training.
Blood Viscosity↗
Immunoreactivity for LN2 and LN3 distinguishes small cell carcinomas from non-small cell carcinomas in the lung.
Immunoreactivity to LN2 and LN3, monoclonal antibodies that recognize components of the class II major histocompatibility complex, was assessed in 72 cases of non-small cell lung carcinoma (NSCLC) (32 biopsy specimens, 40 resection specimens) and 64 cases of small cell carcinoma (56 biopsy specimens, 8 resections) of the lung. All cases were reviewed independently by three pathologists for histological classification. Only 1 of the 64 small cell carcinomas showed immunoreactivity for LN2, and none of the 64 cases showed reactivity for LN3. Among the non-small cell carcinomas, 25 of 48 cases were positive for LN2 and 43 of 71 were positive for LN3; the sensitivity was greater for adenocarcinoma (78.5%) than for squamous cell carcinoma (37%). A combined sensitivity of 64.7% was observed when the results of LN2 and LN3 were combined, and this sensitivity was not significantly diminished in the biopsy subset of cases (59.4%). Differentiation within histological subtypes of NSCLC (ie, well, moderate, or poorly differentiated) did not alter test sensitivity. In conclusion, LN2 and LN3, used alone or in combination, appear highly specific for non-small cell carcinoma and moderately sensitive in both biopsy and resection specimens; therefore, these antibodies may be diagnostically useful in distinguishing small cell from non-small cell carcinoma of the lung.
Antibodies, Monoclonal↗
Effect of spinal cord injury on the heart and cardiovascular fitness.
The use of various FES protocols to encourage increases in physical activity and to augment physical fitness and reduce heart disease risk is a relatively new, but growing field of investigation. The evidence so far supports its use in improving potential health benefits for patients with SCI. Such benefits may include more efficient and safer cardiac function; greater stimulus for metabolic, cardiovascular, and pulmonary training adaptations; and greater stimulus for skeletal muscle training adaptations. In addition, the availability of relatively inexpensive commercial FES units to elicit muscular contractions, the ease of use of gel-less, reusable electrodes, and the increasing popularity of home and commercial upper body exercise equipment mean that such benefits are likely to be more accessible to the SCI population through increased convenience and decreased cost. The US Department of Health and Human Services has identified those with SCI as a "special population" whose health problems are accentuated, and so need to be specifically addressed. FES presents "a clear opportunity.... For health promotion and disease prevention efforts to improve the health prospects and functional independence of people with disabilities." As a corollary to this, the Centers for Disease Control and Prevention have recommended the development of techniques to prevent or ameliorate secondary disabilities in persons with a SCI. Patients with SCI have an increased susceptibility to cardiac morbidity and mortality in the acute and early stages of their injury. Most of these patients make an excellent adaptation except when confronted with infection or hypoxia. SCI by itself does not promote atherosclerosis; however, in association with multiple secondary conditions related to SCI, along with advancing age, patients with SCI are predisposed to relatively greater risk of heart disease. The epidemiologic significance of this is reflected in demographic studies that indicate an increasing number of SCI patients becoming aged. Currently 71,000 (40%) of the total 179,000 patients with SCI living in the United States are older than 40 years, and 45,000 have injuries sustained more than 20 years earlier. In addition, new injuries in the older population are increasing (currently 11% of all injuries), and some of these new patients with SCI already have pre-existing cardiac disease. Studies have demonstrated that improved lifestyle, physical activity, lipid management, and dietary restrictions can affect major risk factors for coronary artery disease. Therefore an aggressive cardiac prevention program is appropriate for patients with SCI as part of their rehabilitation. At a given submaximal workload, arm exercise is performed at a greater physiologic cost than is leg exercise. At maximal effort, however, physiologic responses are generally greater in leg exercise than arm exercise. Arm exercise is less efficient and less effective than lower body exercise in developing and maintaining both central and peripheral aspects of cardiovascular fitness. The situation is further compounded in SCI because of poor venous return as a result of lower-limb blood pooling, as a result of lack of sympathetic tone, and a diminished or absent venous "muscle pump" in the legs. This latter mechanism perhaps contributes the greatest diminution in the potential for aerobic performance in the SCI population. Obtaining a cardiopulmonary training effect in individuals with SCI is quite possible. Current studies indicate decreases in submaximal HR, respiratory quotient, minute ventilation, and oxygen uptake, with increases in maximal power output, oxygen uptake, minute ventilation, and lactic acid. Individuals with SCI have been shown to benefit from lower limb functional electrical stimulation (FES)-induced exercise. Studies have consistently reported increases in lower limb strength and cycle endurance performance with these protocols, as well as improvements in metabolic and
Autonomic Nervous System Diseases↗
Filling the gap: weaning practices of children aged 0-2 years in western metropolitan Melbourne.
OBJECTIVE: To investigate weaning practices of children aged 0-2 years in Melbourne's western metropolitan region (WMR). METHODOLOGY: The study group comprised children aged 0-2 years attending six maternal and child health centres in the City of Brimbank in Melbourne's WMR. One hundred and nineteen parents were asked to complete a questionnaire about their child. Interpreters were used as required. In total, 115 questionnaires were completed representing a response rate of 97%. All maternal and child health nurses working in the target region were asked to complete a questionnaire. Of these, five were selected randomly to participate in follow-up indepth interviews. Weaning was defined as the addition of food/fluids other than breast milk or formula. RESULTS: The mean age for the introduction of solids was 4.3 months. Of the children already introduced to solids, 67% had commenced between 4 and 6 months whilst 29% of the infants were taking solids by 3 months of age. Of the children already having juice, 85% had done so by the age of 6 months. The mean age for the introduction of cow's milk as the main drink was 10.7 months (S.D. 2.8). For English speaking families the mean age was 11.3 months (S.D. 1.8) whilst for families speaking languages other than English the mean age was 9.7 months (S.D. 4.1). CONCLUSIONS: Most parents in this group were following the recommended guidelines for weaning. Some parents had poor knowledge of appropriate weaning time, use of fruit juice and introduction of cow's milk as the main drink. Additional information and education is required in these areas. Further investigation is required in relation to use of cow's milk and ethnicity.
Australia↗
Transcriptional regulation of fibroblast growth factor-2 expression in human astrocytes: implications for cell plasticity.
Induction of the fibroblast growth factor-2 (FGF-2) gene and the consequent accumulation of FGF-2 in the nucleus are operative events in mitotic activation and hypertrophy of human astrocytes. In the brain, these events are associated with cellular degeneration and may reflect release of the FGF-2 gene from cell contact inhibition. We used cultures of human astrocytes to examine whether expression of FGF-2 is also controlled by soluble growth factors. Treatment of subconfluent astrocytes with interleukin-1beta, epidermal or platelet-derived growth factors, 18-kDa FGF-2, or serum or direct stimulation of protein kinase C (PKC) with phorbol 12-myristate 13-acetate or adenylate cyclase with forskolin increased the levels of 18-, 22-, and 24-kDa FGF-2 isoforms and FGF-2 mRNA. Transfection of FGF-2 promoter-luciferase constructs identified a unique -555/-513 bp growth factor-responsive element (GFRE) that confers high basal promoter activity and activation by growth factors to a downstream promoter region. It also identified a separate region (-624/-556 bp) essential for PKC and cAMP stimulation. DNA-protein binding assays indicated that novel cis-acting elements and trans-acting factors mediate activation of the FGF-2 gene. Southwestern analysis identified 40-, 50-, 60-, and 100-kDa GFRE-binding proteins and 165-, 112-, and 90-kDa proteins that interacted with the PKC/cAMP-responsive region. The GFRE and the element essential for PKC and cAMP stimulation overlap with the region that mediates cell contact inhibition of the FGF-2 promoter. The results show a two-stage regulation of the FGF-2 gene: 1) an initial induction by reduced cell contact, and 2) further activation by growth factors or the PKC-signaling pathway. The hierarchic regulation of the FGF-2 gene promoter by cell density and growth factors or PKC reflects a two-stage activation of protein binding to the GFRE and to the PKC/cAMP-responsive region, respectively.
Astrocytes↗
Does race influence the provision of care to persons with sickle cell disease? Perceptions of multidisciplinary providers.
This study examined whether multidisciplinary health care providers (HCPs) perceived race of persons with sickle cell disease (SCD) as an influence in the delivery of health care. A total of 227 multidisciplinary HCPs completed the three-item Influence of Patient Race on Provision of Health Care Services Index (Cronbach's alpha = 0.77). Results suggest that African American HCPs were more likely to perceive race as an influence along all scale items, whereas Caucasian and other race HCPs did not. Female HCPs and those who serve adults were more likely than male HCPs and those who serve children to perceive race as having an influence on the quality of health care. Findings suggest a need for the examination of the health care delivery systems in which persons with SCD receive care to determine if race does, in fact, affect the delivery of health care and to explain the discrepancies in the perceptions of the HCPs.
Adult↗
A randomized comparison of exercise training in patients with normal vs reduced ventricular function.
BACKGROUND: Exercise training is recommended after myocardial infarction (MI) or bypass surgery in order to improve exercise tolerance. In some patients, the decrement in exercise capacity secondary to deconditioning and the left ventricular stunning associated with MI or coronary artery bypass graft (CABG) spontaneously improves after the event. However, the impact of the status of the left ventricle on these improvements is unknown. METHODS: Sixty-seven patients 1 month after MI or CABG were randomized to a training (n=34; age, 59+/-7 years) or a control group (n=33; age, 55+/-6 years). Forty-two patients had an ejection fraction >50% (22 in the training group and 20 in the control group), and 25 patients had an ejection fraction <40% (12 in the exercise group and 13 in the control group). After stabilization for approximately 1 month after the event, patients in the exercise group underwent 8 weeks of twice daily exercise at a residential rehabilitation center, while control patients received usual care. Initially and after 8 weeks, patients in both groups underwent maximal exercise testing with gas exchange and lactate analysis. RESULTS: Exercise training increased peak oxygen consumption (VO2) only in the reduced ejection fraction group (19.4+/-3.0 to 23.9+/-4.8 mL/kg/min; p<0.05); the exercise group with normal ventricular function did not change significantly. Changes in VO2 at the lactate threshold paralleled those of peak VO2 for both groups. Conversely, control patients with normal ventricular function increased peak VO2 spontaneously (20.8+/-3.9 to 24.8+/-3.5 mL/kg/min; p<0.01), whereas control patients with reduced ventricular function did not improve peak VO2. CONCLUSION: These data suggest that patients with depressed left ventricular function strongly benefit from rehabilitation, whereas most patients with preserved left ventricular function following MI or CABG tend to improve spontaneously 1 to 3 months after the event.
Coronary Artery Bypass↗
Predicting severe angiographic coronary artery disease using computerization of clinical and exercise test data.
Currently the standard exercise test is shifting from being a tool for the cardiologist to utilization by the nonspecialist. This change could be facilitated by computerization similar to the interpretation programs available for the resting ECG. Therefore, we sought to determine if computerization of both exercise ECG measurements and prediction equations can substitute for visual analysis performed by cardiologists to predict which patients have severe angiographic coronary artery disease. We performed a retrospective analysis of consecutive patients referred for evaluation of possible or known coronary artery disease who underwent both exercise testing with digital recording of their exercise ECGs and coronary angiography at two university-affiliated Veteran's Affairs medical centers and a Hungarian hospital. There were 2,385 consecutive male patients with complete data who had exercise tests between 1987 and 1997. Measurements included clinical and exercise test data, and visual interpretation of the ECG paper tracings and > 100 computed measurements from the digitized ECG recordings and compilation of angiographic data from clinical reports. The computer measurements had similar diagnostic power compared with visual interpretation. Computerized ECG measurements from maximal exercise or recovery were equivalent or superior to all other measurements. Prediction equations applied by computer were only able to correctly classify two or three more patients out of 100 tested than ECG measurements alone. beta-Blockers had no effect on test characteristics while ST depression on the resting ECG decreased specificity. By setting probability limits using the scores from the equations, the population was divided into high-, intermediate-, and low-probability groups. A strategy using further testing in the intermediate group resulted in 86% sensitivity and 85% specificity for identifying patients with severe coronary disease. We conclude that computerized exercise ST measurements are comparable to visual ST measurements by a cardiologist and computerized scores only minimally improved the discriminatory power of the test. However, using these scores in a stratification algorithm allows the nonspecialist physician to improve the discriminatory characteristics of the standard exercise test even when resting ST depression is present. Computerization permitted accurate identification of patients with severe coronary disease who require referral.
Coronary Angiography↗
Can an herb really help depression?
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Antidepressive Agents↗
The role of exercise testing and gas-exchange measurement in the prognostic assessment of patients with heart failure.
Functional impairment has long been recognized as an important factor in the risk paradigm among patients with heart disease. In chronic heart failure, this issue has been even more important in recent years because of the steady growth in the number of patients awaiting heart transplantation relative to the available pool of donor hearts. The use of gas-exchange techniques to assess patients with heart failure has attracted interest because these techniques provide a more precise, reproducible, objective, and physiologic expression of exercise tolerance. Numerous studies published in the 1990s demonstrate that maximal oxygen uptake (peak VO2) is an independent predictor of mortality in patients with heart failure. Achievement of a peak VO2 that is less than 14 mL/kg/min has been recognized as one of the relative indications for transplantation, because patients who achieve a measurement that is higher than 14 mL/kg/min have a 1-year mortality rate similar to that of patients who undergo transplantation (i.e., > 90%). However, some debate exists regarding the optimal cutpoint that separates survivors from nonsurvivors, and studies have not consistently defined the timing of the test relative to optimization of medical therapy. It has also been debated which hemodynamic variables, at rest or during exercise, should be used in combination with peak VO2 to optimally stratify risk in these patients. This article reviews the applications of cardiopulmonary exercise testing in prognosis among patients with chronic heart failure.
Chronic Disease↗
Optimal timing of phase II rehabilitation after cardiac surgery. The cardiologist's view.
Structured programmes of rehabilitation have been shown to be effective in restoring functional capacity, increasing return to work and improving the psychosocial status of patients following open heart surgery. However, uncertainty still exists about the optimal timing of rehabilitation after cardiac surgery. Data in the literature suggest that phase II rehabilitation can begin as early as one week after open heart surgery without having a negative influence on infections, mortality or readmissions. Early rehabilitation can even improve graft patency after CABG. However, age, operative complications and co-morbidities must be considered individually for each patient when determining the beginning of phase II rehabilitation.
Cardiology↗