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Samartzis L, Dimopoulos S, Tziongourou M, Koroboki E, Kyprianou T, Nanas S. SSRIs versus exercise training for depression in chronic heart failure: a meta-analysis of randomized controlled trials. Int J Cardiol 2013; 168:4956-8. [PMID: 23920059 DOI: 10.1016/j.ijcard.2013.07.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/13/2013] [Indexed: 02/07/2023]
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Tzanis G, Philippou A, Dimopoulos S, Karatzanos E, Sousonis V, Kapelios C, Rontogianni D, Terrovitis J, Koutsilieris M, Nanas S. Anabolic effects of interval exercise training on skeletal muscle of patients with chronic heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zis P, Dimopoulos S, Markaki V, Tavernarakis A, Nanas S. Non-coronary myocardial infarction in myasthenia gravis: Case report and review of the literature. World J Cardiol 2013; 5:265-269. [PMID: 23888198 PMCID: PMC3722426 DOI: 10.4330/wjc.v5.i7.265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/10/2013] [Accepted: 07/05/2013] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular adverse events in patients with myasthenia gravis (MG) are rare, but the early recognition of such events is crucial. We describe a case of a non-coronary myocardial infarction (MI) during the initial treatment period with pyridostigmine bromide in a female patient with MG. Clinicians should be cautious about the appearance of potential MI in patients with MG. A baseline electrocardiogram is advocated, when the early recognition of the MI clinical signs and the laboratory findings (myocardial markers) are vital to the immediate and appropriate management of this medical emergency, as well as to prevent future cardiovascular events. In this case report possible causes of myocardial adverse events in the context of MG, which may occur during the ongoing treatment and the clinical course of the disease, are discussed.
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Maffiuletti NA, Roig M, Karatzanos E, Nanas S. Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review. BMC Med 2013; 11:137. [PMID: 23701811 PMCID: PMC3668245 DOI: 10.1186/1741-7015-11-137] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/19/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically ill patients, in comparison with usual care. METHODS We searched PubMed, CENTRAL, CINAHL, Web of Science, and PEDro to identify randomized controlled trials exploring the effect of NMES in critically ill patients, which had a well-defined NMES protocol, provided outcomes related to skeletal-muscle strength and/or mass, and for which full text was available. Two independent reviewers extracted data on muscle-related outcomes (strength and mass), and participant and intervention characteristics, and assessed the methodological quality of the studies. Owing to the lack of means and standard deviations (SDs) in some studies, as well as the lack of baseline measurements in two studies, it was impossible to conduct a full meta-analysis. When means and SDs were provided, the effect sizes of individual outcomes were calculated, and otherwise, a qualitative analysis was performed. RESULTS The search yielded 8 eligible studies involving 172 patients. The methodological quality of the studies was moderate to high. Five studies reported an increase in strength or better preservation of strength with NMES, with one study having a large effect size. Two studies found better preservation of muscle mass with NMES, with small to moderate effect sizes, while no significant benefits were found in two other studies. CONCLUSIONS NMES added to usual care proved to be more effective than usual care alone for preventing skeletal-muscle weakness in critically ill patients. However, there is inconclusive evidence for its benefit in prevention of muscle wasting.
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Kutlay S, Kurultak I, Nergizoglu G, Erturk S, Karatan O, Azevedo P, Pinto CT, Pereira CM, Marinho A, Vanmassenhove J, Hoste E, Glorieux G, Dhondt A, Vanholder R, Van Biesen W, Rei S, Aleksandrova I, Kiselev V, Ilynskiy M, Berdnikov G, Marchenkova L, Vanmassenhove J, Hoste E, Glorieux G, Dhondt A, Vanholder R, Van Biesen W, Daher EF, Vieira APF, Souza JB, Falcao FS, Costa CR, Fernandes AACS, Mota RMS, Lima RSA, Silva Junior GB, Ulusal Okyay G, Erten Y, Er R, Aybar M, Inal S, Tekbudak M, Aygencel G, Onec K, Bali M, Sindel S, Soto K, Fidalgo P, Papoila AL, Vanmassenhove J, Hoste E, Glorieux G, Dhondt A, Vanholder R, Van Biesen W, Lentini P, Zanoli L, Granata A, Contestabile A, Basso A, Berlingo G, de Cal M, Pellanda V, Dell'Aquila R, Fortrie G, Stads S, van Bommel J, Zietse R, Betjes MG, Berrada A, Arias C, Riera M, Orfila MA, Rodriguez E, Barrios C, Peruzzi L, Chiale F, Camilla R, Martano C, Cresi F, Bertino E, Coppo R, Klimenko A, Villevalde S, Efremovtseva M, Kobalava Z, Pipili C, Ioannidou S, Kokkoris S, Poulaki S, Tripodaki ES, Parisi M, Papastylianou A, Nanas S, Wang YN, Cheng H, Chen YP, Wen Z, Li X, Shen P, Zou Y, Lu Y, Ma X, Chen Y, Ren H, Chen X, Chen N, Yue T, Cheng H, Chen YP, Elmamoun S, Wodeyar H, Goldsmith C, Abraham A, Wootton A, Ahmed S, Hill C, Curtis S, Miller A, Hine T, Stevens KK, Patel RK, Mark PB, Delles C, Jardine AG, Wilflingseder J, Heinzel A, Mayer P, Perco P, Kainz A, Mayer B, Oberbauer R, Huang TM, Wu VC, Park DJ, Bae EJ, Kang YJ, Cho HS, Chang SH, Lentini P, Zanoli L, Granata A, Contestabile A, Berlingo G, Basso A, Pellanda V, de Cal M, Stramana R, Cognolato D, Baiocchi M, Dell'Aquila R, Chiella BM, Pilla C, Balbinotto A, Antunes VH, Heglert A, Collares FM, Thome FS, Gjyzari A, Thereska N, Xhango O, Xue J, Chen MC, Wang L, Chen YJ, Sun XZ, An WS, Kim ES, Son YK, Kim SE, Kim KH, Oh YJ, Tsai HB, Ko WJ, Chao CT, Fortrie G, Stads S, Aarnoudse AJL, Zietse R, Betjes MG, Peride I, Radulescu D, Niculae A, Ciocalteu A, Checherita AI, Kao CC, Wang CY, Lai CF, Huang TM, Chen HH, Wu VC, Ko WJ, Wu KD, Klaus F, Goldani JC, Cantisani G, Zanotelli ML, Carvalho L, Klaus D, Garcia VD, Keitel E, Hussaini SM, Rao PN, Kul A, Ye N, Zhang Y, Cheng H, Chen YP, Baines R, Westacott R, Trew J, Kirtley J, Selby N, Carr S, Xu G, Steffgen J, Blaschke S, Brun-Schulte-Wissing N, Pagel P, Huber F, Mapes J, Jaehnige A, Pestel S, Deray G, Rouviere O, Bacigalupo L, Maes B, Hannedouche T, Vrtovsnik F, Rigothier C, Billiouw JM, Campioni P, Marti-Bonmati L, Gao YM, Li D, Cheng H, Chen YP, Woo S, Lee J, Noh H, Kwon SH, Han DC, Hetherington L, Valluri A, McQuarrie E, Fleming S, Geddes C, Bell S, MacKinnon B, Bell S, Patton A, Sneddon J, Donnan P, Vadiveloo T, Marwick C, Bennie M, Davey P, Yasuda H, Tsuji N, Tsuji T, Iwakura T, Ohashi N, Kato A, Fujigaki Y, Sasaki S, Kawarazaki H, Shibagaki Y, Kimura K, Lingaraju U, Rajanna S, Radhakrishnan H, Parekh A, Sreedhar CG, Sarvi R, Rainone F, Merlino L, Ritchie JP, Kalra PA, Daher EF, Vieira APF, Jacinto CN, Abreu KLS, Silva Junior GB, Neves M, Baptista JP, Rodrigues L, Pinho J, Teixeira L, Pimentel J, Gonzalez Sanchidrian S, Rangel Hidalgo G, Cebrian Andrada C, Deira Lorenzo J, Marin Alvarez J, Garcia-Bernalt Funes V, Gallego Dominguez S, Labrador Gomez P, Castellano Cervino I, Novillo Santana R, Gomez-Martino Arroyo J, Kim Y, Choi BS, Kim YO, Yoon SA, Lin MC, Wu VC, Ko WJ, Wu KD, Wang WJ, Melo MJ, Lopes JA, Raimundo M, Fragoso A, Antunes F, Martin-Moreno PL, Varo N, Restituto P, Sayon-Orea C, Garcia-Fernandez N, Leite Filho NCV, Souza LEO, Cavalcante RM, Silva Junior GB, Morais BM, Leite TT, Silva SL, Kubrusly M, Daher EF, Jung YS, Kim YN, Shin HS, Rim H, Bentall A, Al-Baaj F, Williamson S, Cheshire S, Jelakovic M, Ivkovic V, Laganovic M, Karanovic S, Pecin I, Premuzic V, Vukovic Lela I, Vrdoljak A, Fucek M, Cvitkovic A, Juric D, Bozina N, Bitunjac M, Leko N, Abramovic Baric M, Matijevic V, Jelakovic B, Ullah A, Exarchou K, Archer T, Anijeet H, Brown R, Ahmed S, Zhang Y, Ye N, Cheng H, Cheng YP, Rocha JCG, Gushiken da Silva T, de Castro PF, Kioroglo PS, Branco Martins JP, Tzanno-Martins C, Biesenbach P, Luf F, Fleischmann E, Grunberger T, Druml W, Gaipov A, Turkmen K, Toker A, Solak Y, Cicekler H, Ucar R, Kilicaslan A, Gormus N, Tonbul HZ, Yeksan M, Turk S, Monteburini T, Cenerelli S, Santarelli S, Boggi R, Tazza L, Bossola M, Ferraresi M, Merlo I, Giovinazzo G, Quercia AD, Gai M, Leonardi G, Anania P, Guarena C, Cantaluppi V, Pacitti A, Biancone L, Hissa PNG, Daher EDF, Liborio AB, Thereza BMF, Mendes CCP, Sousa ARO. AKI - human studies. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Agapitou V, Dimopoulos S, Kapelios C, Karatzanos E, Manetos C, Georgantas A, Ntalianis A, Terrovitis J, Karga H, Nanas S. Hormonal imbalance in relation to exercise intolerance and ventilatory inefficiency in chronic heart failure. J Heart Lung Transplant 2013; 32:431-6. [PMID: 23402947 DOI: 10.1016/j.healun.2012.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 09/04/2012] [Accepted: 12/20/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Skeletal muscle wasting is associated with altered catabolic/anabolic balance and poor prognosis in patients with chronic heart failure (CHF). This study evaluated catabolic and anabolic abnormalities in relation to disease severity in CHF patients. METHODS Forty-two stable CHF patients (34 men; aged 56±12 years, body mass index, 27±5 kg/m2) receiving optimal medical treatment underwent incremental symptom-limited cardiopulmonary exercise testing on a cycle ergometer. Blood samples were drawn within 10 days to determine serum cortisol, plasma adrenocorticotropin (ACTH), and serum dehydroepiandrosterone sulfate, insulin-like growth factor 1, growth hormone, and total testosterone in men. RESULTS Patients with higher cortisol levels presented with impaired peak oxygen uptake (Vo2 peak: 18.3±3.9 vs. 14.2±3.7 ml/kg/min, p<0.01), ventilatory (Ve) response to exercise (Ve/carbon dioxide output [Vco2] slope: 36±6 vs 30±5, p<0.01), and chronotropic reserve ([peak heart rate [HR]--resting HR/220--age--resting HR]×100%: 40±19 vs. 58±18, p=0.01) compared with those with lower serum cortisol. Cortisol was inversely correlated with Vo2 peak, (r = -0.57; p<0.01) and was correlated with Ve/Vco2 slope (r = 0.47; p<0.01) and chronotropic reserve (r = 0.44; p = 0.017). In multivariate regression analysis, cortisol was an independent predictor of Vo2peak (R2 = 0.365, F = 12.5, SE = 3.4; p≤0.001) and Ve/Vco2 slope (R2 = 0.154; F = 8.5; SE = 5.96; p = 0.006), after accounting for age, body mass index, sex, CHF etiology, creatinine, left ventricular ejection fraction, and ACTH in all patients. In men, cortisol and dehydroepiandrosterone levels were both independent predictors of Vo2peak (R2 = 0.595, F = 24.53, SE = 2.76; p<0.001) after accounting also for all measured hormones, whereas cortisol remained the only independent predictor of Ve/Vco2 slope (R2 = 0.133; F = 6.1; SE = 6.2; p = 0.02). CONCLUSIONS Enhanced catabolic status is significantly associated with exercise intolerance, ventilatory inefficiency, and chronotropic incompetence in CHF patients, suggesting a significant contributing mechanism to their limited functional status.
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Kokkoris S, Pipili C, Grapsa E, Kyprianou T, Nanas S. Novel biomarkers of acute kidney injury in the general adult ICU: a review. Ren Fail 2013; 35:579-91. [PMID: 23472851 DOI: 10.3109/0886022x.2013.773835] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury is one of the most frequent problems occurring in the critically ill patients of the intensive care units and it is well established that it increases both morbidity and mortality in these patients. Moreover, despite technological and pharmaceutical advances during the last decades, the incidence as well as the mortality associated with acute kidney injury in these patients remains unchanged. Creatinine, the most common renal dysfunction biomarker in use, has many disadvantages, such as time delay in its increase and the influence by other factors on its serum concentration, such as age, gender, muscle mass, etc. Hence, the need for better renal biomarkers in order to timely intervene for acute kidney injury prevention is imperative. The lack of an early biomarker is an obstacle for the development of new acute kidney injury prevention strategies. With the incidence of acute kidney injury reaching epidemic dimensions, the need for novel markers is urgent. During the last years, the research for finding such biomarkers has been intense. The purpose of the present article is to review the studies which have tested the predictive ability of those markers (in urine and/or plasma) for early detection of acute kidney injury in the mixed adult intensive care unit population and underline the potential limitations encountered in the various studies.
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Mastorakos G, Paltoglou G, Greene M, Ilias I, Papamichalopoulos A, Dimopoulos S, Pouliou E, Fatouros IG, Nanas S. Inappropriately normal plasma ACTH and cortisol concentrations in the face of increased circulating interleukin-6 concentration in exercise in patients with sarcoidosis. Stress 2013; 16:202-10. [PMID: 22871212 DOI: 10.3109/10253890.2012.715221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Sarcoidosis is an autoimmune disease, and hypothalamic-pituitary-adrenal (HPA) axis activity is blunted in autoimmunity. Exercise stimulates the HPA axis, and we hypothesized that in sarcoidosis patients responses to treadmill exercise would be reduced. Hence, we studied 44 sarcoidosis patients [27 untreated (age, mean ± SD, 42 ± 2 years, 12 males, 15 females) and 17 dexamethasone treated (age, 46 ± 4 years, 7 males, 10 females)] and 20 healthy controls (40 ± 5 years old, 9 males, 11 females). Blood samples were drawn before, at peak (exhaustion), and 15 min after treadmill exercise for adrenocorticotropic hormone (ACTH), cortisol, tumor necrosis factor (TNF), interleukin-1β (IL-1β) and IL-6 measurements. At peak, plasma ACTH (pg/ml) was increased in untreated (mean ± SE, ΔACTH = 162.8 ± 29.9) and treated (ΔACTH = 123.3 ± 48.1) patients and controls (ΔACTH = 112.3 ± 41.7). Post-exercise, cortisol (ng/ml) was increased (p < 0.05) in untreated patients (Δcortisol = 48.4 ± 14.7) and controls (Δcortisol = 46.0 ± 15.9), but not significantly in treated patients (Δcortisol = 1.43 ± 2.56). At baseline, serum IL-6 (pg/ml) and TNF (pg/ml) were higher in untreated (3.02 ± 0.54 and 3.89 ± 0.72) and treated (1.75 ± 0.33 and 2.16 ± 1.00) patients, respectively, than in controls (0.80 ± 0.66 and 1.58 ± 0.32). At peak exercise, IL-6 was increased in untreated (ΔIL-6 = 0.96 ± 0.14) and treated (ΔIL-6 = 0.91 ± 0.47) patients and controls (ΔIL-6 = 0.96 ± 0.18); IL-1β was increased only in controls. Hence, the HPA axis of untreated sarcoidosis patients and controls responded similarly to treadmill exercise. In sarcoidosis patients, increased IL-6 was associated with HPA stimulation. Cortisol concentrations were similar between patients and controls, although IL-6 concentrations were higher in patients. Thus, in the face of chronically elevated IL-6 levels in sarcoidosis, there may be dysfunctional IL-6-induced HPA responses or HPA adaptation to high IL-6 concentrations.
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Malandraki GA, Markaki V, Georgopoulos VC, Bauer JL, Kalogeropoulos I, Nanas S. An international pilot study of asynchronous teleconsultation for oropharyngeal dysphagia. J Telemed Telecare 2013; 19:75-9. [DOI: 10.1177/1357633x12474963] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated whether an expert's consultation provided via telemedicine could improve the quality of care for patients with dysphagia. A trained clinician completed videofluoroscopic swallowing studies (VFSS) of 17 consecutive patients in a Greek hospital. The videofluoroscopic images were then stored on a website for independent review by an expert Speech and Language Pathologist in the US. An extra Rater evaluated 20% of all data for additional reliability testing. Eight diagnostic indicators of swallowing impairment and an overall subjective severity index were recorded for each study. Clinicians were also asked to choose from ten common treatment options for patients with dysphagia. There was good inter-rater agreement for most of the diagnostic indicators examined (ranging from 78% to 90%; kappa = 0.52-0.71) between all three Raters. Agreement on overall severity ratings was exact for more than half of the patients and within one-point on the 4-point scale for all other patients except one. However, the quality of care would have been substandard for more than half of the patients if teleconsultation had not been employed. In settings where a swallowing expert is not available and real-time telemedicine is not feasible, the use of asynchronous teleconsultation can produce better quality of care for patients with dysphagia.
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Samartzis L, Dimopoulos S, Tziongourou M, Nanas S. Effect of psychosocial interventions on quality of life in patients with chronic heart failure: a meta-analysis of randomized controlled trials. J Card Fail 2013; 19:125-34. [PMID: 23384638 DOI: 10.1016/j.cardfail.2012.12.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with chronic heart failure (CHF) usually experience poor quality of life (QoL). Psychosocial interventions tend to affect QoL in CHF. The aim of this study was to explore: 1) the effectiveness of psychosocial interventions on patients' QoL; 2) the magnitude of this effect; and 3) factors that appear to moderate the reported effect on QoL. METHODS AND RESULTS Meta-analysis of the data of 1,074 intervention patients and 1,106 control patients from 16 randomized controlled trials (RCTs) that reported QoL measures in treatment and control groups before and after a psychosocial intervention. Subgroup analyses were conducted between: 1) face-to-face versus telephone interventions; 2) interventions that included only patients versus those that included patients and their caregivers; and 3) interventions conducted by a physician and a nurse only, versus those conducted by a multidisciplinary team. Psychosocial interventions improved QoL of CHF patients (standardized mean difference 0.46, confidence interval [CI] 0.19-0.72; P < .001). Face-to-face interventions showed greater QoL improvement compared with telephone interventions (χ(2) = 5.73; df = 1; P < .02). Interventions that included caregivers did not appear to be significantly more effective (χ(2) = 1.12; df = 1; P > .29). A trend was found for multidisciplinary team approaches being more effective compared with nonmultidisciplinary approaches (χ(2) = 1.96; df = 1; P = .16). CONCLUSIONS A significant overall QoL improvement emerged after conducting psychosocial interventions with CHF patients. Interventions based on a face-to-face approach showed greater benefit for patients' QoL compared with telephone-based approaches. No significant advantage was found for interventions conducted by a multidisciplinary team compared with a physician and nurse approach, or for psychosocial interventions which included patients' caregivers compared with patient-only approaches.
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Vasileiadis I, Kravari M, Terrovitis J, Gerovasili V, Drakos S, Ntaliannis A, Dimopoulos S, Anastasiou-Nana M, Nanas S. Interval exercise training improves tissue oxygenation in patients with chronic heart failure. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.33047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Koutroumpi M, Dimopoulos S, Psarra K, Kyprianou T, Nanas S. Circulating endothelial and progenitor cells: Evidence from acute and long-term exercise effects. World J Cardiol 2012; 4:312-26. [PMID: 23272272 PMCID: PMC3530787 DOI: 10.4330/wjc.v4.i12.312] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/31/2012] [Accepted: 11/06/2012] [Indexed: 02/06/2023] Open
Abstract
Circulating bone-marrow-derived cells, named endothelial progenitor cells (EPCs), are capable of maintaining, generating, and replacing terminally differentiated cells within their own specific tissue as a consequence of physiological cell turnover or tissue damage due to injury. Endothelium maintenance and restoration of normal endothelial cell function is guaranteed by a complex physiological procedure in which EPCs play a significant role. Decreased number of peripheral blood EPCs has been associated with endothelial dysfunction and high cardiovascular risk. In this review, we initially report current knowledge with regard to the role of EPCs in healthy subjects and the clinical value of EPCs in different disease populations such as arterial hypertension, obstructive sleep-apnea syndrome, obesity, diabetes mellitus, peripheral arterial disease, coronary artery disease, pulmonary hypertension, and heart failure. Recent studies have introduced the novel concept that physical activity, either performed as a single exercise session or performed as part of an exercise training program, results in a significant increase of circulating EPCs. In the second part of this review we provide preliminary evidence from recent studies investigating the effects of acute and long-term exercise in healthy subjects and athletes as well as in disease populations.
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Georgiopoulou VV, Dimopoulos S, Sakellariou D, Papazachou O, Gerovasili V, Tasoulis A, Agapitou V, Vogiatzis I, Roussos C, Nanas S. Cardiopulmonary rehabilitation enhances heart rate recovery in patients with COPD. Respir Care 2012; 57:2095-103. [PMID: 22710548 DOI: 10.4187/respcare.01485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Autonomic dysfunction is present early in the course of COPD, and is associated with adverse outcomes. We utilized heart rate recovery, a simple and validated index of autonomic balance, to investigate the effects of exercise training on autonomic dysfunction in patients with COPD. METHODS We evaluated 45 stable subjects with COPD who participated in a 36-session exercise-based cardiopulmonary rehabilitation program. Subjects underwent maximal cardiopulmonary exercise testing at baseline and after completion of the rehabilitation program. We recorded exercise testing parameters and heart rate during rest, exercise, and recovery. Heart rate recovery was calculated as heart rate at peak exercise minus heart rate at the first minute of recovery. RESULTS Thirty-nine subjects (age 66.3 ± 7.8 y, 90% male, body mass index 27.1 ± 4.1 kg/m(2), FEV(1) 45.7 ± 18.7%) completed the program. In these subjects, heart rate recovery increased from 16.2 ± 8.0 beats/min to 18.4 ± 8.4 beats/min (P = .01), resting heart rate decreased from 88.0 ± 10.7 beats/min to 83.3 ± 10.5 beats/min (P = .004), and heart rate at anaerobic threshold decreased from 109.0 ± 12.5 beats/min to 105.5 ± 11.7 beats/min (P = .040). In addition, oxygen consumption (V(O(2))) increased from 14.3 ± 3.7 mL/kg/min to 15.2 ± 3.8 mL/kg/min at peak exercise, and from 9.7 ± 2.4 mL/kg/min to 10.4 ± 2.6 mL/kg/min at anaerobic threshold (both P = .02), while the V(O(2))/t slope increased from -0.32 ± 0.16 mL/kg/min(2) to -0.38 ± 0.19 mL/kg/min(2) (P = .003). Parameters of ventilatory performance improved also. CONCLUSIONS In subjects with COPD, exercise-based rehabilitation improves heart rate recovery, modestly though, which indicates a degree of attenuated autonomic dysfunction. Exercise and muscular oxidative capacity, as expressed by V(O(2))/t slope, is also improved.
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Kokkoris S, Parisi M, Ioannidou S, Douka E, Pipili C, Kyprianou T, Kotanidou A, Nanas S. Combination of renal biomarkers predicts acute kidney injury in critically ill adults. Ren Fail 2012; 34:1100-8. [PMID: 22889061 DOI: 10.3109/0886022x.2012.713279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Most studies so far have focused on the performance of individual biomarkers to detect early acute kidney injury (AKI) in the adult intensive care unit (ICU) patients; however, they have not determined the predictive ability of their combinations. The aim of this study was to compare the predictive abilities of plasma neutrophil gelatinase-associated lipocalin (pNGAL), urine neutrophil gelatinase-associated lipocalin (uNGAL), plasma cystatin C (pCysC), serum creatinine (sCr), and their combinations in detecting AKI in an adult general ICU population. METHODS A total of 100 consecutive ICU patients were included in the analysis. AKI was defined according to RIFLE criteria. Biomarker predictive abilities were evaluated by area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS AKI occurred in 36% of patients 7 days post-admission. All three novel biomarkers as well as sCr had moderate predictive abilities for AKI occurrence. The most efficient combinations (pNGAL + sCr and pNGAL + uNGAL + sCr) were selected to participate in the subsequent analyses. Both combinations, when added to a reference clinical model, increased its AUC significantly (0.858, p = 0.04). Their NRI (0.78, p = 0.0002) was equal to that of pNGAL, but higher than that of the other three biomarkers, whereas their IDI was higher than that of any individual biomarker (0.23, p = 0.0001). Both combinations had better specificities, positive likelihood ratios, and positive predictive values than those of any individual biomarker. CONCLUSION The biomarker combinations had better predictive characteristics compared with those of each biomarker alone.
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Gok Oguz E, Olmaz R, Turgutalp K, Muslu N, Sungur MA, Kiykim A, Van Biesen W, Vanmassenhove J, Glorieux G, Vanholder R, Chew S, Forster K, Kaufeld T, Kielstein J, Schilling T, Haverich A, Haller H, Schmidt B, Hu P, Liang X, Liang X, Chen Y, LI R, Jiang F, LI Z, Shi W, Lim CCW, Lim CCW, Chia CML, Tan AK, Tan CS, Hu P, Liang X, Liang X, Chen Y, LI R, Jiang F, LI Z, Shi W, Ng R, Subramani S, Chew S, Perez de Jose A, Bernis Carro C, Madero Jarabo R, Bustamante J, Sanchez Tomero JA, Chung W, Ro H, Chang JH, Lee HH, Jung JY, Vanmassenhove J, Van Biesen W, Glorieux G, Vanholder R, Fazzari L, Giuliani A, Scrivano J, Pettorini L, Benedetto U, Luciani R, Roscitano A, Napoletano A, Coclite D, Cordova E, Punzo G, Sinatra R, Mene P, Pirozzi N, Shavit L, Shavit L, Manilov R, Algur N, Wiener-Well Y, Slotki I, Pipili C, Pipili C, Vrettou CS, Avrami K, Economidou F, Glynos K, Ioannidou S, Markaki V, Douka E, Nanas S, De Pascalis A, De Pascalis A, Cofano P, Proia S, Valletta A, Vitale O, Russo F, Buongiorno E, Filiopoulos V, Biblaki D, Lazarou D, Chrysis D, Fatourou M, Lafoyianni S, Vlassopoulos D, Zakiyanov O, Kriha V, Vachek J, Svarcova J, Zima T, Tesar V, Kalousova M, Kaushik M, Kaushik M, Ronco C, Cruz D, Zhang L, Zhang W, Zhang W, Chen N, Ejaz AA, Kambhampati G, Ejaz N, Dass B, Lapsia V, Arif AA, Asmar A, Shimada M, Alsabbagh M, Aiyer R, Johnson R, Chen TH, Chang CH, Chang MY, Tian YC, Hung CC, Fang JT, Yang CW, Chen YC, Cantaluppi V, Quercia AD, Figliolini F, Giacalone S, Pacitti A, Gai M, Guarena C, Leonardi G, Leonardi G, Biancone L, Camussi G, Segoloni GP, De Cal M, Lentini P, Clementi A, Virzi GM, Scalzotto E, Ronco C, Lacquaniti A, Lacquaniti A, Donato V, Fazio MR, Lucisano S, Cernaro V, Lupica R, Buemi M, Turgutalp K, Helvaci I, Anik E, Kiykim A, Wani M, Wani DI, Bhat DMA, Banday DK, Najar DMS, Reshi DAR, Palla DNA, Turgutalp K, Kiykim A, Helvaci I, Iglesias P, Olea T, Vega-Cabrera C, Heras M, Bajo MA, Del Peso G, Arias MJ, Selgas R, Diez JJ, Daher E, Costa PL, Pereira ENS, Santos RDP, Abreu KL, Silva Junior G, Pereira EDB, Raimundo M, Crichton S, Syed Y, Martin J, Whiteley C, Bennett D, Ostermann M, Gjyzari A, Thereska N, Koroshi A, Barbullushi M, Kodra S, Idrizi A, Strakosha A, Petrela E, Raimundo M, Crichton S, Syed Y, Martin J, Lemmich Smith J, Bennett D, Ostermann M, Klimenko A, Tuykhmenev E, Villevalde S, Kobalava Z, Avdoshina S, Villevalde S, Tyukhmenev E, Efremovtseva M, Kobalava Z, Hayashi H, Hayashi H, Suzuki S, Kataoka K, Kondoh Y, Taniguchi H, Sugiyama D, Nishimura K, Sato W, Maruyama S, Matsuo S, Yuzawa Y, Geraldine D, Muriel F, Alexandre H, Eric R, Fu P, Zhang L, Pozzato M, Ferrari F, Cecere P, Mesiano P, Vallero A, Livigni S, Quarello F, Hudier L, Decaux O, Haddj-Elmrabet A, Mandart L, Lino-Daniel M, Bridoux F, Renaudineau E, Sawadogo T, Le Pogamp P, Vigneau C, Famee D, Koo HM, Oh HJ, Han SH, Choi KH, Kang SW, Mehdi M, Nicolas M, Mariat C, Shah P, Kute VB, Vanikar A, Gumber M, Patel H, Trivedi H, Pipili C, Pipili C, Manetos C, Vrettou CS, Poulaki S, Tripodaki ES, Papastylianou A, Routsi C, Nanas S, Uchida K, Kensuke U, Yamagata K, Saitou C, Okada M, Chita G, Davies M, Veriawa Y, Naicker S, Mukhopadhyay P, Mukherjee D, Mishra R, Kar M, Zickler D, Wesselmann H, Schindler R, Gutierrez* E, Egido J, Rubio-Navarro A, Buendia I, Blanco-Colio LM, Toldos O, Manzarbeitia F, De Lorenzo A, Sanchez R, Praga^ M, Moreno^ JA, Kim MY, Kang NR, Jang HR, Lee JE, Huh W, Kim YG, Kim DJ, Hong SC, Kim JS, Oh HY, Okamoto T, Kamata K, Naito S, Tazaki H, Kan S, Anne-Kathrin LG, Matthias K, Speer T, Andreas L, Heinrich G, Thomas V, Poppleton A, Danilo F, Matthias K, Lai CF, Wu VC, Shiao CC, Huang TM, Wu KD, Bedford M, Farmer C, Irving J, Stevens P, Patera F, Patera F, Mattozzi F, Battistoni S, Fagugli RM, Park MY, Choi SJ, Kim JG, Hwang SD, Xie H, Chen H, Xu S, He Q, Liu J, Hu W, Liu Z, Dalboni M, Blaya R, Quinto BM, Narciso R, Oliveira M, Monte J, Durao M, Cendoroglo M, Batista M, Hanemann AL, Liborio A, Daher E, Martins A, Pinheiro MCC, Silva Junior G, Meneses G, De Paula Pessoa R, Sousa M, Bezerra FSM, Albuquerque PLMM, Lima JB, Lima CB, Veras MDSB, Silva Junior G, Daher E, Nemoto Matsui T, Totoli C, Cruz Andreoli MC, Vilela Coelho MP, Guimaraes de Souza NK, Ammirati AL, De Carvalho Barreto F, Ferraz Neto BH, Fortunato Cardoso Dos Santos B, Abraham A, Abraham G, Mathew M, Duarte PMA, Duarte FB, Barros EM, Castro FQS, Silva Junior G, Daher E, Palomba H, Castro I, Sousa SR, Jesus AN, Romano T, Burdmann E, Yu L, Kwon SH, You JY, Hyun YK, Woo SA, Jeon JS, Noh HJ, Han DC, Tozija L, Tozija L, Petronievic Z, Selim G, Nikolov I, Stojceva-Taneva O, Cakalaroski K, Lukasz A, Beneke J, Schmidt B, Kielstein J, Haller H, Menne J, Schiffer M, Polanco N, Hernandez E, Gutierrez E, Gutierrez Millet V, Gonzalez Monte E, Morales E, Praga M, Francisco Javier L, Nuria GF, Jose Maria MG, Bes Rastrollo M, Angioi A, Conti M, Cao R, Atzeni A, Pili G, Matta V, Murgia E, Melis P, Binda V, Pani A, Thome* F, Leusin F, Barros E, Morsch C, Balbinotto A, Pilla C, Premru V, Buturovic-Ponikvar J, Ponikvar R, Marn-Pernat A, Knap B, Kovac J, Gubensek J, Kersnic B, Krnjak L, Prezelj M, Granatova J, Havrda M, Hruskova Z, Kratka K, Remes O, Mokrejsova M, Bolkova M, Lanska V, Rychlik I, Uniacke MD, Lewis RJ, Harris S, Roderick P, Thome* F, Balbinotto A, Barros E, Morsch C, Martin N, Ulrich K, Jan B, Jorn B, Reinhard B, Jan K, Hermann H, Meyer Tobias F, Leyla R, Schmidt Bernhard MW, Harald S, Jurgen S, Tanja K, Menne J, Mario S, Jan B, Jan B, Sang Hi E, Leyla R, Claus M, Frank V, Aleksej S, Sengul S, Jan K, Jorn B, Reinhard B, Meyer Tobias F, Schmidt Bernhard MW, Mario S, Martin N, Ulrich K, Robert S, Karin W, Tanja K, Hermann H, Menne J, Leyla R, Leyla R, Jan K, Jan B, Reinhard B, Feikah G, Hermann H, Tanja K, Ulrich K, Menne Tobias F, Claus M, Martin N, Mario S, Schmidt Bernhard MW, Harald S, Jurgen S, Menne J, Claus M, Claus M, Jan K, Jan B, Reinhard B, Feikah G, Hermann H, Ulrich K, Menne Tobias F, Meyer Tobias N, Martin N, Leyla R, Schmidt Bernhard MW, Harald S, Jurgen S, Tanja K, Mario S, Menne J, Kielstein J, Beutel G, Fleig S, Steinhoff J, Meyer T, Hafer C, Bramstedt J, Busch V, Vischedyk M, Kuhlmann U, Ries W, Mitzner S, Mees S, Stracke S, Nurnberger J, Gerke P, Wiesner M, Sucke B, Abu-Tair M, Kribben A, Klause N, Schindler R, Merkel F, Schnatter S, Dorresteijn E, Samuelsson O, Brunkhorst R, Stec-Hus Registry G, Reising A, Hafer C, Kielstein J, Schmidt B, Bange FC, Hiss M, Vetter F, Kielstein J, Beneke J, Bode-Boger SM, Martens-Lobenhoffer J, Schiffer M, Schmidt BMW, Haller H, Menne J, Kielstein JT, Shin HS, Jung YS, Rim H. AKI - Clinical. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dimopoulos S, Tzanis G, Manetos C, Tasoulis A, Mpouchla A, Tseliou E, Vasileiadis I, Diakos N, Terrovitis J, Nanas S. Hyperoxia affects peripheral tissue microcirculation in patients with pulmonary arterial hypertension. Crit Care 2012. [PMCID: PMC3363624 DOI: 10.1186/cc10813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sidiras G, Patsaki I, Dakoutrou M, Karatzanos E, Gerovasili V, Kouvarakos A, Kardara A, Apostolou K, Dimopoulos S, Markaki V, Nanas S. Muscle strength assessment of critically ill patients is associated with functional ability and quality of life at hospital discharge. Crit Care 2012. [PMCID: PMC3363947 DOI: 10.1186/cc11136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Argyriou G, Terrovitis J, Sainis G, Papas V, Marvaki C, Nanas S, Routsi C. Role of illness severity scores in predicting mortality in the coronary care unit. Crit Care 2012. [PMCID: PMC3363832 DOI: 10.1186/cc11021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Vrettou CS, Kokkoris S, Apostolou K, Parisi M, Haritatos E, Dimopoulos S, Nanas S. Plasma and urine neutrophil gelatinase-associated lipocalin in septic and nonseptic ICU patients. Crit Care 2012. [PMCID: PMC3363770 DOI: 10.1186/cc10959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pipili C, Vrettou CS, Poulaki S, Papastylianou A, Parisi M, Tripodaki ES, Ioannidou S, Kokkoris S, Douka E, Nanas S. Evaluation of microcirculation before and during continuous renal replacement therapy and the impact of dose prescription. Crit Care 2012. [PMCID: PMC3363790 DOI: 10.1186/cc10979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Papakonstantinou I, Perivolioti E, Vrettou C, Baraboutis I, Magira E, Balioti E, Panopoulou D, Pitsolis T, Routsi C, Nanas S. Risk factors for bronchial acquisition of resistant Gram-negative bacteria in critically ill patients and outcome. Crit Care 2012; 16. [PMCID: PMC3363463 DOI: 10.1186/cc10652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Stefanidis K, Pentilas N, Dimopoulos S, Nanas S, Savel RH, Shiloh AL, Poularas J, Slama M, Karakitsos D. Echogenic Technology Improves Cannula Visibility during Ultrasound-Guided Internal Jugular Vein Catheterization via a Transverse Approach. Crit Care Res Pract 2012; 2012:306182. [PMID: 22649715 PMCID: PMC3357505 DOI: 10.1155/2012/306182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/01/2012] [Indexed: 02/07/2023] Open
Abstract
Objective. Echogenic technology has recently enhanced the ability of cannulas to be visualized during ultrasound-guided vascular access. We studied whether the use of an EC could improve visualization if compared with a nonechogenic vascular cannula (NEC) during real-time ultrasound-guided internal jugular vein (IJV) cannulation in the intensive care unit (ICU). Material and Methods. We prospectively enrolled 80 mechanically ventilated patients who required central venous access in a randomized study that was conducted in two medical-surgical ICUs. Forty patients underwent EC and 40 patients were randomized to NEC. The procedure was ultrasound-guided IJV cannulation via a transverse approach. Results. The EC group exhibited increased visibility as compared to the NEC group (88% ± 8% versus 20% ± 15%, resp. P < 0.01). There was strong agreement between the procedure operators and independent observers (k = 0.9; 95% confidence intervals assessed by bootstrap analysis = 0.87-0.95; P < 0.01). Access time (5.2 s ± 2.5 versus 10.6 s ± 5.7) and mechanical complications were both decreased in the EC group compared to the NEC group (P < 0.05). Conclusion. Echogenic technology significantly improved cannula visibility and decreased access time and mechanical complications during real-time ultrasound-guided IJV cannulation via a transverse approach.
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Stefanidis K, Dimopoulos S, Kolofousi C, Cokkinos DD, Chatzimichail K, Eisen LA, Wachtel M, Karakitsos D, Nanas S. Sonographic lobe localization of alveolar-interstitial syndrome in the critically ill. Crit Care Res Pract 2012; 2012:179719. [PMID: 22645669 PMCID: PMC3357508 DOI: 10.1155/2012/179719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 02/22/2012] [Indexed: 02/07/2023] Open
Abstract
Introduction. Fast and accurate diagnosis of alveolar-interstitial syndrome is of major importance in the critically ill. We evaluated the utility of lung ultrasound (US) in detecting and localizing alveolar-interstitial syndrome in respective pulmonary lobes as compared to computed tomography scans (CT). Methods. One hundred and seven critically ill patients participated in the study. The presence of diffuse comet-tail artifacts was considered a sign of alveolar-interstitial syndrome. We designated lobar reflections along intercostal spaces and surface lines by means of sonoanatomy in an effort to accurately localize lung pathology. Each sonographic finding was thereafter grouped into the respective lobe. Results. From 107 patients, 77 were finally included in the analysis (42 males with mean age = 61 ± 17 years, APACHE II score = 17.6 ± 6.4, and lung injury score = 1.0 ± 0.7). US exhibited high sensitivity and specificity values (ranging from over 80% for the lower lung fields up to over 90% for the upper lung fields) and considerable consistency in the diagnosis and localization of alveolar-interstitial syndrome. Conclusions. US is a reliable, bedside method for accurate detection and localization of alveolar-interstitial syndrome in the critically ill.
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Dimopoulos S, Diakos N, Tseliou E, Tasoulis A, Mpouchla A, Manetos C, Katsaros L, Drakos S, Terrovitis J, Nanas S. Chronotropic incompetence and abnormal heart rate recovery early after left ventricular assist device implantation. Pacing Clin Electrophysiol 2011; 34:1607-14. [PMID: 21950763 DOI: 10.1111/j.1540-8159.2011.03215.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronotropic response to exercise and heart rate recovery immediately after exercise (HRR(1) ) are valid prognostic markers in patients with chronic heart failure (CHF). The aim of this study was to evaluate heart rate profile during and after exercise in CHF patients early after left ventricular assist device (LVAD) implantation. METHODS We enrolled seven stable consecutive CHF patients (five males, mean age: 45 ± 16 years) after 1 month of LVAD (HeartMate II; Thoratec Corp, Pleasanton, CA, USA) implantation, seven healthy subjects, and 14 patients with advanced HF (HF control group) who performed an incremental symptom-limited cardiopulmonary exercise testing (CPET). CHF patients performed CPET at 1 and 3 months after LVAD. HRR(1) was defined as the HR difference from peak to 1 minute after exercise and chronotropic response to exercise as the chronotropic reserve ([CR, %]=[peak HR-resting HR/220-age-resting HR]× 100). RESULTS LVAD patients 3 months after implantation had a significantly different HR profile during exercise compared to healthy controls, with significantly lower CR (57 ± 31 vs 90 ± 14, %, P < 0.001) and HRR(1) (14 ± 6 vs 28 ± 8, bpm, P < 0.01). HR profile during exercise did not significantly change 1 and 3 months after LVAD implantation. There was no statistical difference compared to HF control group and LVAD group regarding cardiopulmonary parameters. CONCLUSIONS LVAD patients present an impaired CR and an abnormal HRR(1) after implantation, indicating significant cardiac autonomic abnormalities. These alterations seem to remain unaltered 3 months after LVAD implantation.
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Manetos C, Dimopoulos S, Tzanis G, Vakrou S, Tasoulis A, Kapelios C, Agapitou V, Ntalianis A, Terrovitis J, Nanas S. Skeletal muscle microcirculatory abnormalities are associated with exercise intolerance, ventilatory inefficiency, and impaired autonomic control in heart failure. J Heart Lung Transplant 2011; 30:1403-8. [PMID: 21982360 DOI: 10.1016/j.healun.2011.08.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/28/2011] [Accepted: 08/30/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Several skeletal muscle abnormalities have been identified in patients with chronic heart failure (CHF), including endothelial dysfunction. We hypothesized that skeletal muscle microcirculation, assessed by near-infrared spectroscopy (NIRS), is impaired in CHF patients and is associated with disease severity. METHODS Eighty-three stable patients with mild-moderate CHF (72 males, mean age 54 ± 14 years, body mass index 26.7 ± 3.4 kg/m(2)) and 8 healthy subjects, matched for age, gender and body mass index, underwent NIRS with the vascular occlusion technique and cardiopulmonary exercise testing (CPET) evaluation on the same day. Tissue oxygen saturation (StO(2), %), defined as the percentage of hemoglobin saturation in the microvasculature compartments, was measured in the thenar muscle by NIRS before, during and after 3-minute occlusion of the brachial artery. Measurements included StO(2), oxygen consumption rate (OCR, %/min) and reperfusion rate (RR, %/min). All subjects underwent a symptom-limited CPET on a cycle ergometer. Measurements included VO(2) at peak exercise (VO(2)peak, ml/kg/min) and anaerobic threshold (VO(2)AT, ml/kg/min), VE/VCO(2) slope, chronotropic reserve (CR, %) and heart rate recovery (HRR(1), bpm). RESULTS CHF patients had significantly lower StO(2) (75 ± 8.2 vs 80.3 ± 6, p < 0.05), lower OCR (32.3 ± 10.4 vs 37.7 ± 5.5, p < 0.05) and lower RR (10 ± 2.8 vs 15.7 ± 6.3, p < 0.05) compared with healthy controls. CHF patients with RR ≥9.5 had a significantly greater VO(2)peak (p < 0.001), VO(2)AT (p < 0.01), CR (p = 0.01) and HRR(1) (p = 0.01), and lower VE/VCO(2) slope (p = 0.001), compared to those with RR <9.5. In a multivariate analysis, RR was identified as an independent predictor of VO(2)peak, VE/VCO(2) slope and HRR(1). CONCLUSIONS Peripheral muscle microcirculation, as assessed by NIRS, is significantly impaired in CHF patients and is associated with disease severity.
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