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Charman SJ, Okwose NC, Taylor CJ, Bailey K, Fuat A, Ristic A, Mant J, Deaton C, Seferovic PM, Coats AJS, Hobbs FDR, MacGowan GA, Jakovljevic DG. Feasibility of the cardiac output response to stress test in suspected heart failure patients. Fam Pract 2022; 39:805-812. [PMID: 35083480 PMCID: PMC9508869 DOI: 10.1093/fampra/cmab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diagnostic tools available to support general practitioners diagnose heart failure (HF) are limited. OBJECTIVES (i) Determine the feasibility of the novel cardiac output response to stress (CORS) test in suspected HF patients, and (ii) Identify differences in the CORS results between (a) confirmed HF patients from non-HF patients, and (b) HF reduced (HFrEF) vs HF preserved (HFpEF) ejection fraction. METHODS Single centre, prospective, observational, feasibility study. Consecutive patients with suspected HF (N = 105; mean age: 72 ± 10 years) were recruited from specialized HF diagnostic clinics in secondary care. The consultant cardiologist confirmed or refuted a HF diagnosis. The patient completed the CORS but the researcher administering the test was blinded from the diagnosis. The CORS assessed cardiac function (stroke volume index, SVI) noninvasively using the bioreactance technology at rest-supine, challenge-standing, and stress-step exercise phases. RESULTS A total of 38 patients were newly diagnosed with HF (HFrEF, n = 21) with 79% being able to complete all phases of the CORS (91% of non-HF patients). A 17% lower SVI was found in HF compared with non-HF patients at rest-supine (43 ± 15 vs 51 ± 16 mL/beat/m2, P = 0.02) and stress-step exercise phase (49 ± 16 vs 58 ± 17 mL/beat/m2, P = 0.02). HFrEF patients demonstrated a lower SVI at rest (39 ± 15 vs 48 ± 13 mL/beat/m2, P = 0.02) and challenge-standing phase (34 ± 9 vs 42 ± 12 mL/beat/m2, P = 0.03) than HFpEF patients. CONCLUSION The CORS is feasible and patients with HF responded differently to non-HF, and HFrEF from HFpEF. These findings provide further evidence for the potential use of the CORS to improve HF diagnostic and referral accuracy in primary care.
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Affiliation(s)
- Sarah J Charman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nduka C Okwose
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Research Centre (CSELS), Institute for Health and Wellbeing, Faculty of Health and Life Sciences, Coventry University, and University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Clare J Taylor
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Kristian Bailey
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ahmet Fuat
- Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust & School of Medicine, Pharmacy and Health, Durham University, Durham, United Kingdom
| | - Arsen Ristic
- Department of Cardiology, Faculty of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Petar M Seferovic
- Department of Cardiology, Faculty of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia
| | - Andrew J S Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - F D Richard Hobbs
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Guy A MacGowan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Djordje G Jakovljevic
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Research Centre (CSELS), Institute for Health and Wellbeing, Faculty of Health and Life Sciences, Coventry University, and University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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Ghitea TC, Aleya L, Tit DM, Behl T, Stoicescu M, Sava C, Iovan C, El-Kharoubi A, Uivarosan D, Pallag A, Bungau S. Influence of diet and sport on the risk of sleep apnea in patients with metabolic syndrome associated with hypothyroidism - a 4-year survey. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:23158-23168. [PMID: 34802081 DOI: 10.1007/s11356-021-17589-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/13/2021] [Indexed: 06/13/2023]
Abstract
Apnea is a common problem observed among obese individuals, affecting the quality of sleep and increasing cardiovascular risk and mortality. The current study monitored the risk of obstructive sleep apnea (OSA) following diet therapy and sports-associated diet therapy in patients with metabolic syndrome (MS) and hypothyroidism. The subjects included in the study were divided into 3 groups: control group (CG) (n=36), diet therapy group (DG) (including patients following a personalized diet therapy program) (n=76), and diet therapy and sports group (DSG) (which considered patients doing sports in addition to following a personalized diet therapy program) (n=80). The evaluation methods included body analysis (body mass index, fat mass, and visceral fat), paraclinical analysis (homeostasis model assessment of insulin resistance), assessment of difficulty in breathing, stress monitoring, hypothyroidism, and risk of OSA. The OSA index was assessed using the Berlin Questionnaire of Sleep Apnea and Epworth Sleepiness Scale. The correlation between OSA with body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR) index, fat mass, and visceral fat showed a statistically significant positive ratio (p<0.05; F=3.871). The obtained results indicated that diet therapy and physical activity reduced the OSA risk by 78.72%.
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Affiliation(s)
- Timea Claudia Ghitea
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028, Oradea, Romania
| | - Lotfi Aleya
- Laboratoire Chrono-environment, CNRS 6249, Université de Franche-Comté, Besançon, France.
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028, Oradea, Romania
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410073, Oradea, Romania
| | - Tapan Behl
- Department of Pharmacology, Chitkara College of Pharmacy, Chitkara University, Punjab, 140401, India
| | - Manuela Stoicescu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073, Oradea, Romania
| | - Cristian Sava
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073, Oradea, Romania
| | - Ciprian Iovan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410068, Oradea, Romania
| | - Amina El-Kharoubi
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073, Oradea, Romania
| | - Diana Uivarosan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410068, Oradea, Romania
| | - Annamaria Pallag
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028, Oradea, Romania
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410073, Oradea, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028, Oradea, Romania.
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410073, Oradea, Romania.
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Pradhan A, Scaringi J, Gerard P, Arena R, Myers J, Kaminsky LA, Kung E. Systematic Review and Regression Modeling of the Effects of Age, Body Size, and Exercise on Cardiovascular Parameters in Healthy Adults. Cardiovasc Eng Technol 2021; 13:343-361. [PMID: 34668143 DOI: 10.1007/s13239-021-00582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Blood pressure, cardiac output, and ventricular volumes correlate to various subject features such as age, body size, and exercise intensity. The purpose of this study is to quantify this correlation through regression modeling. METHODS We conducted a systematic review to compile reference data of healthy subjects for several cardiovascular parameters and subject features. Regression algorithms used these aggregate data to formulate predictive models for the outputs-systolic and diastolic blood pressure, ventricular volumes, cardiac output, and heart rate-against the features-age, height, weight, and exercise intensity. A simulation-based procedure generated data of virtual subjects to test whether these regression models built using aggregate data can perform well for subject-level predictions and to provide an estimate for the expected error. The blood pressure and heart rate models were also validated using real-world subject-level data. RESULTS The direction of trends between model outputs and the input subject features in our study agree with those in current literature. CONCLUSION Although other studies observe exponential predictor-output relations, the linear regression algorithms performed the best for the data in this study. The use of subject-level data and more predictors may provide regression models with higher fidelity. SIGNIFICANCE Models developed in this study can be useful to clinicians for personalized patient assessment and to researchers for tuning computational models.
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Affiliation(s)
- Aseem Pradhan
- Department of Mechanical Engineering, Clemson University, Clemson, SC, USA
| | - John Scaringi
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Patrick Gerard
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being and Clinical Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Ethan Kung
- Department of Mechanical Engineering, Clemson University, Clemson, SC, USA.
- Department of Bioengineering, Clemson University, Clemson, SC, USA.
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Shen Q, Mahoney D, Peltzer J, Rahman F, Krueger KJ, Hiebert JB, Pierce JD. Using the NIH symptom science model to understand fatigue and mitochondrial bioenergetics. ACTA ACUST UNITED AC 2020; 7. [PMID: 33628458 DOI: 10.7243/2056-9157-7-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The symptom of fatigue is prevalent among patients with chronic diseases and conditions such as congestive heart failure and cancer. It has a significant debilitating impact on patients' physical health, quality of life, and well-being. Early detection and appropriate assessment of fatigue is essential for diagnosing, treating, and monitoring disease progression. However, it is often challenging to manage the symptom of fatigue without first investigating the underlying biological mechanisms. In this narrative review, we conceptualize the symptom of fatigue and its relationship with mitochondrial bioenergetics using the National Institute of Health Symptom Science Model (NIH-SSM). In particular, we discuss mental and physical measures to assess fatigue, the importance of adenosine triphosphate (ATP) in cellular and organ functions, and how impaired ATP production contributes to fatigue. Specific methods to measure ATP are described. Recommendations are provided concerning how to integrate biological mechanisms with the symptom of fatigue for future research and clinical practice to help alleviate symptoms and improve patients' quality of life.
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Affiliation(s)
- Qiuhua Shen
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Diane Mahoney
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Jill Peltzer
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Faith Rahman
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Kathryn J Krueger
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - John B Hiebert
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
| | - Janet D Pierce
- University of Kansas Medical Center, Kansas City, Kansas, 66160, United States of America
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Corrigendum. ESC Heart Fail 2019; 6:898. [PMID: 31373445 PMCID: PMC6676266 DOI: 10.1002/ehf2.12441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Charman S, Okwose N, Maniatopoulos G, Graziadio S, Metzler T, Banks H, Vale L, MacGowan GA, Seferović PM, Fuat A, Deaton C, Mant J, Hobbs RFD, Jakovljevic DG. Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study. BMJ Open 2019; 9:e028122. [PMID: 30987993 PMCID: PMC6500186 DOI: 10.1136/bmjopen-2018-028122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To explore the role of the novel cardiac output response to stress (CORS), test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care. DESIGN Qualitative study using semistructured in-depth interviews which were audio recorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach. SETTING Newcastle upon Tyne, UK. PARTICIPANTS Fourteen healthcare professionals (six males, eight females) from primary (general practitioners (GPs), nurses, healthcare assistant, practice managers) and secondary care (consultant cardiologists). RESULTS Four themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that the adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include: establishment of clinical utility, suitability for immobile patients and cost implication to GP practices. CONCLUSION The development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose; however, factors such as cost effectiveness, diagnostic accuracy and seamless implementation in primary care have to be fully explored.
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Affiliation(s)
- Sarah Charman
- Cardiovascular Research Centre, Newcastle University, Newcastle, UK
| | - Nduka Okwose
- Cardiovascular Research Centre, Newcastle University, Newcastle, UK
| | | | - Sara Graziadio
- NIHR In Vitro Diagnostics Co-operative, Newcastle University, Newcastle, UK
| | - Tamara Metzler
- Cardiovascular Research Centre, Newcastle University, Newcastle, UK
| | - Helen Banks
- Cardiovascular Research Centre, Newcastle University, Newcastle, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Guy A MacGowan
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK
| | - Petar M Seferović
- Cardiology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Ahmet Fuat
- Primary Care, Carmel Medical Practice, Darlington, UK
| | - Christi Deaton
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK
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MacGowan GA, Jakovljevic DG. Exercise Hemodynamics to Evaluate the Breathless Patient: Defining the Normal Pulmonary Arterial Wedge Pressure. J Card Fail 2018; 25:123-124. [PMID: 30528706 DOI: 10.1016/j.cardfail.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Guy A MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom; Institutes of Genetic Medicine and Cellular Medicine, Cardiovascular Research Centre, Newcastle University, Newcastle Upon Tyne, United Kingdom.
| | - Djordje G Jakovljevic
- Institutes of Genetic Medicine and Cellular Medicine, Cardiovascular Research Centre, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Charman SJ, Okwose NC, Stefanetti RJ, Bailey K, Skinner J, Ristic A, Seferovic PM, Scott M, Turley S, Fuat A, Mant J, Hobbs RF, MacGowan GA, Jakovljevic DG. A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care. ESC Heart Fail 2018; 5:703-712. [PMID: 29943902 PMCID: PMC6073030 DOI: 10.1002/ehf2.12302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/15/2018] [Accepted: 04/16/2018] [Indexed: 12/28/2022] Open
Abstract
AIMS Primary care physicians lack access to an objective cardiac function test. This study for the first time describes a novel cardiac output response to stress (CORS) test developed to improve diagnosis and monitoring of heart failure in primary care and investigates its reproducibility. METHODS AND RESULTS Prospective observational study recruited 32 consecutive primary care patients (age, 63 ± 9 years; female, n = 18). Cardiac output was measured continuously using the bioreactance method in supine and standing positions and during two 3 min stages of a step-exercise protocol (10 and 15 steps per minute) using a 15 cm height bench. The CORS test was performed on two occasions, i.e. Test 1 and Test 2. There was no significant difference between repeated measures of cardiac output and stroke volume at supine standing and Stage 1 and Stage 2 step exercises (all P > 0.3). There was a significant positive relationship between Test 1 and Test 2 cardiac outputs (r = 0.92, P = 0.01 with coefficient of variation of 7.1%). The mean difference in cardiac output (with upper and lower limits of agreement) between Test 1 and Test 2 was 0.1 (-1.9 to 2.1) L/min, combining supine, standing, and step-exercise data. CONCLUSIONS The CORS, as a novel test for objective evaluation of cardiac function, demonstrates acceptable reproducibility and can potentially be implemented in primary care.
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Affiliation(s)
- Sarah J. Charman
- Cardiovascular Research Centre, Institutes of Cellular and Genetic Medicine, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Nduka C. Okwose
- Cardiovascular Research Centre, Institutes of Cellular and Genetic Medicine, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Renae J. Stefanetti
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Medical SchoolNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Kristian Bailey
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Jane Skinner
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Arsen Ristic
- Cardiology Department, Clinical Centre Serbia, School of MedicineUniversity of BelgradeBelgradeSerbia
| | - Petar M. Seferovic
- Cardiology Department, Clinical Centre Serbia, School of MedicineUniversity of BelgradeBelgradeSerbia
| | | | | | - Ahmet Fuat
- Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust and School of Medicine, Pharmacy and HealthDurham UniversityDurhamUK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Richard F.D. Hobbs
- Nuffield Department of Primary Health Care SciencesUniversity of OxfordOxfordUK
| | - Guy A. MacGowan
- Cardiovascular Research Centre, Institutes of Cellular and Genetic Medicine, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Djordje G. Jakovljevic
- Cardiovascular Research Centre, Institutes of Cellular and Genetic Medicine, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
- RCUK Centre for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
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