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Baral R, Ho JSY, Soroya AN, Hanger M, Clarke RE, Memon SF, Glatzel H, Ahmad M, Providencia R, Bray JJH, D'Ascenzo F. Exercise training improves exercise capacity and quality of life in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae033. [PMID: 38982996 PMCID: PMC11231943 DOI: 10.1093/ehjopen/oeae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/17/2024] [Accepted: 04/09/2024] [Indexed: 07/11/2024]
Abstract
Aims Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality, and there are limited proven therapeutic strategies. Exercise has been shown to be beneficial in several studies. We aimed to evaluate the efficacy of exercise on functional, physiological, and quality-of-life measures. Methods and results A comprehensive search of Medline and Embase was performed. Randomized controlled trials (RCTs) of adult HFpEF patients with data on exercise intervention were included. Using meta-analysis, we produced pooled mean difference (MD) estimates with 95% confidence intervals (CIs) with Review Manager (RevMan) software for the peak oxygen uptake (VO2), Minnesota living with heart failure (MLWHF) and, other diastolic dysfunction scores. A total of 14 studies on 629 HFpEF patients were included (63.2% female) with a mean age of 68.1 years. Exercise was associated with a significant improvement in the peak VO2 (MD 1.96 mL/kg/min, 95% CI 1.25-2.68; P < 0.00001) and MLWHF score (MD -12.06, 95% CI -17.11 to -7.01; P < 0.00001) in HFpEF. Subgroup analysis showed a small but significant improvement in peak VO2 with high-intensity interval training (HIIT) vs. medium-intensity continuous exercise (MCT; MD 1.25 mL/kg/min, 95% CI 0.41-2.08, P = 0.003). Conclusion Exercise increases the exercise capacity and quality of life in HFpEF patients, and high-intensity exercise is associated with a small but statistically significant improvement in exercise capacity than moderate intensity. Further studies with larger participant populations and longer follow-up are needed to confirm these findings and elucidate potential differences between high- and medium-intensity exercise.
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Affiliation(s)
- Ranu Baral
- Kings College Hospital NHS Trust, London, Denmark Hill, London SE5 9RS, UK
| | | | | | - Melissa Hanger
- University College London, Gower St, London WC1E 6BT, UK
| | | | | | - Hannah Glatzel
- Stoke Mandeville Hospital, Mandeville Rd, Aylesbury HP21 8AL, UK
| | - Mahmood Ahmad
- Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Rui Providencia
- University College London, Gower St, London WC1E 6BT, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Jonathan James Hyett Bray
- Institute of Life Sciences-2, Swansea Bay University Health Board and Swansea University Medical School, Swansea University, Sketty, Swansea SA2 8QA, UK
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Science, University of Turin, Via Verdi 8, 10124 Torino, P.I. 02099550010, Italy
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Chen D, Feng J, He H, Xiao W, Liu X. Classification, Diagnosis, and Treatment of Obesity-Related Heart Diseases. Metab Syndr Relat Disord 2024; 22:161-169. [PMID: 38294776 DOI: 10.1089/met.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Evidence-based medicine shows that obesity is associated with a wide range of cardiovascular (CV) diseases. Obesity can lead to changes in cardiac structure and function, which can lead to obese cardiomyopathy, subclinical cardiac dysfunction, and even heart failure. It also increases the risk of atrial fibrillation and sudden cardiac death. Many invasive and noninvasive diagnostic methods can detect obesity-related heart disease at an early stage, so that appropriate measures can be selected to prevent adverse CV events. However, studies have shown a protective effect of obesity on clinical outcomes of CV disease, a phenomenon that has been termed the obesity paradox. The "obesity paradox" essentially refers to the fact that the classification of obesity defined by body mass index (BMI) does not consider the impact of obesity heterogeneity on CV disease prognosis, but simply puts subjects with different clinical and biochemical characteristics into the same category. In any case, indicators such as waist-to-hip ratio, ectopic body fat qualitative and quantitative, and CV fitness have been shown to be able to distinguish different CV risks in patients with the same BMI, which is convenient for early intervention in an appropriate way. A multidisciplinary approach, including lifestyle modification, evidence-based generic and novel pharmacotherapy, and surgical intervention, can improve CV outcomes in overweight/obese patients.
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Affiliation(s)
- Dan Chen
- Department of Electrocardiogram, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Artificial Intelligence Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong, China
| | - Juan Feng
- Department of Echocardiography, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - HongYan He
- Department of Electrocardiogram, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, Shandong, China
| | - WeiPing Xiao
- Department of Acupuncture, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, Shandong, China
| | - XiaoJing Liu
- Department of Endocrinology and Metabolism, The Second Hospital of Shandong University, Jinan, Shandong, China
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Salmons H, Ahmed SI, Billingsley HE, Markley R, Damonte JI, Del Buono MG, Kirkman DL, Bohmke NJ, Franco RL, Garten R, Makkiya M, Abbate A, Carbone S. Skeletal muscle quality, measured via phase angle, and cardiorespiratory fitness in patients with obesity and heart failure with preserved ejection fraction. Nutrition 2023; 116:112163. [PMID: 37562184 PMCID: PMC10792099 DOI: 10.1016/j.nut.2023.112163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Cardiorespiratory fitness (CRF) is influenced by body composition quantity and quality in heart failure with preserved ejection fraction (HFpEF) and obesity. Bioelectrical impedance analysis (BIA) provides a noninvasive quantitative and qualitative body composition assessment. The aim of this study was to determine the role of phase angle (PhA), a BIA-measure of skeletal muscle quality and body cell mass, on CRF in patients with obesity and HFpEF. METHODS Fifty-nine consecutive outpatients with HFpEF underwent cardiopulmonary exercise testing to measure CRF. Single-frequency segmental BIA was used to measure PhA and body composition quantity. Resting Doppler echocardiography and biomarkers were measured to assess cardiac function and systemic inflammation. RESULTS Compared with patients with lower PhA, patients with higher PhA (above mean 5.8°) presented a greater absolute peak oxygen consumption (VO2; 1.83 [1.3-2.1] versus 1.39 [1.1-1.6] L/min, P = 0.003), VO2 peak adjusted for body weight (17.5 [12.3-18.1] versus 13.3 [12.7-15.2] mL/kg/min, P = 0.040), and a lower edema index (48.7 [2.9] versus 51.4% [2.7], P < 0.001) and N-terminal pro-B-type natriuretic peptide (NT-proBNP; 64 [50-121] versus 183 [68-343.5] pg/dL, P < 0.001). In the overall sample, PhA was correlated with absolute VO2 peak (r = 0.468, P < 0.001), VO2 peak adjusted for body weight (r = 0.368, P = 0.004), VO2 peak adjusted for fat-free mass (r = 0.315, P = 0.015), edema index (r = -0.508, P < 0.001), and NT-proBNP (r = -0.579, P < 0.001). PhA remained a significant predictor for CRF even after adjustment for potential confounders and HFpEF severity. CONCLUSION In patients with obesity and HFpEF, a greater PhA is an independent predictor for favorable CRF.
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Affiliation(s)
- Hannah Salmons
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Syed Imran Ahmed
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Hayley E Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roshanak Markley
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Juan Ignacio Damonte
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA; Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marco Giuseppe Del Buono
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Danielle L Kirkman
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Natalie J Bohmke
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Robert L Franco
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ryan Garten
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mohammed Makkiya
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
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Guan X, Gao S, Zhao H, Zhou H, Yang Y, Yu S, Wang J. Clinical characteristics of hospitalized term and preterm infants with community-acquired viral pneumonia. BMC Pediatr 2022; 22:452. [PMID: 35897053 PMCID: PMC9325944 DOI: 10.1186/s12887-022-03508-7] [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] [Received: 03/31/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumonia is a serious problem that threatens the health of newborns. This study aimed to investigate the clinical characteristics of hospitalized term and preterm infants with community-acquired viral pneumonia. METHODS This was a retrospective analysis of cases of community-acquired viral pneumonia in the Neonatal Department. Nasopharyngeal aspirate (NPA) samples were collected for pathogen detection, and clinical data were collected. We analysed pathogenic species and clinical characteristics among these infants. RESULTS RSV is the main virus in term infants, and parainfluenza virus (PIV) 3 is the main virus in preterm infants. Patients infected with PIV3 were more susceptible to coinfection with bacteria than those with respiratory syncytial virus (RSV) infection (p < 0.05). Preterm infants infected with PIV3 were more likely to be coinfected with bacteria than term infants (p < 0.05), mainly gram-negative bacteria (especially Klebsiella pneumonia). Term infants with bacterial infection were more prone to fever, cyanosis, moist rales, three concave signs, elevated C-reactive protein (CRP) levels, respiratory failure and the need for higher level of oxygen support and mechanical ventilation than those with simple viral infection (p < 0.05). The incidence of hyponatremia in neonatal community-acquired pneumonia (CAP) was high. CONCLUSIONS RSV and PIV3 were the leading causes of neonatal viral CAP. PIV3 infection is the main cause of viral CAP in preterm infants, and these individuals are more likely to be coinfected with bacteria than term infants, mainly gram-negative bacteria. Term infants with CAP coinfected with bacteria were more likely to have greater disease severity than those with single viral infections.
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Affiliation(s)
- Xinxian Guan
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Shasha Gao
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - He Zhao
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Huiting Zhou
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Yan Yang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China
| | - Shenglin Yu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, China.
| | - Jian Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China.
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5
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Meijer R, van Hooff M, Papen-Botterhuis NE, Molenaar CJL, Regis M, Timmers T, van de Poll-Franse LV, Savelberg HHCM, Schep G. Estimating VO2peak in 18–90 Year-Old Adults: Development and Validation of the FitMáx©-Questionnaire. Int J Gen Med 2022; 15:3727-3737. [PMID: 35411174 PMCID: PMC8994663 DOI: 10.2147/ijgm.s355589] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Cardiorespiratory fitness (CRF) plays an essential role in health outcomes and quality of life. However, it is often not assessed nor estimated. Objective CRF assessment is costly, labour intensive and not widely available. Patient-reported outcome measures estimate CRF more cost-efficiently, but current questionnaires lack accuracy. The aim of this study is to develop a new self-reported questionnaire to estimate CRF. Materials and Methods The FitMáx©-questionnaire, consisting of only three questions assessing walking, stair climbing, and cycling capacity, was compared with the commonly used Duke Activity Status Index (DASI) and Veterans Specific Activity Questionnaire (VSAQ). These questionnaires were compared to peak oxygen uptake (VO2peak) as measured with cardiopulmonary exercise testing. This study included 759 cardiac, pulmonary and oncologic patients and healthy persons aged 18‒90. Results FitMáx© strongly correlated (r = 0.94 (0.92‒0.95) SEE = 4.14 mL∙kg−1∙min−1) with measured VO2peak. Bias between predicted and measured VO2peak was −0.24 (−9.23‒8.75; 95% limits of agreement) mL·kg−1·min−1. The FitMáx© scored superiorly on correlation and SEE compared with the DASI and VSAQ, r = 0.75 (0.68‒0.80) SEE = 4.62 mL∙kg−1∙min−1 and r = 0.87 (0.83‒0.90) SEE = 6.75 mL∙kg−1∙min−1, respectively. Conclusion FitMáx© is a valid and accessible questionnaire to estimate CRF expressed as VO2peak in clinical practice and shows substantial improvement compared to currently used questionnaires.
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Affiliation(s)
- Renske Meijer
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Correspondence: Renske Meijer, Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands, Tel +31 40 8888 000, Email ; ;
| | - Martijn van Hooff
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | | | - Marta Regis
- Academy, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Mathematics and Computer Science, University of Technology, Eindhoven, the Netherlands
| | - Thomas Timmers
- Department of Research & Development, Interactive Studios, Rosmalen, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Net
herlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Goof Schep
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
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Ge Y, Liu J, Zhang L, Gao Y, Wang B, Wang X, Li J, Zheng X. Association of Lean Body Mass and Fat Mass With 1-Year Mortality Among Patients With Heart Failure. Front Cardiovasc Med 2022; 9:824628. [PMID: 35295256 PMCID: PMC8918916 DOI: 10.3389/fcvm.2022.824628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 01/05/2023] Open
Abstract
BackgroundPrior studies have found an unexplained inverse or U-shaped relationship between body mass index (BMI) and mortality in heart failure (HF) patients. However, little is known about the independent effects of each body component, i.e., lean body mass (LBM) and fat mass (FM), on mortality.MethodsWe used data from the China Patient-centered Evaluative Assessment of Cardiac Events-Prospective Heart Failure Study. LBM and FM were calculated using equations developed from the National Health and Nutrition Examination Survey. LBM and FM index, calculated by dividing LBM or FM in kilograms by the square of height in meters, were used for analysis. We used restricted cubic spline and Cox model to examine the association of LBM and FM index with 1-year all-cause mortality.ResultsAmong 4,305 patients, median (interquartile range) age was 67 (57–76) years, 37.7% were women. During the 1-year follow-up, 691 (16.1%) patients died. After adjustments, LBM index was inversely associated with mortality in a linear way (P-overall association < 0.01; P-non-linearity = 0.52), but no association between FM index and mortality was observed (P-overall association = 0.19). Compared with patients in the 1st quartile of the LBM index, those in the 2nd, 3rd, and 4th quartiles had lower risk of death, with hazard ratio of 0.80 (95% CI 0.66–0.97), 0.65 (95% CI 0.52–0.83), and 0.61 (95% CI 0.45–0.82), respectively. In contrast, this association was not observed between FM index quartiles and mortality.ConclusionHigher LBM, not FM, was associated with lower 1-year mortality among HF patients.
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Affiliation(s)
- Yilan Ge
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiamin Liu
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihua Zhang
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Gao
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Wang
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuling Wang
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Jing Li
| | - Xin Zheng
- National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Coronary Artery Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
- *Correspondence: Xin Zheng
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Chu DJ, Ahmed AM, Qureshi WT, Brawner CA, Keteyian SJ, Nasir K, Blumenthal RS, Blaha MJ, Ehrman JK, Cainzos-Achirica M, Patel KV, Al Rifai M, Al-Mallah MH. Prognostic Value of Cardiorespiratory Fitness in Patients with Chronic Kidney Disease: The FIT (Henry Ford Exercise Testing) Project. Am J Med 2022; 135:67-75.e1. [PMID: 34509447 DOI: 10.1016/j.amjmed.2021.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/01/2021] [Accepted: 07/31/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE We conducted this study to investigate the association of cardiorespiratory fitness and all-cause mortality among patients with chronic kidney disease. METHODS We studied a retrospective cohort of patients from the Henry Ford Health System who underwent clinically indicated exercise stress testing with baseline cardiorespiratory fitness and estimated glomerular filtration rate measurement. Cardiorespiratory fitness was expressed as metabolic equivalents of task, and kidney function was categorized into stages according to estimated glomerular filtration rate. Multivariable-adjusted Cox proportional hazard models were used to examine the association between metabolic equivalents of task and all-cause mortality among patients with chronic kidney disease stages 3-5. Discrimination of mortality was assessed using receiver operating characteristic curves, while reclassification was evaluated using net reclassification index (NRI). RESULTS Among 50,121 participants, the mean age was 55 ± 12.6 years; 47.5% were women, 64.5% were white, and 6877 (13.7%) participants had chronic kidney disease stage 3-5. Over a median follow-up of 6.7 years, 6308 participants died (12.6%). Each 1-unit higher metabolic equivalents of task was associated with a significant 15% reduction in all-cause mortality (hazard ratio 0.85; 95% confidence interval [CI], 0.84-0.87). Metabolic equivalents of task improved discriminatory ability of mortality prediction when added to traditional risk factors and estimated glomerular filtration rate (area under the curve 0.7996; 95% CI, 0.789-0.810 vs 0.759; 95% CI, 0.748-0.770, respectively; P < .001). The addition of metabolic equivalents of task to traditional risk factors resulted in significant reclassification (6% for events, 5% for non-events: NRI = 0.13, P < .001). CONCLUSIONS Cardiorespiratory fitness improves mortality risk prediction among patients with chronic kidney disease. Cardiorespiratory fitness provides incremental prognostic information when added to traditional risk factors and may help guide treatment options among patients with renal dysfunction.
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Affiliation(s)
- Daniel J Chu
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Amjad M Ahmed
- King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Waqas T Qureshi
- Department of Cardiology, University of Massachusetts, Worcester
| | | | | | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md; Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md
| | | | | | - Kershaw V Patel
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Mahmoud Al Rifai
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas.
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Pella D, Toth S, Paralic J, Gonsorcik J, Fedacko J, Jarcuska P, Pella D, Pella Z, Sabol F, Jankajova M, Valocik G, Putrya A, Kirschová A, Plachy L, Rabajdova M, Hunavy M, Kafkova B, Doci I, Timkova S, Dvorožňáková M, Babic F, Butka P, Dimunova L, Marekova M, Paralicova Z, Majernik J, Luczy J, Janosik J, Kmec M. The possible role of machine learning in detection of increased cardiovascular risk patients - KSC MR Study (design). Arch Med Sci 2022; 18:991-997. [PMID: 35832722 PMCID: PMC9266729 DOI: 10.5114/aoms.2020.99156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/14/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Currently, just a few major parameters are used for cardiovascular (CV) risk quantification to identify many of the high-risk subjects; however, they leave a lot of them with an underestimated level of CV risk which does not reflect the reality. MATERIAL AND METHODS The submitted study design of the Kosice Selective Coronarography Multiple Risk (KSC MR) Study will use computer analysis of coronary angiography results of admitted patients along with broad patients' characteristics based on questionnaires, physical findings, laboratory and many other examinations. RESULTS Obtained data will undergo machine learning protocols with the aim of developing algorithms which will include all available parameters and accurately calculate the probability of coronary artery disease. CONCLUSIONS The KSC MR study results, if positive, could establisha base for development of proper software for revealing high-risk patients, as well as patients with suggested positive coronary angiography findings, based on the principles of personalised medicine.
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Affiliation(s)
- Daniel Pella
- 2 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Stefan Toth
- SLOVACRIN & Medical Science Park, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovak Republic
| | - Jan Paralic
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Kosice, Kosice, Slovak Republic
| | - Jozef Gonsorcik
- 2 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Jan Fedacko
- SLOVACRIN & Medical Science Park, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovak Republic
| | - Peter Jarcuska
- 2 Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Dominik Pella
- 1 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Zuzana Pella
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Kosice, Kosice, Slovak Republic
| | - Frantisek Sabol
- Department of Cardiosurgery, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Monika Jankajova
- 1 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Gabriel Valocik
- Department of Cardiosurgery, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Alina Putrya
- 2 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Andrea Kirschová
- 1 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Lukas Plachy
- 2 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Miroslava Rabajdova
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovak Republic
| | - Mikulas Hunavy
- 1 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Bibiana Kafkova
- 1 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Ivan Doci
- 2 Department of Psychiatry, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Silvia Timkova
- 1 Dental Clinic, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Mariana Dvorožňáková
- 2 Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Frantisek Babic
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Kosice, Kosice, Slovak Republic
| | - Peter Butka
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Kosice, Kosice, Slovak Republic
| | - Lucia Dimunova
- Institute of Nursing, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovak Republic
| | - Maria Marekova
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovak Republic
| | - Zuzana Paralicova
- Department of Infectology and Travel Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Jaroslav Majernik
- Department of Medical Informatics, Faculty of Medicine, Pavol Jozef Safarik University, Košice, Slovak Republic
| | - Jan Luczy
- Department of Cardiosurgery, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Košice, Slovak Republic
| | - Jakub Janosik
- Academy Dental Centre and Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Martin Kmec
- Cardiovascular Disease Centre, J.A. Reiman Faculty Hospital Presov, Presov, Slovak Republic
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Ezzatvar Y, Izquierdo M, Núñez J, Calatayud J, Ramírez-Vélez R, García-Hermoso A. Cardiorespiratory fitness measured with cardiopulmonary exercise testing and mortality in patients with cardiovascular disease: A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:609-619. [PMID: 34198003 PMCID: PMC8724619 DOI: 10.1016/j.jshs.2021.06.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) is inversely associated with mortality in apparently healthy subjects and in some clinical populations, but evidence for the association between CRF and all-cause and/or cardiovascular disease (CVD) mortality in patients with established CVD is lacking. This study aimed to quantify this association. METHODS We searched for prospective cohort studies that measured CRF with cardiopulmonary exercise testing in patients with CVD and that examined all-cause and CVD mortality with at least 6 months of follow-up. Pooled hazard ratios (HRs) were calculated using random-effect inverse-variance analyses. RESULTS Data were obtained from 21 studies and included 159,352 patients diagnosed with CVD (38.1% female). Pooled HRs for all-cause and CVD mortality comparing the highest vs. lowest category of CRF were 0.42 (95% confidence interval (95%CI): 0.28-0.61) and 0.27 (95%CI: 0.16-0.48), respectively. Pooled HRs per 1 metabolic equivalent (1-MET) increment were significant for all-cause mortality (HR = 0.81; 95%CI: 0.74-0.88) but not for CVD mortality (HR = 0.75; 95%CI: 0.48-1.18). Coronary artery disease patients with high CRF had a lower risk of all-cause mortality (HR = 0.32; 95%CI: 0.26-0.41) than did their unfit counterparts. Each 1-MET increase was associated with lower all-cause mortality risk among coronary artery disease patients (HR = 0.83; 95%CI: 0.76-0.91) but not lower among those with heart failure (HR = 0.69; 95%CI: 0.36-1.32). CONCLUSION A better CRF was associated with lower risk of all-cause mortality and CVD. This study supports the use of CRF as a powerful predictor of mortality in this population.
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Affiliation(s)
- Yasmin Ezzatvar
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, Universitat de València, Valencia 46010, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), Navarra Medical Research Institute (IdiSNA), Pamplona 31008, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Julio Núñez
- Department of Cardiology, Valencia University Hospital, Biomedical Research Institute (INCLIVA), Valencia 46010, Spain; CIBER in Cardiovascular Diseases (CIBERCV), Madrid 28029, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, Universitat de València, Valencia 46010, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), Navarra Medical Research Institute (IdiSNA), Pamplona 31008, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), Navarra Medical Research Institute (IdiSNA), Pamplona 31008, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain; Sciences of Physical Activity, Sports and Health School, University of Santiago of Chile (USACH), Santiago 71783-5, Chile.
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10
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Wang CH, Han S, Tong F, Li Y, Li ZC, Sun ZJ. Risk prediction model of in-hospital mortality in heart failure with preserved ejection fraction and mid-range ejection fraction: a retrospective cohort study. Biomark Med 2021; 15:1223-1232. [PMID: 34498488 DOI: 10.2217/bmm-2021-0025] [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: 11/21/2022] Open
Abstract
Aim: To develop and validate internally a multivariate risk model for predicting the in-hospital mortality of patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-range ejection fraction (HFmrEF). Methods & results: The clinical data of 8172 inpatients with HFpEF and HFmrEF was used to establish a retrospective database. These patients, among whom 307 in-hospital deaths (3.8%) occurred, were randomly assigned to derivation and verification cohort. Among the extracted data from the derivation cohort were nine variables significantly related to in-hospital mortality, which were scored 0-4, for a total score of 24, which allowed formation of a risk predictive model. The verification cohort was then used to validate the discrimination and calibration capacities of this predictive model: the area under curve equaled 0.8575 (0.8285, 0.8865) for the derivation cohort, and 0.8323 (0.7999, 0.8646) for the verification cohort. According to this risk score, we divided patients into four risk classes (low-, medium-, high- and extremely high-risk) and revealed that the risk of in-hospital mortality increased with increasing risk class with an obvious linear relationship between actual and predicted mortality (r = 0.998, p < 0.001). Conclusion: The model based on nine common clinical variables should provide an accurate prediction of in-hospital mortality and appears to be a reliable risk classification system for patients with HFpEF and HFmrEF.
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Affiliation(s)
- Chuan-He Wang
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Su Han
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Fei Tong
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Ying Li
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Zhi-Chao Li
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, China
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Tucker WJ, Angadi SS, Haykowsky MJ, Nelson MD, Sarma S, Tomczak CR. Pathophysiology of Exercise Intolerance and Its Treatment With Exercise-Based Cardiac Rehabilitation in Heart Failure With Preserved Ejection Fraction. J Cardiopulm Rehabil Prev 2021; 40:9-16. [PMID: 31764536 DOI: 10.1097/hcr.0000000000000481] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is the fastest growing form of heart failure in the United States. The cardinal feature of HFpEF is reduced exercise tolerance (peak oxygen uptake, (Equation is included in full-text article.)O2peak) secondary to impaired cardiac, vascular, and skeletal muscle function. There are currently no evidence-based drug therapies to improve clinical outcomes in patients with HFpEF. In contrast, exercise training is a proven effective intervention for improving (Equation is included in full-text article.)O2peak, aerobic endurance, and quality of life in HFpEF patients. This brief review discusses the pathophysiology of exercise intolerance and the role of exercise training to improve (Equation is included in full-text article.)O2peak in clinically stable HFpEF patients. It also discusses the mechanisms responsible for the exercise training-mediated improvements in (Equation is included in full-text article.)O2peak in HFpEF. Finally, it provides evidence-based exercise prescription guidelines for cardiac rehabilitation specialists to assist them with safely implementing exercise-based cardiac rehabilitation programs for HFpEF patients.
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Affiliation(s)
- Wesley J Tucker
- Department of Kinesiology (Drs Tucker and Nelson) and College of Nursing and Health Innovation (Drs Tucker and Haykowsky), University of Texas at Arlington, Arlington; Department of Nutrition & Food Sciences, Texas Woman's University, Houston (Dr Tucker); College of Health Solutions, Arizona State University, and Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona (Dr Angadi); Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (Dr Sarma); and College of Kinesiology, University of Saskatchewan, Saskatoon, Canada (Dr Tomczak)
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12
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Arundel C, Lam PH, Faselis C, Sheriff HM, Dooley DJ, Morgan C, Fonarow GC, Aronow WS, Allman RM, Ahmed A. Length of stay and readmission in older adults hospitalized for heart failure. Arch Med Sci 2021; 17:891-899. [PMID: 34336017 PMCID: PMC8314416 DOI: 10.5114/aoms.2019.89702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hospital length of stay (LoS) and hospital readmissions are metrics of healthcare performance. We examined the association between these two metrics in older patients hospitalized with decompensated heart failure (HF). MATERIAL AND METHODS Eight thousand and forty-nine patients hospitalized for HF in 106 U.S. hospitals had a median LoS of 5 days; among them, 3777 had a LoS > 5 days. Using propensity scores for LoS > 5 days, we assembled 2723 pairs of patients with LoS 1-5 vs. > 5 days. The matched cohort of 5446 patients was balanced on 40 baseline characteristics. We repeated the above process in 7045 patients after excluding those with LoS > 10 days, thus assembling a second matched cohort of 2399 pairs of patients with LoS 1-5 vs. 6-10 days. Hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with longer LoS were estimated in matched cohorts. RESULTS In the primary matched cohort (n = 5446), LoS > 5 days was associated with a higher risk of all-cause readmission at 30 days (HR = 1.16; 95% CI: 1.04-1.31; p = 0.010), but not during longer follow-up. A longer LoS was also associated with a higher risk of mortality during 8.8 years of follow-up (HR = 1.13; 95% CI: 1.06-1.21; p < 0.001). LoS had no association with HF readmission. Similar associations were observed among the matched sensitivity cohort (n = 4798) that excluded patients with LoS > 10 days. CONCLUSIONS In propensity score-matched balanced cohorts of patients with HF, a longer LoS was independently associated with poor outcomes, which persisted when LoS > 10 days were excluded.
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Affiliation(s)
- Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Phillip H. Lam
- Veterans Affairs Medical Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Helen M. Sheriff
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Daniel. J. Dooley
- Georgetown University, Washington, DC, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Charity Morgan
- Veterans Affairs Medical Center, Washington, DC, USA
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Wilbert S. Aronow
- Weschester Medical Center, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Richard M. Allman
- George Washington University, Washington, DC, USA
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC, USA
- George Washington University, Washington, DC, USA
- Georgetown University, Washington, DC, USA
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Wu H, Cao Y, Liang L. Effect of dynamic atrioventricular and interventricular delay optimization for cardiac resynchronization therapy on cardiac function and neuroendocrine factors in patients with congestive heart failure. Arch Med Sci 2021; 17:551-556. [PMID: 33747292 PMCID: PMC7959086 DOI: 10.5114/aoms/131564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Haoyu Wu
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Yiwei Cao
- Department of Electrocardiology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Lei Liang
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an, China
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Chu DJ, Al Rifai M, Virani SS, Brawner CA, Nasir K, Al-Mallah MH. The relationship between cardiorespiratory fitness, cardiovascular risk factors and atherosclerosis. Atherosclerosis 2020; 304:44-52. [DOI: 10.1016/j.atherosclerosis.2020.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023]
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