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Wójcicki K, Krysztofiak H, Dąbrowska K, Chruścicki D, Nalewajko K, Feusette P, Gierlotka M, Płonka J. New-onset acute heart failure: Clinical profile and one-year outcomes. Observations from the OP-AHF Registry. Kardiol Pol 2024; 82:210-213. [PMID: 38230468 DOI: 10.33963/v.kp.98444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Kacper Wójcicki
- Students' Research Group 'Cardios', Faculty of Medicine, University of Opole, Opole, Poland
| | - Helena Krysztofiak
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland.
| | - Klaudia Dąbrowska
- Students' Research Group 'Cardios', Faculty of Medicine, University of Opole, Opole, Poland
| | - Damian Chruścicki
- Students' Research Group 'Cardios', Faculty of Medicine, University of Opole, Opole, Poland
| | - Krzysztof Nalewajko
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Piotr Feusette
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Joanna Płonka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
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Kałużna-Oleksy M, Krysztofiak H, Sawczak F, Kukfisz A, Szczechla M, Soloch A, Cierzniak M, Szubarga A, Przytarska K, Dudek M, Uchmanowicz I, Straburzyńska-Migaj E. Sex differences in the nutritional status and its association with long-term prognosis in patients with heart failure with reduced ejection fraction: a prospective cohort study. Eur J Cardiovasc Nurs 2024:zvad105. [PMID: 38170824 DOI: 10.1093/eurjcn/zvad105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024]
Abstract
AIMS Many studies show the association between malnutrition and poor prognosis in heart failure (HF) patients. Our research aimed to analyse sex differences in patients with HF with reduced ejection fraction (HFrEF), emphasizing nutritional status and the influence of selected parameters on the prognosis. METHODS AND RESULTS We enrolled 276 consecutive patients diagnosed with HFrEF. Nutritional status was assessed using Mini Nutritional Assessment (MNA), geriatric nutritional risk index (GNRI), and body mass index (BMI). The mean follow-up period was 564.4 ± 346.3 days. The analysed group included 81.2% of men. The median age was 58, interquartile range (IQR) 49-64 years. Among all patients, almost 60% were classified as NYHA III or IV. Half of the participants were at risk of malnutrition, and 2.9% were malnourished. During follow-up, 72 (26.1%) patients died. The female sex was not associated with a higher occurrence of malnutrition (P = 0.99) or nutritional risk (P = 0.85), according to MNA. Coherently, GNRI scores did not differ significantly between the sexes (P = 0.29). In contrast, BMI was significantly higher in males (29.4 ± 5.3 vs. 25.9 ± 4.7; P < 0.001). Impaired nutritional status assessed with any method (MNA, GNRI, BMI) was not significantly associated with a worse prognosis. In multivariable analysis, NYHA class, lower estimated glomerular filtration rate, higher B-type natriuretic peptide (BNP), higher N-terminal fragment of proBNP, and higher uric acid were independent of sex and age predictors of all-cause mortality. CONCLUSION There were no sex differences in the nutritional status in the HFrEF patients, apart from lower BMI in females. Impaired nutritional status was not associated with mortality in both men and women.
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Affiliation(s)
- Marta Kałużna-Oleksy
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Helena Krysztofiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Filip Sawczak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Agata Kukfisz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Curie-Sklodowska 9, 41-800 Zabrze, Poland
| | - Magdalena Szczechla
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Aleksandra Soloch
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Maria Cierzniak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Alicja Szubarga
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Katarzyna Przytarska
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Magdalena Dudek
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Bartla 5, 51-618 Wroclaw, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
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Dudek M, Kałużna-Oleksy M, Migaj J, Sawczak F, Krysztofiak H, Lesiak M, Straburzyńska-Migaj E. sST2 and Heart Failure-Clinical Utility and Prognosis. J Clin Med 2023; 12:3136. [PMID: 37176577 PMCID: PMC10179304 DOI: 10.3390/jcm12093136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
New parameters and markers are constantly being sought to help better assess patients with heart failure (HF). ST2 protein has gained interest as a potential biomarker in cardiovascular disease. It is known that the IL-33/ST2L system belongs to the cardioprotective pathway, which prevents the fibrosis, hypertrophy, and apoptosis of cardiomyocytes and also inhibits the inflammatory response. Soluble ST2 (sST2) is involved in the immune response and secreted in response to the mechanical overload of the myocardium, thus providing information on the processes of myocardial remodeling and fibrosis. A total of 110 hospitalized patients diagnosed with heart failure with reduced ejection fraction (HFrEF) were included in the study. Clinical and biochemical parameters were studied. During the follow-up, 30.9% patients died and 57.3% patients reached the composite endpoint. Using ROC curves, the reference cut-off point for sST2 was determined to be 45.818 pg/mL for all-cause deaths. Significantly higher concentrations of inflammatory parameters and natriuretic peptides were found in the group of patients with higher sST2 concentrations. sST2 protein is an independent risk factor for all-cause deaths of patients with HFrEF.
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Affiliation(s)
- Magdalena Dudek
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Marta Kałużna-Oleksy
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Jacek Migaj
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Filip Sawczak
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Helena Krysztofiak
- Department of Cardiology, University Hospital in Opole, 45-401 Opole, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
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Szubarga A, Sawczak F, Soloch A, Cierzniak M, Kukfisz A, Szczechla M, Migaj J, Dudek M, Straburzynska-Migaj E, Krysztofiak H, Przytarska K, Kaluzna-Oleksy M. Seasonal differences in nutritional status of patients hospitalized with heart failure with reduced ejection fraction. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Heart failure (HF) is increasing steadily while the prognosis still stays poor despite improvements in care and availability of new therapies. The nutritional status. is important in management of HF, as an part of multidisciplinary approach. It is known that the diet depends on the availability of nutritional products and therefore also on the season. The seasonal differences of the nutritional status in HF to our knowledge has not been studied before.
Purpose
The assessment of variability in nutritional status among patients with heart failure with reduced ejection fraction (HFrEF) in different seasons of the year.
Methods
We enrolled 240 consecutive patients hospitalized at the department of cardiology, due to HFrEF with left ventricular ejection fraction (LVEF) <=40%. Patients were interviewed with MNA form to assess their nutritional status. Detailed medical history was collected. Patients were divided according to the astronomical season of the year (spring summer fall winter), depending on the time of the admission to the hospital. We compared MNA scores between mentioned groups of patients using U Mann Whitney test. Due to the possible influence of HF exacerbations on nutritional status, the second analysis was done after exclusion of patients with HF decompensation.
Results
Mean age was 56.4±11.3 years, 15.8 % patients were women, mean BMI – 28.8±5.5 kg/m2, mean LVEF – 23.9±7.7%, mean MNA score – 23.0±2.9 points. MNA score was higher (the sign of better nutritional status) in patients interviewed during spring compared to those assessed in summer (p=0.0094) or fall (p=0.014). The same situation was observed after the exclusion of patients with decompensation of HF: MNA score measured in patients admitted in spring was better than those hospitalized in summer (p=0.042) or fall (p=0.0064). The difference between spring and winter lacked statistical significance (p=0.058). Mean MNA scores and more important data for every season are presented in Figure 1 and 2.
Conclusion(s)
The differences in nutrition state in stable patients with HFrEF suggest that the seasonality of the diet might result from veritable modification in nutrition associated with availability and price of fruit and vegetables or the respondents mood, unrelated to the real nutritional status, impacts the score in the MNA questionnaire. This requires further analyses.
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Affiliation(s)
- A Szubarga
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | - F Sawczak
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | - A Soloch
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | - M Cierzniak
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | - A Kukfisz
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | - M Szczechla
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | - J Migaj
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | - M Dudek
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | | | - H Krysztofiak
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | - K Przytarska
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
| | - M Kaluzna-Oleksy
- Poznan University of Medical Sciences, Clinic of Cardiology I , Poznan , Poland
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Wasniewski F, Sawczak F, Kukfisz A, Szczechla M, Krysztofiak H, Przytarska K, Kaluzna-Oleksy M, Dudek M, Migaj J, Straburzynska-Migaj E. Soluble ST2 and nutritional status in patients hospitalized with heart failure with reduced ejection fraction - pilot study. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Student Scientific Society
Background
Chronic heart failure with reduced ejection fraction (HFrEF) is very often accompanied by malnutrition, which seems to be a marker for poor prognosis. With still high prevalence of HFrEF new aspects of malnourishment should be assessed in order to plan a more individualized management and to achieve better prognosis. In addition to that the multimarker approach to evaluating HFrEF is gaining importance. One of the most promising new markers seems to be the soluble receptor for interleukin-33 (IL-33) - sST2 peptide.
Purpose
The aim of the study was to find relationship between serum sST2 level and malnourishment indicators in patients with HFrEF.
Methods
33 consecutive patients hospitalized in the Department of Cardiology. The sST2 level was assessed using the rapid ST2 test. We assessed nutritional status with the Mini Nutritional Assessment (MNA) questionnaire and collected the chosen clinical and biochemical parameters related to nutrition. It was tested if sST2 level could predict risk of malnutrition defined as MNA score below or equal to 23.5 using ROC curve analysis. Then to further evaluate the relation between nutritional status and sST2 level appropriate correlations were tested.
Results
The studied group consisted of 9.1% women, mean age was 55.3 ± 10.0 years, left ventricular ejection fraction - 24.8 ± 8.7%, sST2 level - 49.84 ± 37.02 ng/ml. Using ROC curve analysis we found that sST2 levels can predict the risk of malnutrition with both considerable sensitivity – 0.786, specificity – 0.737 and an area under the curve (AUC) 0.726 (95%CI 0.548-0.903; p=0.013). The optimal cutoff point - 35 ng/ml was derived and according to this value patients were divided into two groups. MNA score was 22.4 ± 2.3 in group with high ST2 (>35 ng/ml) and 24.4 ± 2.4 in group with low ST2 (<35 ng/ml); the difference was statistically significant (p=0.026). Using Spearman’s Rank-Order Correlation we found that sST2 level correlated significantly with total protein level (p=0.0349, R=-0.46), albumin level (p<0.001, R=-0.80) and total cholesterol level (p=0.002, R=-0.52), while no relevant relation to BMI nor triglycerides was found.
Conclusions
The study revealed a potential value of sST2 level in predicting impaired nutritional status defined with MNA and its correlation with serum protein, albumin and total cholesterol. More research needs to be conducted in order to verify these relations and to study its usefulness.
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Affiliation(s)
- F Wasniewski
- Poznan University of Medical Sciences, 1st Department of Cardiology , Poznan , Poland
| | - F Sawczak
- Poznan University of Medical Sciences, 1st Department of Cardiology , Poznan , Poland
| | - A Kukfisz
- Poznan University of Medical Sciences, 1st Department of Cardiology , Poznan , Poland
| | - M Szczechla
- Poznan University of Medical Sciences, 1st Department of Cardiology , Poznan , Poland
| | - H Krysztofiak
- Poznan University of Medical Sciences, 1st Department of Cardiology , Poznan , Poland
| | - K Przytarska
- Poznan University of Medical Sciences, 1st Department of Cardiology , Poznan , Poland
| | - M Kaluzna-Oleksy
- University Hospital of Lords Transfiguration, 1st Department of Cardiology , Poznan , Poland
| | - M Dudek
- University Hospital of Lords Transfiguration, 1st Department of Cardiology , Poznan , Poland
| | - J Migaj
- University Hospital of Lords Transfiguration, 1st Department of Cardiology , Poznan , Poland
| | - E Straburzynska-Migaj
- University Hospital of Lords Transfiguration, 1st Department of Cardiology , Poznan , Poland
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Telec W, Krysztofiak H, Sowińska A, Kałmucki P, Monkiewicz K, Wruk BA, Szyszka A, Baszko A. The long-term benefit of a cardiac rehabilitation program after myocardial infarction in patients under the Managed Care for Acute Myocardial Infarction Survivors (MACAMIS) program in Poland: A single-center study. Kardiol Pol 2022; 80:1238-1247. [PMID: 36069197 DOI: 10.33963/kp.a2022.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Managed Care for Acute Myocardial Infarction Survivors (MACAMIS) program introduced for patients after myocardial infarction (MI) consists of 4 modules including early cardiac rehabilitation (CR). AIMS We compared the impact of CR on survival of patients after MI included in the MACAMIS program. METHODS Patients in MACAMIS were divided into subgroups based on being qualified or not qual-ified for CR and on whether they completed or failed to complete CR. We evaluated one-, two-, and three-year mortality. RESULTS Of 244 patients in MACAMIS, 174 patients were qualified for CR. They were younger, had less advanced coronary artery disease (CAD), higher ejection fraction (EF), and fewer comorbidities. Finally, 102 (58.6%) patients completed CR. These patients were younger and more likely to have STEMI; they were more often treated invasively, with no differences in comorbidity burden. The survival rates at one, two, and three years were 93.6%, 87.8%, and 65.0%, respectively. Patients who qualified for CR had a better prognosis. The mortality rates at one, two, and three years were 2.38% vs. 16.18% (P = 0.0003), 6.71% vs. 25.4% (P = 0.002), and 26.87% vs. 51.35% (P = 0.01), respectively. Patients who completed CR, again, had a significantly better prognosis. The mortality rate was 1% vs. 10.29% (P = 0.009), 4.17% vs. 17.56% (P = 0.002), and 23.33% vs. 40.54% (P = 0.09) in analyzed periods. The only independent factors related to survival were completion of CR and number of comorbidities. CONCLUSIONS Patients with MI in the MACAMIS program had better prognosis when participating in CR. After completing the MACAMIS program, increased mortality was observed in the following years. Despite the flexibility of the CR program, the proportion of patients who qualified and completed CR remained low.
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Affiliation(s)
- Wojciech Telec
- 2nd Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Anna Sowińska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznań, Poland
| | | | | | | | - Andrzej Szyszka
- 2nd Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Artur Baszko
- 2nd Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
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Kałużna-Oleksy M, Kukfisz A, Migaj J, Dudek M, Krysztofiak H, Sawczak F, Szczechla M, Przytarska K, Straburzyńska-Migaj E, Wleklik M, Uchmanowicz I. A Simple Risk Score Based on Routine Clinical Parameters Can Predict Frailty in Hospitalized Heart Failure Patients. J Clin Med 2021; 10:jcm10245963. [PMID: 34945259 PMCID: PMC8708413 DOI: 10.3390/jcm10245963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 12/17/2022] Open
Abstract
Frailty syndrome (FS) has recently attracted attention as one of the major predictors of heart failure (HF) course severity. We aimed to develop a simple tool for predicting frailty in hospitalized HF patients using routine clinical parameters. A total of 153 hospitalized patients diagnosed with heart failure with reduced ejection fraction (HFrEF) were included in the study. Presence of FS was assessed with the SHARE-FI questionnaire. Clinical and biochemical parameters were collected. Using ROC curves and logistic regression analysis, a model predicting FS presence was developed and tested. Proposed model includes five variables with following cut-off values (1 point for each variable): age > 50 years, systolic pressure on admission < 110 mmHg, total cholesterol < 4.85 mmol/L, bilirubin ≥ 15.5 mmol/L, and alanine aminotransferase ≤ 34 U/L. Receiving 5 points was considered a high risk of FS with positive and negative predictive values (NPV), 83% and 72%, respectively, and specificity of 97%. Awarding 2 points or less ruled out FS in the studied group with negative predictive value 94%. The presented novel, simple score predicts FS in HFrEF patients with routine clinical parameters and has good positive and negative predictive values.
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Affiliation(s)
- Marta Kałużna-Oleksy
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland; (A.K.); (J.M.); (M.D.); (H.K.); (F.S.); (M.S.); (K.P.); (E.S.-M.)
- Lord’s Transfiguration Clinical Hospital, Poznań University of Medical Sciences, 61-848 Poznan, Poland
- Correspondence: ; Tel.: +48-502-896-932
| | - Agata Kukfisz
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland; (A.K.); (J.M.); (M.D.); (H.K.); (F.S.); (M.S.); (K.P.); (E.S.-M.)
| | - Jacek Migaj
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland; (A.K.); (J.M.); (M.D.); (H.K.); (F.S.); (M.S.); (K.P.); (E.S.-M.)
- Lord’s Transfiguration Clinical Hospital, Poznań University of Medical Sciences, 61-848 Poznan, Poland
| | - Magdalena Dudek
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland; (A.K.); (J.M.); (M.D.); (H.K.); (F.S.); (M.S.); (K.P.); (E.S.-M.)
- Lord’s Transfiguration Clinical Hospital, Poznań University of Medical Sciences, 61-848 Poznan, Poland
| | - Helena Krysztofiak
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland; (A.K.); (J.M.); (M.D.); (H.K.); (F.S.); (M.S.); (K.P.); (E.S.-M.)
| | - Filip Sawczak
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland; (A.K.); (J.M.); (M.D.); (H.K.); (F.S.); (M.S.); (K.P.); (E.S.-M.)
| | - Magdalena Szczechla
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland; (A.K.); (J.M.); (M.D.); (H.K.); (F.S.); (M.S.); (K.P.); (E.S.-M.)
| | - Katarzyna Przytarska
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland; (A.K.); (J.M.); (M.D.); (H.K.); (F.S.); (M.S.); (K.P.); (E.S.-M.)
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland; (A.K.); (J.M.); (M.D.); (H.K.); (F.S.); (M.S.); (K.P.); (E.S.-M.)
- Lord’s Transfiguration Clinical Hospital, Poznań University of Medical Sciences, 61-848 Poznan, Poland
| | - Marta Wleklik
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
| | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
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Sawczak F, Kukfisz A, Przytarska K, Szczechla M, Krysztofiak H, Kaluzna-Oleksy M, Migaj J, Straburzynska-Migaj E. The relationship between clinical parameters and natriuretic peptides and quality of life in patients with heart failure with reduced ejection fraction. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Heart failure (HF) patients are exposed to severe symptoms of the disease, fatal prognosis, rehospitalizations and low quality of life status. Furthermore, it was observed that more patients with HF would rather live better than longer.
Purpose
The aim of the study was to determine the relationship between clinical parameters, natriuretic peptides level and quality of life (QoL) in patients with heart failure with reduced ejection fraction.
Methods
111 patients hospitalized due to heart failure with reduced ejection fraction (HFrEF) were examined using WHOQOL-BREF questionnaire and divided into three groups of similar quantity due to their transformed score of somatic domain of QoL: first group with score <45 - worst QoL (n = 33), second group with score between 45 and 55 (n = 42), and third with score >55 - best QoL (n = 36). Then the group with highest scores, with best somatic QoL, was compared with those with lowest scores in respect of chosen clinical and biochemical parameters.
Results
Patients with the highest somatic domain score, comparing with the lowest, had significantly higher BMI (mean 29.8 ± 5.5 vs. 26.8 ± 5.7 kg/m2, p = 0.016), lower BNP level (465 vs. 967 pg/ml, median 275 vs. 690, p =0.005), higher LVEF (30.7 ± 12.0 vs. 23.9 ± 10.8%, p = 0.006), higher triglycerides level (2.02 ± 1.22 vs. 1.43 ± 0.76 mmol/l, p = 0.027) and iron level (17.8 ± 6.6 vs. 13.6 ± 5.5 µmol/l, p = 0.019) as well as transferrin saturation (28.0 ± 11.0 vs. 21.3 ± 8.9 %, p = 0.015). The percentage of patients with NYHA class I and II was higher in the group with the highest somatic domain score in comparison with the lowest (66.6% vs. 33.3% respectively, p = 0.034).
Conclusions
The somatic domain of WHOQOL-BREF in patients with HFrEF correlates with patients’ clinical state assessed with the NYHA class and BNP level. QoL status was not associated with age and gender which are depicted in the literature as the important aspects influencing QoL of the community.
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Affiliation(s)
- F Sawczak
- University Hospital of Lords Transfiguration, Poznan, Poland
| | - A Kukfisz
- University Hospital of Lords Transfiguration, Poznan, Poland
| | - K Przytarska
- University Hospital of Lords Transfiguration, Poznan, Poland
| | - M Szczechla
- University Hospital of Lords Transfiguration, Poznan, Poland
| | - H Krysztofiak
- University Hospital of Lords Transfiguration, Poznan, Poland
| | | | - J Migaj
- University Hospital of Lords Transfiguration, Poznan, Poland
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9
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Krysztofiak H, Wleklik M, Migaj J, Dudek M, Uchmanowicz I, Lisiak M, Kubielas G, Straburzyńska-Migaj E, Lesiak M, Kałużna-Oleksy M. Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure. Clin Interv Aging 2020; 15:2041-2051. [PMID: 33173285 PMCID: PMC7646468 DOI: 10.2147/cia.s273967] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).
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Affiliation(s)
- Helena Krysztofiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland
| | - Marta Wleklik
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Magdalena Dudek
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | | | - Magdalena Lisiak
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Kubielas
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
| | - Marta Kałużna-Oleksy
- 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland.,Poznan University of Medical Sciences Hospital of Lord's Transfiguration, Poznan, Poland
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10
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Telec W, Krysztofiak H, Kalmucki P, Baszko A, Szyszka A. Post-myocardial transitional care in Poland - single centre experience with novel Coordinated Comprehensive Care programme – clinical and laboratory follow-up. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac rehabilitation (CR) is an inherent part of the transitional care after acute myocardial infarction (AMI). Polish health care system has created a novel Coordinated Comprehensive Care Program after AMI, which ensures outpatient follow-ups, further invasive treatment and free-of-charge CR for all patients after acute MI.
Purpose
The aim of the study was to analyze the impact of CR on clinical and laboratory characteristics of the patients who completed the recommended programme.
Methods
118 participants were enrolled. They were divided into two groups, depending on the criterium of completion (rehabilitation group) or non-completion (no rehabilitation group) of the CR. The clinical and laboratory data at discharge and after 12 months were collected and analyzed in both groups.
Results
The majority of the patients (n=83, 70,3%) underwent CR. This group was younger in comparison to patients who did not participate in CR (63.0±8.6 vs. 69.8±8.7 years; p<0.01). Index hospitalization was significantly shorter in rehabilitation group (7 vs. 8 days, respectively; p<0,04). LDL-C reduction was observed in both groups, but only rehabilitation group presented statistically significant reduction (median LDL at discharge 108,5 vs. 67,0 mg/dl at follow-up; p<0.01). No rehabilitation group had LDL-C non-significantly decreased (p=0.16). NT-proBNP decreased in both groups over 12 months, but only rehabilitation group had significant reduction (median 590,0 pg/ml at discharge vs. 199,0 at follow-up; p<0.01). Laboratory follow-up is summarized in Figure 1. BMI increased in both groups, with statistical importance in rehabilitation group (p<0,01).
Conclusions
Post-myocardial rehabilitation is more frequently prescribed to younger patients with shorter index hospitalisation. Clinical and laboratory parameters improve more in the group that underwent CR programme and this might warant more effort on increasing CR accessibility and patient enrollement. The phenomenon of weight gain in patients after acute myocardial infarction independently from undergoing rehabilitation program or not needs further research.
Figure 1. 12-month laboratory follow-up.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- W Telec
- Poznan University of Medical Sciences, Chair of Cardiology, II Department of Cardiology, Poznan, Poland
| | - H Krysztofiak
- Hipolit Cegielski Medical Center, Department of Cardiology, Poznan, Poland
| | - P Kalmucki
- Hipolit Cegielski Medical Center, Department of Cardiology, Poznan, Poland
| | - A Baszko
- Poznan University of Medical Sciences, Chair of Cardiology, II Department of Cardiology, Poznan, Poland
| | - A Szyszka
- Poznan University of Medical Sciences, Chair of Cardiology, II Department of Cardiology, Poznan, Poland
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11
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Kałużna-Oleksy M, Krysztofiak H, Migaj J, Wleklik M, Dudek M, Uchmanowicz I, Lesiak M, Straburzyńska-Migaj E. Relationship between Nutritional Status and Clinical and Biochemical Parameters in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction, with 1-year Follow-Up. Nutrients 2020; 12:nu12082330. [PMID: 32759722 PMCID: PMC7468814 DOI: 10.3390/nu12082330] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023] Open
Abstract
Heart Failure (HF) is a cardiovascular disease with continually increasing morbidity and high mortality. The purpose of this study was to analyze nutritional status in patients diagnosed with HF with reduced ejection fraction (HFrEF) and evaluate the impact of malnutrition on their prognosis. The Polish version of MNA form (Mini Nutritional Assessment) was used to assess the patients’ nutritional status. The New York Heart Association (NYHA) class, exacerbation of HF, chosen echocardiographic and biochemical parameters, e.g., natriuretic peptides or serum albumin, were also analyzed. Among the 120 consecutive patients, 47 (39%) had a normal nutritional status, 62 (52%) were at risk of malnutrition and 11 (9%) were malnourished. The patients with malnutrition more frequently presented with HF exacerbation in comparison to those with normal nutritional status (82% vs. 30% respectively, p = 0.004). There were no significant differences between the investigated groups as to natriuretic peptides; however, both the malnourished patients and those at risk of malnutrition tend to show higher B-type natriuretic peptide (BNP) and NT-proBNP concentrations. During the average 344 days of follow-up 19 patients died and 25 were hospitalized due to decompensated HF. Malnutrition or being at risk of malnutrition seems to be associated with both worse outcomes and clinical status in HFrEF patients.
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Affiliation(s)
- Marta Kałużna-Oleksy
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Helena Krysztofiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Correspondence: ; Tel.: +48-535-600-625
| | - Jacek Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Marta Wleklik
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
| | - Magdalena Dudek
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.W.); (I.U.)
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland; (M.K.-O.); (J.M.); (M.D.); (M.L.); (E.S.-M.)
- Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, 61-848 Poznan, Poland
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12
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Telec W, Kalmucki P, Krysztofiak H, Szyszka A, Baszko A. P2518Failure of completion of post-myocardial infarction rehabilitation programme - Who and why? Single center experience with novel Coordinated Comprehensive Care program in Poland. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Rehabilitation after acute myocardial infarction is a well-proven strategy to improve outcomes and reduce complications rate. Poland recently introduced a novel, fully-reimbursed Coordinated Comprehensive Care (CCC) program after myocardial infarction, a significant portion of which comprises access to free-of-charge cardiac rehabilitation.
Purpose
The purpose of the study was to analyze all patients qualified for the Coordinated Comprehensive Care Program and evaluate reasons for not completing rehabilitation. We compared two groups of patients - those who completed the rehabilitation and those that did not - in terms of clinical, demographic and laboratory characteristics.
Methods
All patients (n=169) referred from the cardiology department for the CCC program were included in the study. They were divided into two groups, depending on single, strict criterium of completion or non-completion of the rehabilitation program. Demographic, clinical and laboratory data were collected and analyzed.
Results
The majority of the patients (n=100, 59.2%) did not undergo cardiac rehabilitation. 61 of them were not qualified for rehabilitation programme by the consortium of doctors: 33 of them due to the need for further invasive treatment, the remainder 28 were disqualified due to severe comorbidities. 32 patients did not commence the program despite referral and encouragement, mostly (n=25) due to personal reasons, 7 patients did not specify reasons for not participating in the rehabilitation. 7 patients were lost to follow-up.
Patients who completed rehabilitation (n=69, 40.8%) were younger that those who did not (64.4±9.8 vs. 67.1±9.5 years, respectively; p=0.076), had significantly higher baseline LVEF (49.1±9.4 vs. 44.7±11.9%, p<0.03), and had lower serum creatinine level (0.99±0.28 vs. 1.15±0.59 mg/dl; p<0.03). There were more patients with LVEF<35% (n=23; 23%) in the no-rehabilitation, than in the other group (n=5; 7.25%; p<0.01).
Rehabilitation completed (n=69) Rehabilitation NOT completed (n=100) p Gender – male 40 (35.4%) 73 (64.6%) <0.05 LVEF- % 49.12 (±9.43) 44.69 (±11.97) <0.03 No. of patients with EF <35% 5 (7.25%) 23 (23%) <0.01
Conclusion
Although fully-reimbursed cardiac rehabilitation is provided for all patients following acute myocardial infarction, there is a significant number of patients who fail to complete the programme. This group comprises more male patients with worse clinical and laboratory test results, especially LVEF and renal function. Efforts should be made to address the problem and modify the programme accordingly.
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Affiliation(s)
- W Telec
- Poznan University of Medical Sciences, Chair of Cardiology, II Department of Cardiology, Poznan, Poland
| | - P Kalmucki
- Poznan University of Medical Sciences, Chair of Cardiology, II Department of Cardiology, Poznan, Poland
| | - H Krysztofiak
- Hipolit Cegielski Medical Center, Department of Cardiology, Poznan, Poland
| | - A Szyszka
- Poznan University of Medical Sciences, Chair of Cardiology, II Department of Cardiology, Poznan, Poland
| | - A Baszko
- Poznan University of Medical Sciences, Chair of Cardiology, II Department of Cardiology, Poznan, Poland
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13
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Zahid W, Haugaa K, Bergestuen D, Skulstad H, Thiis-Evensen E, Fosse E, Edvardsen T, Magnino C, Omede' P, Grosso Marra W, Chiarlo M, Presutti D, Bucca C, Moretti C, Gaita F, Veglio F, Milan A, Smith B, Dobson G, Grapsa J, Nihoyannopoulos P, Jaroch J, Loboz-Grudzien K, Magda S, Florescu M, Bociaga Z, Ciobanu A, Kruszynska E, Dudek K, Vinereanu D, Ryabikov A, Malyutina S, Shakhmatov S, Simonova G, Gafarov V, Veryovkin E, Krol W, Braksator W, Konopka M, Kuch M, Gierlak W, Krysztofiak H, Burkhard-Jagodzinska K, Mamcarz A, Dluzniewski M, Ciecierzynska B, Jaroch J, Kruszynska E, Bociaga Z, Loboz-Rudnicka M, Rychard W, Polanski J, Dudek K, Loboz-Grudzien K, Granstam SO, Bjorklund E, Roos M, Shah D, Coghlan G, Papadimitraki E, Dellaportas A, Kotrotsou A, Mourouzis I, Vlachodimitris I, Spiropoulos S, Karagiannakis D, Anastasiadis G, Economou C. Prognostic impact of ventricular indices: Systemic hypertension. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Chwalbińska-Moneta J, Kaciuba-Uściłko H, Krysztofiak H, Ziemba A, Krzemiński K, Kruk B, Nazar K. Relationship between EMG blood lactate, and plasma catecholamine thresholds during graded exercise in men. J Physiol Pharmacol 1998; 49:433-41. [PMID: 9789795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The aim of this study was to follow up the electromyographic activity (EMG) of dynamically working muscles with simultaneous determinations of blood lactate and plasma catecholamine concentrations during progressive exercise. Twenty eight male soccer players aged 20.6 +/- 0.8 yrs performed incremental bicycle ergometer exercise test. The test consisted of 3-min stages exercise separated by 1-min rest intervals. Work load at each stage increased by 50 W until volitional exhaustion. The root mean square (rms)-EMG activity of the rectus femoris and soleus muscles were recorded continuously during exercise. Venous blood samples were taken after each exercise stage for determination of blood lactate (LA). Additionally in seven subjects adrenaline (A) and noradrenaline (NA) concentrations were determined. The EMG activity increased negligibly during exercise of low to moderate intensities revealing an abrupt rise at the load corresponding to thresholds of blood lactate and plasma catecholamine accumulation (LA-T, A-T, NA-T). Close correlations (P < 0.001) were found between blood LA concentration and EMG derived from rectus f. (r = 0.72) and soleus (r = 0.68) muscles. The mean threshold exercise intensities for m. rectus f. and m. soleus EMG (176 +/- 9 W and 172 +/- 9 W, respectively) did not differ significantly from lactate (164 +/- 7 W), noradrenaline (178 +/- 6 W) and adrenaline (180 +/- 5 W) thresholds, all of them detected by log-log transformation. The results indicate that threshold character of EMG changes in dynamically working muscles reflects to some extend the patterns of blood lactate and plasma catecholamine changes during incremental exercise.
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15
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Chmura J, Krysztofiak H, Ziemba AW, Nazar K, Kaciuba-Uścilko H. Psychomotor performance during prolonged exercise above and below the blood lactate threshold. Eur J Appl Physiol Occup Physiol 1998; 77:77-80. [PMID: 9459525 DOI: 10.1007/s004210050303] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previous investigations from this laboratory have demonstrated that during graded exercise with exercise intensities increasing every 3 min until exhaustion the multiple choice reaction time (RT) decreased until the intensity exceeded the lactate threshold (LT) by approximately 25%, and then rapidly increased. The aim of this study was to follow up changes in RT during prolonged exercise at constant intensities above and below LT and to relate these changes to changes in venous blood lactate [La-]b, and plasma catecholamine [CA]pl concentration responses to the exercise. For this purpose eight young soccer players exercised for 20-min on a cycle ergometer at 10% above LT, and nine exercised for 60 min at an intensity 30% below LT. During both tests RT, heart rate (HR), as well as [La-]b, and [CA]pl were measured. Above LT, RT decreased from the 5th min until the end of exercise, whilst HR, [La-]b, and [CA]pl increased progressively. Significant inverse correlations were ascertained between RT and plasma adrenaline (r = -0.651) and noradrenaline concentrations (r = -0.678). During exercise below LT, RT decreased up to approximately 40 min, then it reached a nadir, and stabilized at this level. This was accompanied by only small changes in [La-]b and [CA]pl. The present findings would indicate that young athletes are able to maintain for a relatively long time, or even increase, their psychomotor performance during endurance exercise both below and above the LT.
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Affiliation(s)
- J Chmura
- Department of Applied Physiology, Medical Research Centre, Polish Academy of Sciences, Warsaw
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16
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Chmielewski M, Mamcarz A, Dłuzniewski M, Braksator W, Król J, Krysztofiak H, Kuch M, Beranek G. [Efficacy of mononitrate retard therapy in patients with advanced congestive heart failure]. Pol Merkur Lekarski 1997; 3:101-4. [PMID: 9461702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To determine the efficacy of mononitrate retard therapy in congestive heart failure 54 pts (42 males and 12 females, aged 67.2 +/- 8.7 yrs.) with NYHA functional class 1-3 and left ventricular ejection fraction less than 40% were investigated. Clinical examination, exercise treadmill test (ETT), ecg holter monitoring and echocardiography (echo-2D) were performed before and after 4 weeks of therapy with Olicard 40 mg Retard. 4 weeks treatment with mononitrate improved clinical parameters. The shift to lower functional NYHA class was observed in 12 cases (p < 0.01). Number of anginal pains per week was reduced from average 3.15 to 1.55 (p < 0.01). Mononitrate therapy improved exercise tolerance during ETT. Exercise time increased from 424 +/- 168 to 568 +/- 143 sec. (p < 0.001) as well as total workload in METS (3.6 +/- 1.4 vs. 4.9 +/- 1.9, p < 0.001). The time to 0.1 mV ischemic ST segment depression was extended from 215 +/- 149 to 357 +/- 173 sec. (p < 0.01). Holter monitoring revealed moderate increase in heart rate and significant reduction of ventricular arrhythmia (p < 0.05). No changes in systolic and diastolic echo-2D parameters were observed.
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Affiliation(s)
- M Chmielewski
- Zakładu Zaburzeń Rytmu, Wyoziału Lekarskiego Akademii Medycznej w Warszawie
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17
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Nazar K, Kaciuba-Uscilko H, Ziemba W, Krysztofiak H, Wójcik-Ziólkowska E, Niewiadomski W, Chwalbinska-Moneta J, Bicz B, Stupnicka E, Okinczyc A. Physiological characteristics and hormonal profile of young normotensive men with exaggerated blood pressure response to exercise. Clin Physiol 1997; 17:1-18. [PMID: 9015654 DOI: 10.1046/j.1365-2281.1997.01818.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Exaggerated blood pressure (BP) response to exercise in normotensive subjects is considered as a predictor of future hypertension. The aim of the study was to find out whether elevated BP response to exercise is associated with any other haemodynamic, metabolic or hormonal abnormalities. Abnormal BP response to exercise, i.e. systolic BP (SBP) > 200 mmHg at 150 W or lower workload, was found in 37 out of 180 normotensive, male students, aged 20-24 years. Fifteen students with elevated exercise BP (group E) volunteered for further examinations. Their resting and ambulatory BP showed high normal values. Eight of them had a family history of hypertension. Four subjects met the criteria of cardiac hypertrophy. Significant correlations were found between exercise SBP and left ventricular mass index, average 24 h and daytime SBP recordings. In comparison with normal subjects of the same age (group N, n = 13), those from group E did not differ in body mass index, plasma lipid profile, fasting glucose, insulin and catecholamine (CA) concentrations, but had increased erythrocyte sodium content, slightly elevated plasma renin activity and cortisol level. During exercise, E subjects showed greater cardiac output (CO) increases with normal heart rate, total peripheral resistance (TPR) and plasma CA. There were no significant differences between groups in haemodynamic and plasma CA responses to posture change from supine to standing. Glucose ingestion (75 g) caused smaller increases in CO and smaller decreases in TPR in E than in N subjects without differences in BP, blood glucose plasma insulin and CA. It is concluded that young normotensive men with exaggerated BP response to exercise show some other characteristics that may be considered as markers of predisposition to hypertension or factors promoting the development of hypertension.
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Affiliation(s)
- K Nazar
- Department of Applied Physiology, Polish Academy of Sciences, Warsaw, Poland
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