1
|
Bhutani D, Pan S, Latif F, Goldsmith RL, Saith SE, Mapara MY, Chakraborty R, Lentzsch S, Maurer MS. Cardiopulmonary exercise testing in patients with Cardiac Amyloidosis. Clin Lymphoma Myeloma Leuk 2021; 21:545-548. [PMID: 34024744 DOI: 10.1016/j.clml.2021.03.015] [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] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac involvement and dysfunction are common in patients presenting with AL and ATTR Amyloidosis. Cardiopulmonary exercise testing (CPET) performance is the gold standard to quantify functional capacity. PATIENTS AND METHODS In this study, we evaluated CPET measurements in 41 patients with cardiac Amyloidosis and their correlation with current amyloid specific staging criteria. RESULTS In both AL and ATTR cardiac Amyloidosis, percent predicted peak VO2 is significantly reduced and correlates with biomarker abnormalities. The association of cardiac biomarkers with peak VO2 is stronger for AL Amyloidosis (NT-proBNP (r = -0.57, P=0.006), Troponin (r = -0.70, p < 0.001) than ATTR (NT-proBNP (r = -0.4, P = 0.04) and Troponin (r = -0.57, P = 0.002) despite lower left ventricular mass in the former, suggesting that this may be further evidence for light chain toxicity in AL amyloidosis. CONCLUSION Our findings suggest further evidence for AL toxicity.
Collapse
Affiliation(s)
- Divaya Bhutani
- Division of Hematology and Oncology, Department of Medicine Columbia University Irving Medical Center.
| | - Samuel Pan
- Department of Biostatistics, Columbia University Irving Medical Center
| | - Farhana Latif
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Rochelle L Goldsmith
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Sunil E Saith
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Markus Y Mapara
- Division of Hematology and Oncology, Department of Medicine Columbia University Irving Medical Center
| | - Rajshekhar Chakraborty
- Division of Hematology and Oncology, Department of Medicine Columbia University Irving Medical Center
| | - Suzanne Lentzsch
- Division of Hematology and Oncology, Department of Medicine Columbia University Irving Medical Center
| | - Mathew S Maurer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
2
|
Wiegn P, Chan R, Jost C, Saville BR, Parise H, Prutchi D, Carson PE, Stagg A, Goldsmith RL, Burkhoff D. Safety, Performance, and Efficacy of Cardiac Contractility Modulation Delivered by the 2-Lead Optimizer Smart System. Circ Heart Fail 2020; 13:e006512. [DOI: 10.1161/circheartfailure.119.006512] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 12/18/2022]
Abstract
Background:
Prior studies of cardiac contractility modulation (CCM) employed a 3-lead Optimizer system. A new 2-lead system eliminated the need for an atrial lead. This study tested the safety and effectiveness of this 2-lead system compared with the 3-lead system.
Methods:
Patients with New York Heart Association III/IVa symptoms despite medical therapy, left ventricular ejection fraction 25% to 45%, and not eligible for cardiac resynchronization therapy could participate. All subjects received an Optimizer 2-lead implant. The primary end point was the estimated difference in the change of peak VO
2
from baseline to 24 weeks between FIX-HF-5C2 (2-lead system) subjects relative to control subjects from the prior FIX-HF-5C (3-lead system) study. Changes in New York Heart Association were a secondary end point. The primary safety end point was a comparison of device-related adverse events between FIX-HF-5C2 and FIX-HF-5C subjects.
Results:
Sixty subjects, 88% male, 66±9 years old with left ventricular ejection fraction 34±6% were included. Baseline characteristics were similar between FIX-HF-5C and FIX-HF-5C2 subjects except that 15% of FIX-HF-5C2 subjects had permanent atrial fibrillation versus 0% in FIX-HF-5C. CCM delivery did not differ significantly between 2- and 3-lead systems (19 892±3472 versus 19 583±4998 CCM signals/day, CI of difference [−1228 to 1847]). The change of peak VO
2
from baseline to 24 weeks was 1.72 (95% Bayesian credible interval, 1.02–2.42) mL/kg per minute greater in the 2-lead device group versus controls. 83.1% of 2-lead subjects compared with 42.7% of controls experienced ≥1 class New York Heart Association improvement (
P
<0.001). There were decreased Optimizer-related adverse events with the 2-lead system compared with the 3-lead system (0% versus 8%;
P
=0.03).
Conclusions:
The 2-lead system effectively delivers comparable amount of CCM signals (including in subjects with atrial fibrillation) as the 3-lead system, is equally safe and improves peak VO
2
and New York Heart Association. Device-related adverse effects are less with the 2-lead system.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03339310
Collapse
Affiliation(s)
- Phi Wiegn
- Department of Clinical Cardiac Electrophysiology, Dallas VA Medical Center, TX (P.W.)
| | | | - Charles Jost
- Southwest Cardiovascular Associates, Mesa, AZ (C.J.)
| | | | | | | | - Peter E. Carson
- Department of Medicine, Washington VA Medical Center, DC (P.E.C.)
| | | | - Rochelle L. Goldsmith
- Exercise Physiology Laboratory, Columbia University Medical Center, New York (R.L.G.)
| | | |
Collapse
|
3
|
Rosenbaum M, Goldsmith RL, Haddad F, Baldwin KM, Smiley R, Gallagher D, Leibel RL. Triiodothyronine and leptin repletion in humans similarly reverse weight-loss-induced changes in skeletal muscle. Am J Physiol Endocrinol Metab 2018; 315:E771-E779. [PMID: 29920214 PMCID: PMC6293163 DOI: 10.1152/ajpendo.00116.2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Subjects maintaining a ≥10% dietary weight loss exhibit decreased circulating concentrations of bioactive thyroid hormones and increased skeletal muscle work efficiency largely due to increased expression of more-efficient myosin heavy chain (MHC) isoforms (MHC I) and significantly mediated by the adipocyte-derived hormone leptin. The primary purpose of this study was to examine the effects of triiodothyronine (T3) repletion on energy homeostasis and skeletal muscle physiology in weight-reduced subjects and to compare these results with the effects of leptin repletion. Nine healthy in-patients with obesity were studied at usual weight (Wtinitial) and following a 10% dietary weight loss while receiving 5 wk of a placebo (Wt-10%placebo) or T3 (Wt-10%T3) in a single-blind crossover design. Primary outcome variables were skeletal muscle work efficiency and vastus lateralis muscle mRNA expression. These results were compared with the effects of leptin repletion in a population of 22 subjects, some of whom participated in a previous study. At Wt-10%placebo, skeletal muscle work efficiency and relative expression of the more-efficient/less-efficient MHC I/MHC II isoforms were significantly increased and the ratio of the less-efficient to the more-efficient sarco(endo)plasmic reticulum Ca2+-ATPase isoforms (SERCA1/SERCA2) was significantly decreased. These changes were largely reversed by T3 repletion to a degree similar to the changes that occurred with leptin repletion. These data support the hypothesis that the effects of leptin on energy expenditure in weight-reduced individuals are largely mediated by T3 and suggest that further study of the possible role of thyroid hormone repletion as adjunctive therapy to help sustain weight loss is needed.
Collapse
Affiliation(s)
- Michael Rosenbaum
- Departments of Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Rochelle L Goldsmith
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons , New York, New York
| | - Fadia Haddad
- Department of Physiology and Biophysics, University of California at Irvine , Irvine, California
| | - Kenneth M Baldwin
- Department of Physiology and Biophysics, University of California at Irvine , Irvine, California
| | - Richard Smiley
- Departments of Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Anesthesia, Columbia University College of Physicians and Surgeons , New York, New York
| | - Dympna Gallagher
- Obesity Research Center, Columbia University, St. Luke's-Roosevelt Hospital , New York, New York
| | - Rudolph L Leibel
- Departments of Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Division of Molecular Genetics, Columbia University College of Physicians and Surgeons , New York, New York
| |
Collapse
|
4
|
Abraham WT, Kuck KH, Goldsmith RL, Lindenfeld J, Reddy VY, Carson PE, Mann DL, Saville B, Parise H, Chan R, Wiegn P, Hastings JL, Kaplan AJ, Edelmann F, Luthje L, Kahwash R, Tomassoni GF, Gutterman DD, Stagg A, Burkhoff D, Hasenfuß G. A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation. JACC Heart Fail 2018; 6:874-883. [PMID: 29754812 DOI: 10.1016/j.jchf.2018.04.010] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study sought to confirm a subgroup analysis of the prior FIX-HF-5 (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure) study showing that cardiac contractility modulation (CCM) improved exercise tolerance (ET) and quality of life in patients with ejection fractions between 25% and 45%. BACKGROUND CCM therapy for New York Heart Association (NYHA) functional class III and IV heart failure (HF) patients consists of nonexcitatory electrical signals delivered to the heart during the absolute refractory period. METHODS A total of 160 patients with NYHA functional class III or IV symptoms, QRS duration <130 ms, and ejection fraction ≥25% and ≤45% were randomized to continued medical therapy (control, n = 86) or CCM (treatment, n = 74, unblinded) for 24 weeks. Peak Vo2 (primary endpoint), Minnesota Living With Heart Failure questionnaire, NYHA functional class, and 6-min hall walk were measured at baseline and at 12 and 24 weeks. Bayesian repeated measures linear modeling was used for the primary endpoint analysis with 30% borrowing from the FIX-HF-5 subgroup. Safety was assessed by the percentage of patients free of device-related adverse events with a pre-specified lower bound of 70%. RESULTS The difference in peak Vo2 between groups was 0.84 (95% Bayesian credible interval: 0.123 to 1.552) ml O2/kg/min, satisfying the primary endpoint. Minnesota Living With Heart Failure questionnaire (p < 0.001), NYHA functional class (p < 0.001), and 6-min hall walk (p = 0.02) were all better in the treatment versus control group. There were 7 device-related events, yielding a lower bound of 80% of patients free of events, satisfying the primary safety endpoint. The composite of cardiovascular death and HF hospitalizations was reduced from 10.8% to 2.9% (p = 0.048). CONCLUSIONS CCM is safe, improves exercise tolerance and quality of life in the specified group of HF patients, and leads to fewer HF hospitalizations. (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure; NCT01381172).
Collapse
Affiliation(s)
- William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio.
| | - Karl-Heinz Kuck
- Department of Cardiology, ASKLEPIOS Klinik St. Georg, Hamburg, Germany
| | - Rochelle L Goldsmith
- Exercise Physiology Laboratory, Columbia University Medical Center, New York, New York
| | - JoAnn Lindenfeld
- Department of Heart Failure and Transplant, Vanderbilt Heart, Nashville, Tennessee
| | - Vivek Y Reddy
- Department of Cardiac Arrhythmia Services, The Mount Sinai Hospital, New York, New York
| | - Peter E Carson
- Medical Intensive Care Unit, Washington VA Medical Center, Washington, DC
| | - Douglas L Mann
- Cardiovascular Division, Medicine, Washington University School of Medicine, St. Louis, Missouri
| | | | - Helen Parise
- R. P. Chiacchierini Consulting, Gaithersburg, Maryland
| | | | - Phi Wiegn
- Department of Clinical Cardiac Electrophysiology, Dallas VA Medical Center, Dallas, Texas
| | - Jeffrey L Hastings
- Department of Clinical Cardiac Electrophysiology, Dallas VA Medical Center, Dallas, Texas
| | - Andrew J Kaplan
- Department of Clinical Cardiac Electrophysiology, Cardiovascular Associates of Mesa, Mesa, Arizona
| | - Frank Edelmann
- Department of Cardiology and Pneumology, Universität Göttingen, Göttingen, Germany
| | - Lars Luthje
- Department of Cardiology and Pneumology, Universität Göttingen, Göttingen, Germany
| | - Rami Kahwash
- Department of Heart Failure & Transplantation, The Ohio State University Heart and Vascular Center, Columbus, Ohio
| | - Gery F Tomassoni
- Department of Clinical Cardiac Electrophysiology, Baptist Health Lexington, Lexington, Kentucky
| | - David D Gutterman
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Angela Stagg
- Clinical Trials, Impulse Dynamics, Orangeburg, New York
| | | | - Gerd Hasenfuß
- Heart Center of Göttingen, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
5
|
Rosenbaum M, Heaner M, Goldsmith RL, Christian Schulze P, Shukla A, Shen W, Shane EJ, Naor E, Leibel RL, Aronne LJ. Resistance Training Reduces Skeletal Muscle Work Efficiency in Weight-Reduced and Non-Weight-Reduced Subjects. Obesity (Silver Spring) 2018; 26:1576-1583. [PMID: 30260099 PMCID: PMC6905638 DOI: 10.1002/oby.22274] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/09/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective of this study is to determine whether resistance training is similarly effective in reducing skeletal muscle efficiency and increasing strength in weight-reduced and maximal weight subjects. METHODS This study examined the effects of supervised resistance exercise on skeletal muscle in 14 individuals with overweight and obesity sustaining a 10% or greater weight loss for over 6 months and a phenotypically similar group of 15 subjects who had not reduced weight and were weight stable at their maximal lifetime body weight. We assessed skeletal muscle work efficiency and fuel utilization (bicycle ergometry), strength (dynamometry), body composition (dual energy x-ray absorptiometry), and resting energy expenditure (indirect calorimetry) before and after 12 weeks of thrice-weekly resistance training. RESULTS Non-weight-reduced subjects were significantly (10%-20%) stronger before and after the intervention than reduced-weight subjects and gained significantly more fat-free mass with a greater decline in percentage of body fat than weight-reduced subjects. Resistance training resulted in similar significant decreases (~10%) in skeletal muscle work efficiency at low-level exercise and ~10% to 20% increases in leg strength in both weight-reduced and non-weight-reduced subjects. CONCLUSIONS Resistance training similarly increases muscle strength and decreases efficiency regardless of weight loss history. Increased resistance training could be an effective adjunct to reduced-weight maintenance therapy.
Collapse
Affiliation(s)
- Michael Rosenbaum
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York, USA
| | - Martica Heaner
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York, USA
| | - Rochelle L Goldsmith
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - P Christian Schulze
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Alpana Shukla
- Division of Endocrinology, Diabetes, & Metabolism, New York Weill Cornell Medical Center Comprehensive Weight Control Center, New York, New York, USA
| | - Wei Shen
- Division of Pediatric Gastroenterology and the Institute of Human Nutrition, Columbia University Medical Center, New York, New York, USA
| | - Elizabeth J Shane
- Department of Medicine, Division of Endocrinology and Metabolism, Columbia , University Medical Center, New York, New York, USA
| | - Elinor Naor
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York, USA
| | - Rudolph L Leibel
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York, USA
| | - Louis J Aronne
- Division of Endocrinology, Diabetes, & Metabolism, New York Weill Cornell Medical Center Comprehensive Weight Control Center, New York, New York, USA
| |
Collapse
|
6
|
Baldwin KM, Joanisse DR, Haddad F, Goldsmith RL, Gallagher D, Pavlovich KH, Shamoon EL, Leibel RL, Rosenbaum M. Effects of weight loss and leptin on skeletal muscle in human subjects. Am J Physiol Regul Integr Comp Physiol 2011; 301:R1259-66. [PMID: 21917907 PMCID: PMC3213951 DOI: 10.1152/ajpregu.00397.2011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 09/06/2011] [Indexed: 01/12/2023]
Abstract
Maintenance of a 10% or greater reduced body weight results in decreases in the energy cost of low levels of physical activity beyond those attributable to the altered body weight. These changes in nonresting energy expenditure are due mainly to increased skeletal muscle work efficiency following weight loss and are reversed by the administration of the adipocyte-derived hormone leptin. We have also shown previously that the maintenance of a reduced weight is accompanied by a decrease in ratio of glycolytic (phosphofructokinase) to oxidative (cytochrome c oxidase) activity in vastus lateralis muscle that would suggest an increase in the relative expression of the myosin heavy chain I (MHC I) isoform. We performed analyses of vastus lateralis muscle needle biopsy samples to determine whether maintenance of an altered body weight was associated with changes in skeletal muscle metabolic properties as well as mRNA expression of different isoforms of the MHC and sarcoplasmic endoplasmic reticular Ca(2+)-dependent ATPase (SERCA) in subjects studied before weight loss and then again after losing 10% of their initial weight and receiving twice daily injections of either placebo or replacement leptin in a single blind crossover design. We found that the maintenance of a reduced body weight was associated with significant increases in the relative gene expression of MHC I mRNA that was reversed by the administration of leptin as well as an increase in the expression of SERCA2 that was not significantly affected by leptin. Leptin administration also resulted in a significant increase in the expression of the less MHC IIx isoform compared with subjects receiving placebo. These findings are consistent with the leptin-reversible increase in skeletal muscle chemomechanical work efficiency and decrease in the ratio of glycolytic/oxidative enzyme activities observed in subjects following dietary weight loss.
Collapse
Affiliation(s)
- Kenneth M. Baldwin
- Department of Physiology and Biophysics, School of Medicine, University of California at Irvine, Irvine, California
| | | | - Fadia Haddad
- Department of Physiology and Biophysics, School of Medicine, University of California at Irvine, Irvine, California
| | - Rochelle L. Goldsmith
- Division of Exercise Physiology; Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York
| | - Dympna Gallagher
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York; and
| | - Katherine H. Pavlovich
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University, New York, New York
| | - Elisabeth L. Shamoon
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University, New York, New York
| | - Rudolph L. Leibel
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University, New York, New York
| | - Michael Rosenbaum
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University, New York, New York
| |
Collapse
|
7
|
Myers J, Goldsmith RL, Keteyian SJ, Brawner CA, Brazil DA, Aldred H, Ehrman JK, Burkhoff D. Reply. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
Myers J, Goldsmith RL, Keteyian SJ, Brawner CA, Brazil DA, Aldred H, Ehrman JK, Burkhoff D. The Ventilatory Anaerobic Threshold in Heart Failure: A Multicenter Evaluation of Reliability. J Card Fail 2010; 16:76-83. [DOI: 10.1016/j.cardfail.2009.08.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 07/07/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022]
|
9
|
Arezzi E, Goldsmith RL, Hudaihed A, Colombo PC, Vittorio TJ, Lurie AW, Jorde UP. Chronotropic Incompetence Is More Common in Patients with Congestive Heart Failure Due to Ischemic Cardiomyopathy. J Card Fail 2006. [DOI: 10.1016/j.cardfail.2006.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Hirsh DS, Vittorio TJ, Barbarash SL, Hudaihed A, Tseng CH, Arwady A, Goldsmith RL, Jorde UP. Association of Heart Rate Recovery and Maximum Oxygen Consumption in Patients With Chronic Congestive Heart Failure. J Heart Lung Transplant 2006; 25:942-5. [PMID: 16890115 DOI: 10.1016/j.healun.2006.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 04/10/2006] [Accepted: 04/17/2006] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Peak oxygen consumption (peak VO2) is one of the strongest predictors of mortality in patients with congestive heart failure (CHF). In contrast to measurements of peak VO2, which requires analysis of expired gases, heart rate recovery, defined as maximum heart rate minus heart rate at 1 minute after exercise, is easily obtained. The current study was undertaken to determine the association between peak VO2 and heart rate recovery in patients with CHF. METHODS Retrospective data on VO2 and heart rate recovery were analyzed in 296 patients with CHF secondary to left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] <50%) who had undergone cardiopulmonary exercise testing (CPET). Patients exercised on a treadmill using a graded work rate protocol with the work increasing to a symptom-limited maximum. Peak oxygen consumption was defined as the highest value of oxygen uptake attained in the final 20 seconds of exercise when the respiratory exchange ratio was >1.0. RESULTS Heart rate recovery and peak VO2 correlated moderately (r = 0.47, p < 0.001). The degree of correlation was similar in patients receiving beta-blockers (r = 0.47, p < 0.001) and those not receiving beta-blockers (r = 0.49, p < 0.001). CONCLUSIONS Although heart rate recovery and peak VO2 correlated moderately, from a clinical standpoint, this finding is probably not strong enough to use heart rate recovery in lieu of peak VO2. This modest correlation of two independent predictors of outcome may suggest their usefulness when combined in a multivariate score.
Collapse
Affiliation(s)
- David S Hirsh
- Heart Failure Program, New York University School of Medicine, New York, New York 10016, USA
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Kawut SM, Horn EM, Berekashvili KK, Garofano RP, Goldsmith RL, Widlitz AC, Rosenzweig EB, Kerstein D, Barst RJ. New predictors of outcome in idiopathic pulmonary arterial hypertension. Am J Cardiol 2005; 95:199-203. [PMID: 15642552 DOI: 10.1016/j.amjcard.2004.09.006] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Revised: 09/08/2004] [Accepted: 09/08/2004] [Indexed: 10/26/2022]
Abstract
Idiopathic pulmonary arterial hypertension (PAH) is a rare disease with a poor prognosis. New therapies have improved the outcome of this condition; accordingly, the factors that determine outcome may have changed. We aimed to identify determinants of survival in a cohort of consecutive patients with PAH: which was idiopathic, familial, or associated with anorexigen use. We performed a retrospective cohort study of 84 consecutive patients with PAH who underwent initial evaluation at our center from January 1994 to June 2002. The primary outcome was death or lung transplantation. Survival at 1, 3, and 5 [corrected] years was 87%, 75%, and 61%, respectively. Multivariate analysis showed that being of African-American or Asian descent was associated with an increased risk of death. Warfarin use was associated with a reduced risk of death. Higher serum albumin and cardiac index and acute vasoreactivity were independently associated with improved survival. These data suggest that the determinants of outcome have changed. Race is identified as a new risk factor, which may be attributable to biologic or socioeconomic differences. Cardiac function and acute reactivity of the pulmonary vascular bed remain strong independent predictors of outcome.
Collapse
Affiliation(s)
- Steven M Kawut
- Department of Internal Medicine, Joseph L. Mailman School of Public Health, Columbia University, 622 West 168th Street, New York, NY 10032, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Neuberg GW, Vittorio T, Androne S, Yushak M, Goldsmith RL, Jorde UP, Katz SD, Bigger J, Packer M. Effect of digoxin withdrawal in patients with chronic heart failure receiving carvedilol. J Card Fail 2004. [DOI: 10.1016/j.cardfail.2004.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
13
|
|
14
|
Barbarash SL, Arwady A, Goldsmith RL, Vittorio TJ, Hryniewicz K, Burcham JL, Katz SD, Jorde UP. Utility of heart rate recovery as a predictor for maximum oxygen consumption in patients with chronic heart failure (CHF). J Card Fail 2003. [DOI: 10.1016/s1071-9164(03)00397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Abstract
OBJECTIVE To re-examine the standard pNN50 heart rate variability (HRV) statistic by determining how other thresholds compare with the commonly adopted 50 ms threshold in distinguishing physiological and pathological groups. DESIGN Retrospective analysis of Holter monitor databases. SUBJECTS Comparison of HRV data between 72 healthy subjects and 43 with congestive heart failure (CHF); between sleeping and waking states in the 72 healthy subjects; and between 20 young and 20 healthy elderly subjects. MAIN OUTCOME MEASURES Probability values for discriminating between groups using a family of pNN values ranging from pNN4 to pNN100. RESULTS For all three comparisons, pNN values substantially less than 50 ms consistently provided better separation between groups. For the normal versus CHF groups, p < 10(-13) for pNN12 versus p < 10(-4) for pNN50; for the sleeping versus awake groups, p < 10(-21) for pNN12 versus p < 10(-10) for pNN50; and for the young versus elderly groups, p < 10(-6) for pNN28 versus p < 10(-4) for pNN50. In addition, for the subgroups of elderly healthy subjects versus younger patients with CHF, p < 0.007 for pNN20 versus p < 0.17 for pNN50; and for the subgroup of New York Heart Association functional class I-II CHF versus class III-IV, p < 0.04 for pNN10 versus p < 0.13 for pNN50. CONCLUSIONS pNN50 is only one member of a general pNNx family of HRV statistics. Enhanced discrimination between a variety of normal and pathological conditions is obtained by using pNN thresholds as low as 20 ms or less rather than the standard 50 ms threshold.
Collapse
Affiliation(s)
- J E Mietus
- Margret and H A Rey Institute for Nonlinear Dynamics in Physiology and Medicine, Cardiovascular Division, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
| | | | | | | | | |
Collapse
|
16
|
Abstract
Autonomic nervous system activity contributes to the regulation of cardiac output during rest, exercise, and cardiovascular disease. Measurement of HRV has been particularly useful in assessing parasympathetic activity, while its utility for assessing sympathetic function and overall sympathovagal balance remains controversial. Studies have revealed that parasympathetic tone dominates the resting state, while exercise is associated with prompt withdrawal of vagal tone and subsequent sympathetic activation. Conversely, recovery is characterized by parasympathetic activation followed by sympathetic withdrawal, although clarification of the normal trajectory and autonomic basis of heart rate decay following exercise is needed. Abnormalities in autonomic physiology--especially increased sympathetic activity, attenuated vagal tone, and delayed heart rate recovery--have been associated with increased mortality. Exercise training is associated with a relative enhancement of vagal tone, improved heart rate recovery after exercise, and reduced morbidity in patients with cardiovascular disease. However, whether exercise training leads to reduced mortality in this population because of its ability to specifically modulate autonomic function is unknown at the present time. Although the results of a recent randomized study in patients with CHF and a meta-analysis in the setting of a recent myocardial infarction determined that exercise training leads to improved outcomes in these populations, neither study measured autonomic function. Improved autonomic function due to exercise training is a promising rationale for explaining improvements in outcome, although more research is needed to confirm this hypothesis.
Collapse
Affiliation(s)
- E T Rosenwinkel
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | | | | |
Collapse
|
17
|
Baran DA, Rosenwinkel E, Spierer DK, Lisker J, Whelan J, Rosa M, Goldsmith RL. Validating facemask use for gas exchange analysis in patients with congestive heart failure. J Cardiopulm Rehabil 2001; 21:94-100. [PMID: 11314290 DOI: 10.1097/00008483-200103000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Functional limitation, often associated with congestive heart failure (CHF), is most accurately assessed with measurement of peak VO2 (VO2peak) during exercise testing. VO2peak strongly predicts survival in CHF patients and is used to triage patients for cardiac transplantation. However, the traditional mouthpiece/noseclip equipment used for gas exchange analysis is often cumbersome and uncomfortable. Several alternative facemask designs tested previously in healthy cohorts were inferior to the mouthpiece for measuring VO2peak. In this study, a series of facemasks designed specifically for VO2peak testing (Hans-Rudolph) was employed. Although previously validated in healthy young adults, this apparatus has not been validated in patients with severe CHF. METHODS The Hans-Rudolph facemasks were compared with the mouthpiece apparatus in 30 patients with severe CHF. Each subject completed a cardiopulmonary exercise test with each device. Twelve subjects were randomized to evaluate a possible training effect. To enhance recruitment, 18 additional subjects were recruited after they had completed a test with the mouthpiece. RESULTS There was no evidence of a training effect and no differences in gas exchange measurements were found between the two devices. The weight-adjusted VO2peak measurements were 17.1 +/- 5.3 ml O2/kg/min for the mouthpiece group and 17.3 +/- 5.6 ml O2/kg/min for the mask group (P = 0.54). CONCLUSIONS The facemask was shown to be equivalent to the mouthpiece for measuring VO2peak in CHF patients. Concerns of hypoventilation and decreased VO2peak associated with previous facemask designs were not substantiated. Since successful exercise testing depends on maximal exertion, providing a choice of equipment may facilitate cooperation without sacrificing accuracy.
Collapse
Affiliation(s)
- D A Baran
- Mt. Sinai Medical Center, Department of Medicine, Division of Cardiology, 1 Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
The complex interplay between the dichotomous subdivisions of the autonomic nervous system establishes and maintains a delicately tuned homeostasis in spite of an ever-changing environment. Aerobic exercise training can increase activity of the parasympathetic nervous system and decrease sympathetic activity. Conversely, it is well-documented that cardiac disease is often characterized by attenuated parasympathetic activity and heightened sympathetic tone. A correlation between autonomic disequilibrium and disease has led to the hypothesis that exercise training, as a therapy that restores the autonomic nervous system towards normal function, may be associated with, and possibly responsible for, outcome improvements in various populations. This is merely one of the many benefits that is conferred by chronic exercise training and reviewed in this issue.
Collapse
Affiliation(s)
- R L Goldsmith
- Division of Circulatory Physiology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
| | | | | |
Collapse
|
19
|
Goldsmith RL, Bigger JT, Bloomfield DM, Krum H, Steinman RC, Sackner-Bernstein J, Packer M. Long-term carvedilol therapy increases parasympathetic nervous system activity in chronic congestive heart failure. Am J Cardiol 1997; 80:1101-4. [PMID: 9352991 DOI: 10.1016/s0002-9149(97)00616-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To determine the effect of beta blockade on parasympathetic nervous system activity, we assessed RR variability during 24-hour Holter monitoring in 10 patients with congestive heart failure before and after 3 to 4 months of treatment with the beta blocker carvedilol. High-frequency power increased from 26 to 64 ms2, root-mean-square of successive differences in RR interval increased from 14.3 to 23.7 ms2, and percentage of absolute differences >50 ms between successive normal RR intervals increased from 0.8% to 4.7%, all p <0.01, indicating a substantial increase in parasympathetic modulation of RR intervals.
Collapse
Affiliation(s)
- R L Goldsmith
- Division of Circulatory Physiology, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
The association between increasing age and decreasing vagal modulation is well known. However, the importance of fitness as a determinant of the decline in vagal modulation with age is not established. To test the hypothesis that decreasing vagal modulation is largely a function of declining fitness rather than increasing age, we studied a sample of healthy volunteers with a wide range of fitness levels, but a narrow age range. We assessed fitness by measuring the maximal oxygen uptake (VO2max) achieved during incremental bicycle exercise. Vagal modulation was assessed by calculating high frequency power (0.15-0.40 Hz) of the RR variability power spectrum from 24-h ECG recordings. We studied 37 healthy volunteers who were 22-44 yr old. In our sample, VO2max ranged from 25 to 70 mL.min-1.kg-1 (mean of 45 +/- 13). Age was not significantly related to high frequency power, but VO2max was highly correlated with high frequency power (r = 0.74, P = 0.0001), indicating that physical fitness is strongly associated with vagal modulation. Thus, the decline in vagal modulation often attributed to increasing age may, instead, be the result of a decline in fitness.
Collapse
Affiliation(s)
- R L Goldsmith
- Division of Circulatory Physiology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
| | | | | | | |
Collapse
|
21
|
Morrone TM, Buck LA, Catanese KA, Goldsmith RL, Cahalin LP, Oz MC, Levin HR. Early progressive mobilization of patients with left ventricular assist devices is safe and optimizes recovery before heart transplantation. J Heart Lung Transplant 1996; 15:423-9. [PMID: 8732603] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As early perioperative survival with left ventricular assist device support improves, additional emphasis must be placed on patient rehabilitation. Especially as mean left ventricular assist device support times exceed 100 days, it is essential for health professionals to mobilize patients to prevent the incidence of the deleterious effects of bedrest. The timing of optimal functional performance and the safety of rehabilitation has not been described. METHODS We retrospectively studied patients surviving left ventricular assist device implantation (34 of 41 patients; 27 men, 7 women; age 51 +/- 11 years). Physical therapy consisted of progressive mobilization leading to treadmill exercise or cycling. All patients exercised in the "pump on full" mode with flows >or= 3.0 L/min. RESULTS Twenty of thirty-four patients initiated ambulation at 7 to 10 days with independent ambulation by 14 days in 55% of the group. Treadmill exercise was tolerated by 82% of the patients, begun at postoperative day 21 by eighteen patients. The greatest improvement in exercise performance was seen by 6 to 8 weeks (20 to 30 minutes at 3.17 +/- 0.79 metabolic equivalents). Maximal functional capacity achieved was influenced by medical complications. A total of 1878 treatment sessions lasting 1390 hours was performed. Only four minor incidents occurred representing 2.9 incidents/1000 patient hours; all involved a transient decrease in pump flow. None of these events resulted in an increase in morbidity or mortality. CONCLUSIONS Progressive mobilization in patients with left ventricular assist device is safe. Patients return to independence in activities of daily living and tolerate prolonged workloads of up to 5 metabolic equivalents. There is rapid improvement in functional capacity until 6 weeks after operation. Delay in transplantation until this time may optimize postoperative recovery.
Collapse
Affiliation(s)
- T M Morrone
- Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York, N.Y., USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Aaronson KD, Goldsmith RL, Chen TM, Whelan JF, Packer M, Mancini DM. Peak VO2is superior to 6 minute walk for the prediction of survival in patients with heart failure. J Am Coll Cardiol 1996. [DOI: 10.1016/s0735-1097(96)82389-8] [Citation(s) in RCA: 3] [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: 10/27/2022]
|
23
|
Goldsmith RL, Bloomfield DM, Steinman RC, Bigger J. Ultra low frequency power is the only power spectral measure not confounded by physical fitness. J Am Coll Cardiol 1996. [DOI: 10.1016/s0735-1097(96)80586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Goldsmith RL, Whelan JF, Weinberg AD, Whelan AA, Packer M, Aaronson KD. Prediction of maximal oxygen consumption by six minute walk testing in patients with congestive heart failure. J Am Coll Cardiol 1996. [DOI: 10.1016/s0735-1097(96)81734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
25
|
Krum H, Sackner-Bernstein JD, Goldsmith RL, Kukin ML, Schwartz B, Penn J, Medina N, Yushak M, Horn E, Katz SD. Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe chronic heart failure. Circulation 1995; 92:1499-506. [PMID: 7664433 DOI: 10.1161/01.cir.92.6.1499] [Citation(s) in RCA: 295] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical trials have shown that beta-adrenergic blocking drugs are effective and well tolerated in patients with mild to moderate heart failure, but the utility and safety of these drugs in patients with advanced disease have not been evaluated. METHODS AND RESULTS We enrolled 56 patients with severe chronic heart failure into a double-blind, placebo-controlled study of the vasodilating beta-blocker carvedilol. All patients had advanced heart failure, as evidenced by a mean left ventricular ejection fraction of 0.16 +/- 0.01 and a mean maximal oxygen consumption of 13.6 +/- 0.6 mL.kg-1.min-1 despite digitalis, diuretics, and an angiotensin-converting enzyme inhibitor (if tolerated). After a 3-week, open-label, up-titration period, 49 of the 56 patients were assigned (in a double-blind fashion using a 2:1 randomization) to receive either carvedilol (25 mg BID, n = 33) or matching placebo (n = 16) for 14 weeks, while background therapy remained constant. Hemodynamic and functional variables were measured at the start and end of the study. Compared with the placebo group, patients in the carvedilol group showed improved cardiac performance, as reflected by an increase in left ventricular ejection fraction (P = .005) and stroke volume index (P = .010) and a decrease in pulmonary wedge pressure, mean right atrial pressure, and systemic vascular resistance (P = .003, .002, and .017, respectively). In addition, compared with placebo, patients treated with carvedilol benefited clinically, as shown by an improvement in symptom scores (P = .002), functional class (P = .013), and submaximal exercise tolerance (P = .006). The combined risk of death, worsening heart failure, and life-threatening ventricular tachyarrhythmia was lower in the carvedilol group than in the placebo group (P = .028), but carvedilol-treated patients had more dizziness and advanced heart block. CONCLUSIONS Carvedilol produces clinical and hemodynamic improvement in patients who have severe heart failure despite treatment with angiotensin-converting enzyme inhibitors.
Collapse
Affiliation(s)
- H Krum
- Division of Circulatory Physiology, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
OBJECTIVES This study was conducted to determine the effect of long-term digoxin therapy on autonomic function in patients with mild to moderate chronic heart failure. BACKGROUND Chronic heart failure is characterized by increased sympathetic activity and decreased parasympathetic activity. Intravenous digitalis has been found to reduce sympathetic activity immediately in these patients, but whether short-term neurohormonal effects are sustained during long-term oral therapy has not been assessed. METHODS We determined sympathetic activity in 26 patients with heart failure by measuring plasma norepinephrine levels and parasympathetic activity from variables of heart period variability derived from 24-h ambulatory electrocardiographic Holter recordings obtained before and after 4 to 8 weeks of digoxin therapy. RESULTS After digoxin therapy, plasma norepinephrine decreased significantly from a mean +/- SEM of 552 +/- 80 to 390 +/- 37 ng/ml. In addition, the RR interval increased significantly from 719 +/- 19 to 771 +/- 20 ms. High frequency power increased from 84 +/- 24 to 212 +/- 72 ms2, and the root mean square of successive differences in RR interval increased from 20.3 +/- 1.8 to 27.0 +/- 3.4 ms, indicating a substantial increase in parasympathetic activity. Low frequency power, an index of baroreflex activity, was also significantly increased (239 +/- 80 to 483 +/- 144 ms2) by digoxin therapy. CONCLUSIONS These results indicate 1) that long-term therapy with digoxin acts to ameliorate the autonomic dysfunction of patients with heart failure, and 2) that the short-term neurohormonal effects of digoxin are sustained during prolonged treatment with the drug.
Collapse
Affiliation(s)
- H Krum
- Division of Circulatory Physiology, Columbia University College of Physicians and Surgeons, New York, New York 10032
| | | | | | | |
Collapse
|
27
|
Horn EM, Kukin ML, Neuberg GW, Goldsmith RL, McCarty M, Gratch M, Medina N, Yushak M, Packer M, Bilezikian JP. Lymphocyte G proteins reflect response to treatment in congestive heart failure. Am Heart J 1995; 129:98-106. [PMID: 7817932 DOI: 10.1016/0002-8703(95)90049-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Congestive heart failure is associated with chronotropic and inotropic hyporesponsiveness to adrenergic stimulation. A decrease in Gs alpha or an increase in Gi alpha is associated with a decrease in adenylyl cyclase activity. The current study assessed G proteins in response to treatment with direct-acting vasodilators and correlated changes in lymphocyte beta-adrenergic receptor components with changes in hemodynamic variables. Twenty-three patients with severe chronic congestive heart failure (New York Heart Association functional classes III and IV) were studied. Patients were grouped as responders (n = 10) or nonresponders (n = 13) on the basis of clinical assessment of functional status from questionnaires. Therapy was associated with an increase in cardiac index, a decrease in mean arterial pressure, and a decrease in systemic vascular resistance in all patients. Left ventricular filling pressure significantly decreased in responders (26 +/- 2 mm to 13 +/- 3 mm, p < 0.05) but did not change significantly in nonresponders. Similarly, mean right atrial pressure significantly decreased in responders (11 +/- 2 mm Hg to 4 +/- 1 mm Hg, p < 0.05) but did not change in nonresponders. Plasma norepinephrine increased significantly only in nonresponders (679 +/- 100 pg/ml to 1233 +/- 201 pg/ml, p < 0.05). Whereas lymphocyte beta-adrenergic receptor density and Gs did not significantly change, Gi increased after treatment only in the nonresponder group (23 +/- 5 to 51 +/- 11 fmol/mg, p < 0.05). A poor response to direct-acting vasodilators can be distinguished by reactive increases in plasma norepinephrine and lymphocyte Gi in the absence of a decrease in either left- or right-sided filling pressures.
Collapse
Affiliation(s)
- E M Horn
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, N.Y
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Levin HR, Chen JM, Oz MC, Catanese KA, Krum H, Goldsmith RL, Packer M, Rose EA. Potential of left ventricular assist devices as outpatient therapy while awaiting transplantation. Ann Thorac Surg 1994; 58:1515-20. [PMID: 7979685 DOI: 10.1016/0003-4975(94)91946-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Left ventricular assist devices (LVADs) increasingly are being used as a bridge to transplantation. We studied changes in New York Heart Association class, mean arterial pressure, resting cardiac output, end-organ function, exercise oxygen consumption, and exercise cardiac output in 12 LVAD recipients. In addition, resting levels of neurohormonal factors were evaluated 4 to 16 weeks after implantation. Two of the 12 patients died of right heart failure and 1 of aspiration; all deaths occurred in the first 2 weeks after LVAD implantation. Of the other 9 patients, 8 improved to New York Heart Association class I and 1 to class II, all of whom were in class IV preoperatively. The 4 patients who underwent exercise testing achieved an exercise oxygen consumption of 15.0 +/- 2.7 mL.kg-1.min-1, which was paralleled by an increase in resting cardiac output from 3.07 +/- 0.9 L.min-1 preoperatively to 5.66 +/- 1.1 L.min-1 at 2 months, and mean arterial pressure from 60 +/- 8 to 91 +/- 10 mm Hg at 2 months, a benefit that was maintained for up to 10 months. End-organ function revealed comparable improvement at 2 months for both creatinine (1.68 +/- 0.7 to 1.0 +/- 0.19 mg.dL-1) and total bilirubin (1.37 +/- 1.17 to 0.54 +/- 0.26 mg.dL-1) levels. Levels of neurohormones were within normal limits. Adverse clinical events after the perioperative period were minimal, and no thromboembolic complications occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- H R Levin
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Abstract
OBJECTIVES This study compares 24-h parasympathetic activity in aerobically trained and untrained healthy young men. BACKGROUND Higher values of parasympathetic nervous system activity are associated with a low mortality rate in patients after myocardial infarction, but it remains uncertain what therapeutic interventions can be used to increase parasympathetic activity. Although it is thought that exercise training can increase parasympathetic activity, studies have reported conflicting results, perhaps because this variable was measured for only brief intervals and usually inferred from changes in reflex responses induced by pharmacologic blockade. METHODS Parasympathetic activity was assessed noninvasively from 24-h ECG recordings by calculating high frequency (0.15 to 0.40 Hz) beat to beat heart period variability in eight endurance-trained men (maximal oxygen consumption greater than or equal to 55 ml/kg per min) and eight age-matched (mean = 29 yr) untrained men (maximal oxygen consumption less than or equal to 40 ml/kg per min). The data were analyzed separately for sleeping hours when parasympathetic activity is dominant and also for waking hours. RESULTS The geometric mean of high frequency power was greater in the trained than in the untrained men during the day (852 vs. 177 ms2, p less than 0.005), during the night (1,874 vs. 427 ms2, p less than 0.005) and over the entire 24 h (1,165 vs. 276 ms2, p less than 0.001). CONCLUSIONS Parasympathetic activity is substantially greater in trained than in untrained men, and this effect is present during both waking and sleeping hours. These data suggest that exercise training may increase parasympathetic activity over the entire day and may therefore prove to be a useful adjunct or alternative to drug therapy in lessening the derangements of autonomic balance found in many cardiovascular diseases.
Collapse
Affiliation(s)
- R L Goldsmith
- Department of Medicine, Columbia University, New York, New York
| | | | | | | |
Collapse
|
31
|
Abstract
A new passive sampling device (GASBADGE dosimeter) has been developed for personal/ambient monitoring of industrial air pollutants. Compact and convenient to use (no pump, wet chemicals, or length of stain estimation required, etc.), it may be either worn or used for area monitoring. The operating principle is based upon Fick's first law of diffusion. Analysis of the collection element after exposure yields the time-weighted (TWA) exposure concentration. Promising results have been obtained to date in controlled exposures with sulfur dioxide and nitrogen dioxide. Preliminary data also indicate the applicability of the GASBADGE dosimeter to the monitoring of a wide variety of organic vapors.
Collapse
|