The effect of the fraction of inspired oxygen on the NIRS-derived deoxygenated hemoglobin "breakpoint" during ramp-incremental test.

During ramp-incremental (RI) exercise to exhaustion, the near-infrared spectroscopy-derived deoxygenated hemoglobin ([HHb]) signal in the vastus lateralis muscle shows a linear increase up to a point at which a plateau-like response is manifested ([HHb]bp). This study investigated if 1) the [HHb]bp is affected by different fractions of inspired O2 (FIO2) [hypoxia (16%; HYPO); normoxia (21%; NORM); hyperoxia (30%; HYPER)]; and 2) an abrupt change to hyperoxic-inspired gas just before the occurrence of the [HHb]bp (HYPERSWITCH) would affect the [HHb] plateau-like response. Ten physically active male participants reported to the laboratory on four separate occasions to perform an RI test to exhaustion in NORM, HYPO, and HYPER and an RI test to exhaustion with an abrupt increase in FIO2 (30%; HYPERSWITCH) 15 W before the power output (PO) associated with [HHb]bp in normoxia. PO, [HHb], tissue O2 (StO2), and pulse O2 saturation (SpO2) were recorded continuously. Peak PO was significantly lower in HYPO (290 ± 21 W) and higher in HYPER (321 ± 22 W) and HYPERSWITCH (320 ± 19 W) compared with NORM (311 ± 18 W). The PO associated with [HHb]bp was not different between NORM and HYPER (246 ± 23 vs. 247 ± 24 W), but it was lower in HYPO (198 ± 31 W) than NORM and HYPER. The PO associated with the [HHb]bp in HYPERSWITCH (240 ± 23) was not different compared with NORM. HYPER and HYPERSWITCH resulted in greater StO2 and SpO2 compared with NORM. These results suggest that the [HHb]bp response is not dependent of O2 driving pressure and that other physiological mechanisms might determine its occurrence.

Long-term quality of life in octogenarians and nonagenarians with nonvalvular atrial fibrillation following WATCHMAN™ device implantation.

OBJECTIVES: To assess the impact of WATCHMAN™ on quality of life (QoL) in octogenarians and nonagenarians. BACKGROUND: QoL after WATCHMAN™ device in the elderly remains unknown. METHODS: This is a prospective and retrospective cohort study of patients that underwent WATCHMAN™ implantation in a tertiary cardiovascular center from April 1, 2015 to September 27, 2017. The primary outcome was a prospective assessment of QoL via the SF-12v2 Health Survey (SF-12v2) in those aged ≥80 and ≥90 years. Secondary outcomes include major bleeding, stroke, vascular complications, pericardial effusion, device related thrombus (DRT), prolonged length of stay (LOS), acute kidney injury (AKI), and recurrent hospitalizations. RESULTS: This cohort of 151 patients included 48/151 (32%) females with a mean age of 80 ± 7.7 years. Mean CHA2 DS2 -VASc was 4.38 ± 1.36 and mean HAS-BLED was 3.27 ± 1.17. Octogenarians 65/81(80%) and nonagenarians 16/81(20%) comprised 81/151(54%) of patients (mean age 86 ± 4.3 years) from which 36/65 (55%) octogenarians and 10/16 (63%) nonagenarians completed SF-12v2 evaluation at 22 ± 10 and 30 ± 10-months. Octogenarians demonstrated enhanced physical component scores (PCS), and nonagenarians equal PCS versus the age-adjusted norm (45.43 ± 9.84 versus 38.68 ± 11.04, P = 0.0003, and 41.26 ± 12.36 versus 38.68 ± 11.04, P = 0.6463, respectively). The mental component scores (MCS) of octogenarians and nonagenarians remained comparable (51.80 ± 9.56 and 48.97 ± 9.92 versus 50.06 ± 10.94, respectively, P = 0.4659). No stroke, vascular complications, pericardial effusions, or readmissions related to WATCHMAN™ occurred. No difference among patients <80, ≥80, and ≥90 years was found in major bleeding events, DRT, prolonged LOS, or AKI (P = 0.0569, 0.116, 0.498, and 0.795, respectively). CONCLUSIONS: Octogenarians and nonagenarians experience favorable long-term QoL after WATCHMAN™, with acceptable bleeding risk and low incidence of procedure-related complications.