Ventilatory response to exercise correlates with impaired heart rate variability in patients with chronic congestive heart failure.

In chronic congestive heart failure (CHF) an overactivity of muscle ergoreceptors and peripheral chemoreceptors may lead to an increased ventilatory response to exercise and contribute to the autonomic imbalance. The analysis of heart rate variability (HRV), which is a reliable method of studying autonomic regulations within the cardiovascular system, showed depressed HRV indexes in CHF, but predictors of abnormal HRV pattern in CHF remain controversial. Considering a common mechanism involved in generation of both abnormal ventilation and autonomic dysfunction in CHF, we hypothesized that impaired ventilation may be better than other variables of CHF severity in determining HRV parameters. Seventy-two patients with CHF (57+/-9 years, ejection fraction: 28+/-11%) underwent cardiopulmonary exercise testing; the relation between ventilation and carbon dioxide production (VE/VCO2) was used as an index of the ventilatory response to exercise. Time and frequency-domain measurements of HRV were derived from 24-hour electrocardiographic monitoring. Patients had reduced exercise tolerance with abnormal ventilatory response (peak oxygen consumption [VO2max]: 17.8+/-5.5 ml/kg/min, VE/VCO2: 36.0+/-9.8). Correlations were found between HRV measures and etiology, New York Heart Association (NYHA) functional class, and VO2max, but the strongest relation was observed for VE/VCO2 slope (r values from -0.33 to -0.65, p <0.01). In the multiple regression analysis only VE/VCO2 was found to correlate independently with all HRV measurements. To investigate the role of peripheral chemoreceptor overactivity as the mechanism of autonomic imbalance and the increased ventilatory response to exercise, we assessed peripheral chemosensitivity in 22 patients (mean value of peripheral chemosensitivity: 0.62+/-0.34 L/min/%SaO2, significantly higher than in normal controls, mean value: 0.29+/-0.20 L/min/%SaO2 in our laboratory). The activity of the peripheral chemoreflex inversely correlated with all parameters of HRV. Increased ventilatory response to exercise correlated with depressed HRV measures in patients with CHF better than other clinical variables. An important role of the increased peripheral chemosensitivity in this relation may be relevant, being also a potential link between functional severity and sympathovagal imbalance in CHF.

Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

After acute myocardial infarction, depressed heart rate variability (HRV) has been proven to be a powerful independent predictor of a poor outcome. Although patients with chronic congestive heart failure (CHF) have also markedly impaired HRV, the prognostic value of HRV analysis in these patients remains unknown. The aim of this study was to investigate whether HRV parameters could predict survival in 102 consecutive patients with moderate to severe CHF (90 men, mean age 58 years, New York Heart Association [NYHA] class II to IV, CHF due to idiopathic dilated cardiomyopathy in 24 patients and ischemic heart disease in 78 patients, ejection fraction [EF], 26%; peak oxygen consumption, 16.9 ml/kg/min) after exclusion of patients in atrial fibrilation with diabetes or with chronic renal failure. In the prognostic analysis (Cox proportional-hazards model, Kaplan-Meier survival analysis), the following factors were investigated: age, CHF etiology, NYHA class, EF, peak oxygen consumption, presence of ventricular tachycardia on Holter monitoring, and HRV measures derived from 24-hour electrocardiography monitoring, calculated in the time (standard deviation of all normal RR intervals [SDNN], standard deviation of 5-minute RR intervals [SDANN], mean of all 5-minute standard deviations of RR intervals [SD], root-mean-square of difference of successive RR intervals [rMSSD], and percentage of adjacent RR intervals >50 ms different [pNN50]) and frequency domain (total power [TP], power within low-frequency band [LF], and power within high-frequency band [HF]). During follow-up of 584 +/- 405 days (365 days in all who survived), 19 patients (19%) died (mean time to death: 307 +/- 315 days, range 3 to 989). Cox's univariate analysis identified the following factors to be predictors of death: NYHA (p = 0.003), peak oxygen consumption (p = 0.01), EF (p = 0.02), ventricular tachycardia on Holter monitoring (p = 0.05), and among HRV measures: SDNN (p = 0.004), SDANN (p = 0.003), SD (p = 0.02), and LF (p = 0.003). In multivariate analysis, HRV parameters (SDNN, SDANN, LF) were found to predict survival independently of NYHA functional class, EF, peak oxygen consumption, and ventricular tachycardia on Holter monitoring. The Kaplan-Meier survival curves revealed SDNN < 100 ms to be a useful risk factor; 1-year survival in patients with SDNN < 100 ms was 78% when compared with 95% in those with SDNN > 100 ms (p = 0.008). The coexistence of SDNN < 100 ms and a peak oxygen consumption < 14 ml/kg/min allowed identification of a group of 18 patients with a particularly poor prognosis (1-year survival 63% vs 94% in the remaining patients, p <0.001). We conclude that depressed HRV on 24-hour ambulatory electrocardiography monitoring is an independent risk factor for a poor prognosis in patients with CHF. Whether analysis of HRV could be recommended in the risk stratification for better management of patients with CHF needs further investigation.

Long-term prazosin therapy for COPD pulmonary hypertension.

A 51-year-old patient with COPD, obesity, and pulmonary hypertension underwent long-term prazosin therapy after a successful hemodynamic response to 1 mg of oral prazosin. The 18-month administration of prazosin, in a dose of 3 mg a day, resulted in continued hemodynamic and echocardiographic benefits.

Prognostic factors in medically treated patients with chronic pulmonary embolism.

OBJECTIVE: To evaluate risk factors in medically treated patients with chronic pulmonary embolism (CPE) who are not suitable candidates for definitive surgical therapy. STUDY DESIGN: A total of 53 consecutive patients with angiographically confirmed CPE were involved. Four patients underwent pulmonary endarterectomy, and 49 patients received continuous anticoagulation therapy and were followed up over an average period of 18.7 months (range, 6 to 72 months). RESULTS: Sixteen patients died during the follow-up period, mostly from progressive right ventricle failure. Among the nonsurvivors, 12.5% had distal CPE and 87.5% had proximal CPE (p = 0.03). The survivors had a higher (mean +/- SD) level of PaO(2) (59.3 +/- 11 mm Hg) than the nonsurvivors (50.8 +/- 9 mm Hg; p = 0.02), a lower mean pulmonary artery pressure (mPAP; 30.3 +/- 15 mm Hg vs 51 +/- 21 mm Hg; p = 0.0004), a lower hematocrit value (40.0 +/- 6 vs 44.2 +/- 6; p = 0.03), and better exercise tolerance (4.8 +/- 3 multiples of resting O(2) consumption [METs] vs 2.5 +/- 1 METs; p = 0.02) achieved during the maximal symptom-limited exercise. The patients with coexisting COPD had a higher mortality rate (62.5%) than those without COPD (37.5%; p = 0.04). Independent risk factors in the Cox analysis were as follows: mPAP (p = 0.04), exercise tolerance (p = 0.02), and COPD (p = 0.04). In the Kaplan-Meier analysis, the patient group with lower mortality achieved > 2 METs (p = 0.02) and had mPAP < 30 mm Hg (p = 0.04). CONCLUSION: The prognosis for the medically treated CPE patients, particularly those with pulmonary hypertension, was unfavorable. The prognostic factors for these patients were mPAP, coexistence of COPD, and severe exercise intolerance.

[Dissecting aortic aneurysm complicated by rupture of the right coronary artery and acute myocardial infarction--in a person treated with fibrinolysis]. / Tetniak rozwarstwiajacy aorty wstepujacej powiklany odwarstwieniem prawej tetnicy wiencowej i zawalem serca--u osoby laczonej fibrynolitycznie.

A case report of 45-year-old woman with acute inferior wall and right ventricle myocardial infarction treated with i.v. Streptokinase is presented. Few days later acute aortic dissection involving right coronary artery was detected. After six days the patient was successfully operated. She is in good condition 10 months afterwards.

[Left ventricular mural thrombi in myocardial infarction in echocardiographic studies and clinical observations]. / Zakrzepy przyscienne lewej komory w zawale serca w badaniach echokardiograficznych i obserwacjach klinicznych.

Examinations were performed in 153 consecutive patients with myocardial infarction (MS), which were divided into two groups. Group I (21 persons) consisted of patients with echocardiographically diagnosed left ventricular mural thrombus, and in group II were patients without evidence of thrombi. Significantly more patients with anterior myocardial infarction were in the the group I, whereas those with inferior MI in the group II. Increased left ventricular wall contractility index and considerably percentage of dyskinesis, mostly of the apex region were stated in the group I. 15 patients (71%) of the group I were treated with heparin, but only 4 of them within 4 hours from the beginning of angina pain. In 4 patients of the group I (19%) thromboembolic complications occurred: in 1 patient during proper anticoagulant therapy and in 3 others without treatment with heparin. Thus mural thrombi were observed in majority in patients with anterior myocardial infarction and were localized in a diskinetic region. Echocardiograms of patients with mural thrombi testified to greater than in others left ventricular function impairment. Heparin administration during first hours of myocardial infarction seemed to lower the incidence of mural thrombi and probably thrombembolic complications.

[Effect of resuming work after myocardial infarction on its recurrence and mortality in long-term observations]. / Podjecie pracy po przebytym zawale serca a nawroty choroby i zgony w obserwacji wieloletniej.

60 to 95% pts in the age group below 60 return to work after having* suffered the first M.I. Up to the present moment, it has not been proved whether such return influences in any (positive or negative) way the recurrence of M.I. or the mortality rate. Two groups of pts who underwent M.I. in the years 1976-84 were included in the long term questionnaire observation: 1. 222 men (mean age 49.3 +/- 3.8 yrs) who resumed work and; 2. 153 men (mean age 50.7 +/- 8.4 yrs) who did not return to work after the first M.I. All pts were sent the questionnaires by post annually. The aim of the questionnaire was to establish whether the patient is alive, if he underwent reinfarction and, in case of death--what was its cause. Until 1985 reinfarction occurred in 25%, and until 1989--in 33% of the pts who resumed work, and 42% of pts who did not. The mean value of reinfarction was about 1.4 in the first group and 1.5 in the latter. Until 1985 the death rate was respectively 15% and 12%. Until 1989--the death rate was 28% and 30%. Thus, the differences between those two groups were statistically insignificant. In conclusion, it may--indirectly--speak in favour of resuming work after the first M.I., showing that, although it does not decrease the reinfarction and mortality rates, it also does not increase the risk.

[Chronic obstructive lung disease: does accompanying arrhythmia have any clinical significance?]. / Przewlekla obturacyjna choroba pluc. Czy towarzyszaca arytmia ma znaczenie kliniczne?

Clinical significance of cardiac arrhythmias in patients with advanced and stable chronic obstructive pulmonary disease was assessed 22-24 hour Holter monitoring revealed supraventricular and ventricular arrhythmias in all 65 patients. There was a great variation of arrhythmia quality and quantity in the study group. Among others, 1808 complex ventricular extrasystoles in 33 patients and 302 episodes of nonsustained ventricular tachycardia in 19 patients were recorded. No sustained symptomatic ventricular arrhythmias were observed. We found no correlation between the intensity of ventricular and supraventricular extrasystoles and clinical parameters as assessed by echocardiography, spirometry and gasometry. However, patients with complex ventricular arrhythmias had larger right ventricular diameter in echocardiography. Of 65 studied patients, 14 (21%) died during follow-up ranging from 1 month to 3.2 years, mean 12.2 months. Two outpatients died suddenly. These 14 patients had larger right ventricle and left atrial dimension, more pronounced PaO2 decrease as well as lowered FEV1 as compared to the survivors. No differences in the incidence of cardiac arrhythmias were noted. Summarizing, despite the great prevalence of cardiac arrhythmias in patients with advanced stable COPD we found no life-threatening ventricular arrhythmias during approximately 1500 hours of holter monitoring. Cardiac arrhythmias seem not to influence the prognosis in these patients.

[Constrictive pericarditis in a patient following prosthetic aortic valve replacement caused by postpericardiotomy syndrome]. / Zaciskajace zapalenie osierdzia u chorego po wszczepieniu sztucznej zastawki aortalnej powiklanym zespolem po perikardiotomii.

A case of a 53-year old man is presented who developed postpericardiotomy syndrome and subsequently constrictive pericarditis following prosthetic aortic valve replacement due to severe aortic stenosis. The diagnosis was based on clinical picture and confirmed invasively. Nearly total excision of thickened fibrous pericardium resulted in a slow but full disappearance of constriction signs.

[Atrial fibrillation with chronic obstructive pulmonary disease]. / Migotanie przedsionków w przewleklej obturacyjnej chorobie pluc.

We compared 8 patients with COPD and fixed atrial fibrillation (group I) and 46 patients with COPD and sinus rhythm in ecg (group II). None of the patients had valvular heart disease, arterial hypertension or clinical signs of coronary artery disease. The studied groups did not differ while comparing their gas measurements, spirometry, pulmonary hypertension and right ventricular diameter (as measured in echo study). Patients with fixed atrial fibrillation had larger circuit and area of right atrium (p = 0.001), left atrial and left ventricular diameter (p = 0.001) as well as lower LV function (expressed by FS%). In conclusion, enlargement of both atria may be considered as a cause for fixed atrial fibrillation in patients with COPD. However symptomless coronary artery disease rather then COPD may be the reason for this arrhythmia.

[Giant thrombus of mitral valve prosthesis diagnosed by two-dimensional and Doppler echocardiography and confirmed by autopsy]. / Rozpoznany echokardigrafia dwuwymiarowa i dopplerowska, potwierdzony sekcyjnie ogromny zakrzep sztucznej zastawki mitralnej.

Authors presented intravitally diagnosed and well echocardiographically supplied documentary evidence for a huge thrombus positioned in the left atrioventricular ostium in a 52 years old woman within two months of Björk-Shiley mitral valve replacement because of a mitral valve disease.

[Enalapril improves hemodynamics and exercise tolerance in pulmonary heart disease caused by obstructive lung disease]. / Enalapril poprawia hemodynamike i tolerancje wysilku w zespole plucno-sercowym spowodowanym przewlekla obturacyjna choroba pluc.

Chronic enalapril therapy was assessed in 11 patients with cor pulmonale due to chronic obstructive pulmonary disease. Enalapril was added to the maintenance dose of diuretics and digitalis and when clinical stabilisation was achieved haemodynamics, spirometry, blood gases and maximal treadmill exercise test accompanied by +pulse oximetry were performed before and after 30 days, 10-20 mg a day, enalapril therapy. Haemodynamic study showed moderate but significant decrease in mean pulmonary artery pressure, from 24 +/- 3 to 21 +/- 5 mmHg (p = 0.05). There were no substantial differences in cardiac output as well as in blood gases and spirometry after enalapril therapy. Slight decrease in oxygen delivery, on an average from 9157 +/- 3808 to 8074 +/- 3574 (p = NS), was accompanied by a concomitant fall in haemoglobin. We noted significant improvement of maximal exercise test results after enalapril therapy. Maximal workload achieved and the time of exercise increased. It was accompanied by subjective improvement as assessed by Borg scale. We observed no adverse effects of enalapril during one month therapy in patients with cor pulmonale and COPD.

[Chronic thromboembolic pulmonary hypertension--observation of personal case reports]. / Nadcisnienie plucne na tle przewleklej zatorowosci do duzych naczyn plucnych--obserwacja wlasnych przypadków.

The clinical picture, differential diagnosis and prognosis in chronic thromboembolic pulmonary hypertension (CTEPH) is being discussed on the basis of a dozen of the authors' cases. The clinical course of CTEPH in 2 patients fulfilling the main criterium for pulmonary thromboendarterectomy and undergoing one year anticoagulation is examined. As a result patient with one large pulmonary vessel occlusion (a. lobaris superior sinistra) improved his clinical status as well as hemodynamic and echocardiographic outcome. In patient with multivessel pulmonary occlusion gradual clinical aggravation and hemodynamic-echocardiographic progression of CTEPH was observed.

[Clinical and hemodynamic evaluation of 6-week treatment of pulmonary hypertension in chronic obstructive lung diseases (COLD) with low dose of prazosin]. / Kliniczna i hemodynamiczna ocena 6 tygodniowego leczenia nadcisnienia plucnego wystepujacego w przebiegu przewleklej obturacyjnej choroby pluc (p.o.ch.p.) niewielka dawka prazosyny.

The value of vasodilatatory treatment of pulmonary hypertension due to chronic obturative pulmonary disease (c.o.p.d.) is still controversial. However in patients with c.o.p.d. causal treatment as well as chronic domestic oxygen therapy have a wide range of limitations. Among vasodilator alpha-1 blockers show less vasodilator-related adverse effects, and as known from acute trials they exert a potent effect on pulmonary circulation in patients with pulmonary hypertension and c.o.p.d. Prazosin was studied in 11 patients (10 men, 1 women) aged 63 +/- 7 years with advanced c.o.p.d. (FVC 1.8 +/- 0.41, FEV1 0.99 +/- 0.55 l) (s) after their clinical stabilisation. In 4 of them prazosin was added to the maintenance dose of diuretics and digitalis. Subjective status, NYHA functional class, spirometric (FVC, FEV1) and gaseous (PaO2, PCO2) parameters, weight, systemic blood pressure, and heart rate were noted. During Swan-Ganz catheterization mean pulmonary artery pressure (MPAP), right ventricular end-diastolic pressure (RVEDP), pulmonary wedge pressure (PCWP), cardiac output (CO), systemic (SVR) and pulmonary (PVR) vascular resistance were measured. The acute trial with 1 mg prazosin taken orally was followed by 2- and 6-week of 3 mg prazosin treatment assessment. After a single dose of 1 mg prazosin there was a significant decrease in MPAP from 36 +/- 9 to 28 +/- 10 (p = 0.001) and 44% decrease in RVEDP (p = 0.05). CO increased by 16% (p = 0.01). The fall in PVR (30%, p = 0.01) exceeded that in SVR (17%, NS). No adverse effects were observed. During 2-week 3 mg a day prazosin therapy 2 patients were excluded following dyspnea and systemic hypotonia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of classical and new criteria of electrocardiography in diagnosis of hypoxic cor pulmonale evaluated by hemodynamics tests]. / Wartosc klasycznych i nowych kryteriów elektrokardiograficznych rozpoznawania hipoksyjnego serca plucnego oceniana badaniami hemodynamicznymi.

Electrocardiogram is commonly used in the diagnosis of cor pulmonale in patients with chronic obstructive pulmonary disease (COPD). Pulmonary hemodynamics being the definite method for diagnosis the disease can be used to vary the ecg criteria for diagnosis cor pulmonale. After excluding patients with old myocardial infarction and with pulmonary wedge pressure > 12 mm Hg in 66 patients aged 65.2 with advanced COPD (FEV1 0.78 +/- 0.3 litre) pulmonary hemodynamics and ecg were performed at the same time. The signs of right ventricular hypertrophy were sought for using 3 sets of criteria: the World Health Organisation criteria, new compiled Lehtonen et al. Criteria and right ventricular precordial leads. WHO criteria had a specificity and sensitivity of 50% and 57.6%, the modified right precordial leads-53% and 64.5% and compiled Lehtonen's criteria -57% and 59% respectively. In 32 patients with mild pulmonary hypertension (20-29 mm Hg) sensitivity of WHO criteria was 46.8%, right precordial leads -51.6%, and Lethonen and co. Criteria -50%, in 10 patients with moderate pulmonary hypertension (30-39 mm Hg) 59%-62.5%-50%, in 9 patients with severe hypertension (> or = 40 mm Hg) 100%-100%-100% respectively. Our studies confirm the poor sensitivity and of ecg criteria for diagnosis of cor pulmonale (pulmonary hypertension) in COPD. However, in mild and moderate pulmonary hypertension, sensitivity of ecg diagnosis of cor pulmonale is improved if right modifieds precordial leads are used. New, compiled Lehtonen's criteria failed to improved diagnosis of diagnosis of cor pulmonale. All studied sets of criteria are highly sensitive in COPD patients with severe pulmonary hypertension.

[Osteoporosis caused by long-term steroid therapy of patients with chronic asthmatic bronchitis]. / Osteoporoza w przebiegu przewleklej sterydoterapii u chorych z przewleklym astmatycznym niezytem oskrzeli.

14 patients with chronic bronchitis were observed after from 1.5 to 8 years of regular treatment with corticosteroids of sustained action given intramuscularly. The patients were analysed from the standpoint of age, sex, duration of corticosteroid treatment, type and dose of the drugs, and smoking. In 9 of them accelerated development of osteoporosis was noted its appearance depended significantly only on age and sex.

[Bacterial endocarditis in clinical and echocardiographic observations]. / Bakteryjne zapalenie wsierdzia w obserwacji klinicznej i echokardiograficznej.

Twenty-one patients with infectious endocarditis are reported. The diagnosis was based on finding of at least three clinical symptoms and signs, including systemic manifestations, cardiovascular signs such as the appearance of a new or changing symptoms of cardiac failure, episodes of embolism and abnormalities in laboratory investigations and features of valvular involvement by the inflammatory process, principal changing endocardium image was evidence of an active inflammatory process. The aetiological factors, diagnostic difficulties, therapeutic results and the usefulness of echocardiography in the diagnosis of infectious endocarditis are discussed.

[Comparison of 14-day rehabilitation and oxygen therapy on exercise tolerance and percutaneous oxygen saturation in patients with advanced COPD]. / Porównanie wplywu 14 dniowej rehabilitacji i tlenoterapii na tolerancje wysilku i wysycenie krwi tetniczej tlenem u chorych na zaawansowana POCHP.

UNLABELLED: Whether rehabilitation may be as beneficial as oxygen therapy (T) in the management of chronic obstructive pulmonary disease (COPD) is still not known. The aim of the was to compare the effects of T or R on exercise tolerance (ET) and percutaneous oxygen saturation (SO2) at rest and at the peak exercise in 21 patients with COPD (FEV1, 1.29 L +/- 0.5) Eleven patients with COPD were treated with oxygen (17 hour per day) for 14 days and 10 patients were rehabilitated. Both groups did not differ in age 63.7 vs 69.3 years, in the baseline values of FEV1, PaCO2 and PaO2 and resting SO2%. Before the study patients R and T had similar resting SO2 values and ET (4.5 +/- 1 vs 3.4 +/- 2 METs, p = NS), but those in the R group revealed higher drop in SO2 at peak exercise test (10.9 vs 3.4%, p = 0.007). RESULTS: We found no significance impact of 14- day R and 14- day T on results of exercise test and exercise pulse oximetry in studied patients. However, rehabilitated patients, as opposite to patients on oxygen therapy had tendency to increase number of Mets and to diminish maximal drop in pulse oximetry during exercise. As a result, when we compared group R i T after study patients of R group differed from T patients with number of METs achieved (4.6 vs 3.0, p = 0.02), whereas maximal drop in SO2 at the peak exercise test in R and T patients equalized (7.9 +/- 7 vs 3.2 +/- 3%, p = NS). We conclude that the results of our short term study may suggest better effects of rehabilitation than oxygen therapy on exercise tolerance and oxygen saturation during exercise in COPD patients and justify further studies.

[Effect of acute exercise on cardiac arrhythmias in the course of chronic obstructive pulmonary disease]. / Wplyw ostrego wysilku na niemiarowosc serca w przewleklej obturacyjnej chorobie pluc.

It is suggested that ventricular arrhythmias may be the reason of sudden death in stable patients with COPD. Strenuous effort might provoke danger ventricular arrhythmias in those patients. The impact of maximal exercise test on cardiac ventricular arrhythmias was studied in 24 patients with advanced chronic obstructive pulmonary disease (COPD). The treadmill, self limited exercise test according to Bruce protocol and accompanied by pulse oximetry was performed during 24 hour Holter monitoring. We found ventricular extrasystoles in all patients, in an average 492 +/- 770, complex ventricular extrasystoles in 17 patients and nonsustained ventricular tachycardia in 8 patients. 81% of all ventricular extrasystoles, 80% complex ventricular extrasystoles and 70% nonsustained ventricular tachycardia occurred during the test and up to 2 hour after the test. Patients with complex ventricular arrhythmias were younger and mostly achieved more MET during exercise, but they did not differ in advancing of COPD as measured by spirometry, gas measurements and echocardiography. Although maximal exercise test enhances ventricular arrhythmias it produced no sustained, symptomatic ventricular arrhythmias in patients with advanced and stable COPD.

[Respiratory rehabilitation of patients with chronic obstructive lung diseases in the subjective and objective evaluation]. / Rehabilitacja oddechowa u chorych z przewlekla obturacyjna choroba pluc w ocenie subiektywnej i obiektywnej.

An intensive 14 day respiratory rehabilitation program was carried out in 24 COPD patients of mean age 66.0 +/- 10.0 yrs (FVC 1.56 +/- 0.52 L, FEV1 0.94 +/- 0.4 L/s). A statistically objective improvement was seen measured by the 100 meter tread mill test (p = 0.001) which was not seen in spirometric analysis. Seventeen patients reported a subjective improvement in their clinical state. The authors have demonstrated usefulness of the 100 meter walk test in analysis of rehabilitation processes.