Oxygen Uptake Efficiency Slope and Prediction of Post-operative Morbidity and Mortality in Patients with Lung Cancer.

OBJECTIVE: Peak oxygen consumption is a very valuable cardiopulmonary functional parameter in pre-operative evaluation of patients with lung cancer. However, it has several critical limitations for operability decision due to failure in achieving maximal level of exercise test for cases. The aim of this study was to reveal the importance of more accurate cardiopulmonary parameters that can be calculated from data of submaximal level test, such as oxygen uptake efficiency slope (OUES) and to determine whether it could be used in the operability decision phase for borderline cases by means of morbidity and mortality. MATERIALS AND METHODS: One hundred and twenty-five patients who were scheduled to undergo lung surgery due to lung cancer were included in the study. Peak oxygen uptake (pVO2), heart rate at the anaerobic threshold, and oxygen consumption volume at anaerobic threshold values were obtained after performing the cardiopulmonary exercise test. The OUES value was calculated from the ratio of the peak VO2 value and logarithmic equivalent of the ventilatory volume (VE). The following equation was used for determining OUES: VO2/log10 VE. RESULTS: The peak VO2 mean value was 21.37 ± 4.20 mL/min/kg in patients. However, OUES mean value was 12.44 ± 2.11. When the metabolic parameters of the patients were compared, a significant correlation was determined between the peak VO2 value and peak VE, OUES, and survival (p < 0.01). CONCLUSION: This study demonstrated that OUES is significantly correlated with peak VO2 and it does not require the performance of maximal exercise and can be used together with peak VO2 in this patient population when there is difficulty in making decision for surgery in patients with lung cancer.

Comparison of the functional and cardiovascular effects of home-based versus supervised hospital circuit training exercises in male wheelchair users with chronic paraplegia.

OBJECTIVES: The aim of this study was to compare the efficacy of home-based upper extremity circuit training exercises (CTEs) with supervised hospital program in male patients with traumatic complete paraplegia. PATIENTS AND METHODS: Twenty men with paraplegia (mean age: 38±10.1 years; range, 30 to 43 years) between January 2007 and November 2007 were randomized into two groups. The first group had supervised hospital CTE program, whereas the second group had home-based CTE. The effects of the upper extremity CTE by using elastic bands 60 min per day, five days a week, for a total of eight weeks (70% maximal oxygen consumption [VO2max]) were examined. The Cybex was used for the isokinetic testing of the upper extremities. The VO2max and maximum heart rate (HR) were assessed using an arm ergometer. The Craig Handicap Report Technique Short Form (CHART-SF) was used for the evaluation of functional independence and mobility. Serum lipid profiles were measured. RESULTS: The mean injury duration was 7.9±2 years. The peak torque values of the upper extremities, VO2max, maximum HR, CHART-SF physical independence and mobility scores, and serum lipid profile were all improved in both groups (p<0.05). There were no significant differences in terms of the increase in the muscle strength and serum lipid levels between the groups (p>0.05). The improvement in the VO2max, physical independence, and mobility scores were greater in the supervised exercise group. CONCLUSION: Upper extremity strength, cardiovascular endurance, and lipid profile were improved after supervised and home-based CTE in the men with paraplegia. Home-based exercise programs may be good alternatives to the hospital rehabilitation for this patient population.

Improvement of coronary flow velocity reserve with telmisartan in patients with autosomal-dominant polycystic kidney disease.

OBJECTIVES: Endothelial dysfunction (ED) has been reported in patients with autosomal-dominant polycystic kidney disease (ADPKD). Coronary flow velocity reserve (CFVR) is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. The aim of this study was to investigate the effect of the angiotensin receptor blocker, telmisartan, on CFVR in patients with ADPKD. METHODS: Thirteen patients with ADPKD and well-preserved renal function and 22 healthy controls were included in the study. CFVR was measured at baseline and after dipyridamole infusion by echocardiography. CFVR was calculated as the ratio of hyperemic to baseline average peak diastolic velocities. After the baseline evaluation of CFVR, patients started telmisartan at a dose of 80 mg/day and were followed for 12 months. CFVR was remeasured after 6 and 12 months of therapy. RESULTS: Patients with ADPKD had significantly lower CFVR compared to healthy subjects. CFVR increased significantly after 6 months and 12 months of telmisartan therapy (P = 0.001) in patients with ADPKD. CONCLUSION: One year of telmisartan therapy significantly improved CFVR in patients with ADPKD. This finding suggests that the stimulation of the renin-angiotensin-aldosterone system contributes to the ED in these patients.

Effect of aerobic exercise training on oxygen uptake and kinetics in patients with fibromyalgia.

The aim of this study is to investigate relation between cardiopulmonary performance and muscular microcirculation in patients with fibromyalgia syndrome (FMS). Twenty-one female sedentary patients who were diagnosed as FMS, and 15 sedentary females were enrolled in to the study. All participants underwent a modified Bruce multistage maximal treadmill protocol with metabolic measurements and Near-Infrared Spectroscopy measurements. Exercise sessions were performed 3 times a week for 8 weeks. The results of the study suggest that cardiopulmonary system in charge of delivering oxygen to whole body and muscular microcirculation may have dysfunction in patients with FMS.

Reduced coronary flow reserve and early diastolic filling abnormalities in patients with nephrotic syndrome.

BACKGROUND: Increased cardiovascular disease risk is very well known in nephrotic syndrome. Coronary flow reserve measurement by trans-thoracic echocardiography reflects coronary microvascular and endothelial function. However, diastolic filling abnormalities by echocardiography may indicate diastolic dysfunction. Our aim was to evaluate endothelial and diastolic functions by trans-thoracic echocardiography in nephrotic syndrome. METHODS: Eighteen patients with nephrotic syndrome (five females, 34 +/- 17 years) and 30 controls (10 females, 35 +/- 10 years) were evaluated in this cross-sectional observational study. Age, weight, lipid profile, glucose, blood urea nitrogen, creatinine, serum albumin, total protein, C-reactive protein, erythrocyte sedimentation rate, blood pressures, 24-hour urine volume, and protein were recorded. Glomerular filtration rate was estimated by Cockcroft-Gault Formula. Doppler flow and other echocardiographic parameters were measured by Vivid 7 echocardiography. RESULTS: Coronary flow reserve was significantly lower in patients than controls (p < 0.001) and was negatively correlated with proteinuria (p < 0. 001), creatinine levels (p = 0.03), total cholesterol (p = 0.02), C-reactive protein (p = 0.02), and erythrocyte sedimentation rate (p = 0.005). E/A ratio was significantly lower in patients than in controls (p = 0.005). DT was significantly higher in patients than in controls (p = 0.01) and isovolumic relaxation time was similar in both groups. CONCLUSION: Coronary flow reserve and left ventricular diastolic filling are significantly impaired in nephrotic syndrome. Proteinuria, serum creatinine, total cholesterol and inflammation may have all contributory effects on endothelial dysfunction. Early evaluation of patients with nephrotic syndrome should include coronary flow and diastolic function by echocardiography.

Discrimination between physiologic and pathologic left ventricular dilatation.

The identification of certain cardiovascular disease in athletes may constitute the basis for disqualification from competition in an effort to minimize the risk of sudden cardiac death. The aim of this study was to assess diastolic and systolic parameters measured by tissue Doppler imaging in endurance veteran athletes who had prominent cardiac dilatation and patients with idiopathic dilated cardiomyopathy in order to determine whether these variables might differentiate each other.

Cardiac fatigue and oxygen kinetics after prolonged exercise.

BACKGROUND: Although the underlying mechanisms responsible for cardiac dysfunction after prolonged exercise remains to be elucidated, it has reported cardiac deterioration following exhaustive exercise in the absence of underlying cardiovascular diseases, which has been attributed to cardiac fatigue. The study was designed to investigate the effects of after fatiguing exercise on oxygen kinetics. METHODS: Six athletes have taken examination, firstly by echocardiography, secondly by cardiopulmonary exercise testing and then by near-infrared spectroscopy (NIRS), before 2 days (pre-race) and after 1 day (post-race) marathon competition. RESULTS: We found decrease in left ventricular systolic and diastolic functions, and peak oxygen consumption while increasing half time of muscular oxygen delivery after race period. CONCLUSION: Cardiopulmonary exercise testing in conjunction with oxygen kinetics of skeletal muscle measured by NIRS may be a tool for detecting cardiac fatigue.

Reduced tolerance of exercise in fibromyalgia may be a consequence of impaired microcirculation initiated by deficient action of nitric oxide.

Although the underlying mechanism responsible for muscular fatigue and exercise intolerance remains to be elucidated, it is reported two major mechanisms, central and peripheral hypothesis. As a peripheral mechanism, there are few reports on abnormalities of the microcirculation in patients with fibromyalgia. The key point to note is that ischemia associated with a modest decline in tissue oxygen causes muscle fatigue. It has been shown that have been found low muscle levels of phosphates and abnormalities in microcirculation in fibromyalgia. Based on several novel data, production abnormalities of nitric oxide level might lead to symptoms of fatigue as a long term effect. There a vicious cycle concerning impairment of microcirculation in FM. The cycle is firstly initiated decrease of production of nitric oxide in the endothelial level by some trigger factors. Changed level of nitric oxide may cause microcirculation abnormalities in the tissue levels, muscular region. At the end of these phases, muscular fatigue and exercise intolerance may progressively develop in the FM. It is possible that this theory appears to provide a physiopathological explanation for decreased exercise capacity in patients with fibromyalgia. This paper describes a plausible mechanism for the development of exercise intolerance on microcirculation abnormalities.

Impact of diabetes and diastolic dysfunction on exercise capacity in normotensive patients without coronary artery disease.

OBJECTIVE: The aim of this study was to determine the impact of diabetes and diastolic dysfunction on exercise capacity in asymptomatic, normotensive patients with type 2 diabetes without coronary artery disease. METHODS: A total of 43 type 2 diabetes patients (age: 50 ± 5 years) and 20 healthy controls (age: 48 ± 4 years) were enrolled. Diastolic function was investigated by conventional pulsed-wave (PW) Doppler and tissue Doppler imaging (TDI). Exercise capacity was evaluated with cardiopulmonary exercise testing (CPET). RESULTS: In patients with type 2 diabetes, increase in resting heart rate (HR-rest) (p = 0.013), decrease in maximum heart rate during exercise (HR-max) (p < 0.001) and exercise time (p < 0.001) compared with controls were significant. Patients had significantly increased minute ventilation volume (VE)/maximum carbon dioxide discharge (VCO2) ratio (p < 0.001), decreased maximum oxygen consumption (VO2-max) (p < 0.001), oxygen consumption at anaerobic threshold (VO2-an) (p < 0.001) and maximum carbon dioxide discharge (VCO2) (p < 0.001) compared to controls indicating significantly reduced exercise capacity. HbA1c was inversely correlated with VO2-max (r = -0.456, p < 0.01) independent of the absence or presence of mild diastolic dysfunction. CONCLUSION: Exercise capacity was found to be significantly decreased in normotensive patients with type 2 diabetes without coronary artery disease, and this decrease was independent of diastolic dysfunction.

Can Renal Hematoma Occur without a Direct Trauma During Exercise? A Case Report.

Renal injury can occur during sports activity. Although it is, generally, associated with contact trauma, it is known that the renal injury can be developed during training without a direct trauma. The diagnosis of renal injuries should not be based solely on urine analysis. Computed tomography scan is necessary diagnose possible renal injuries. Key PointsRenal injuries may develop during sporting activities without a direct trauma.CT scan is necessary in order to diagnose possible renal injuries and to grade accurately the degree of injury.

Does Illness Perception Predict Posttraumatic Stress Disorder in Patients with Myocardial Infarction?

INTRODUCTION: Myocardial infarction (MI) as a life-threatening event, carrying high risk of recurrence and chronic disabling complications, increases the risk of developing acute stress disorder (ASD), posttraumatic stress disorder (PTSD), or both. The aim of this study was to investigate the relationship between illness perceptions and having ASD, PTSD, or both in patients after MI. METHOD: Seventy-six patients diagnosed with acute MI were enrolled into our prospective study. We evaluated patients during the first week and six months after MI. Patients were assessed by using the Clinician Administered PTSD Scale (CAPS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Brief Illness Perception Questionnaire (BIPQ), and a semi-structured interview for socio-demographic characteristics during both the first and second evaluations. RESULTS: Acute stress disorder (ASD) developed in 9.2% of patients and PTSD developed in 11.9% of patients with MI. Illness perception factors of 'consequences, identity and concern' predicted the occurrence of both ASD and PTSD, whereas 'emotion' predicted only PTSD. CONCLUSION: The factors of illness perceptions predicted the induction of ASD and PTSD in patients who had acute MI.

The incognita of the known: the athlete's heart syndrome.

Long-term athletic activity causes morphological and functional changes in the heart characterized as left ventricle cavity dimension changes, wall thickness and mass increase and rhythm conduction changes. This condition is identified as "athlete's heart syndrome". The changes that are seen clinically occur as a result of physiological adaptation to exercise. Cardiovascular adaptation depends on the exercise's type as well as its frequency, duration and intensity. In the athlete's physical examination, various changes can be seen that are mistaken with pathological conditions. In addition, there are changes present due to cardiac hypertrophy, increased vagal tone and repolarization. The knowledge and recognition of the organic and functional changes developing in the athlete's heart is being helpful to differentiate physiological changes from cardiac pathologies that can cause sudden death in athletes.