Window of opportunity for respiratory oscillometry: A review of recent research.

Oscillometry has been around for almost 70 years, but there are still many unknowns. The test is performed during tidal breathing and is therefore free from patient-dependent factors that could influence the results. The Forced Oscillation Technique (FOT), which requires minimal patient cooperation, is gaining ground, particularly with elderly patients and children. In pulmonology, it is a valuable tool for assessing obstructive conditions (with a distinction between central and peripheral obstruction) and restrictive disorders (intrapulmonary and extrapulmonary). Its sensitivity allows the assessment of bronchodilator and bronchoconstrictor responses. Different lung diseases show different patterns of changes in FOT, especially studied in asthma and chronic obstructive pulmonary disease. Because of these differences, many studies have analysed the usefulness of this technique in different areas of medicine. In this paper, the authors would like to present the basics of oscillometry with the areas of its most recent clinical applications.

The Role of Positron Emission Tomography in Advancing the Understanding of the Pathogenesis of Heart and Vascular Diseases.

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. For developing new therapies, a better understanding of the underlying pathology is required. Historically, such insights have been primarily derived from pathological studies. In the 21st century, thanks to the advent of cardiovascular positron emission tomography (PET), which depicts the presence and activity of pathophysiological processes, it is now feasible to assess disease activity in vivo. By targeting distinct biological pathways, PET elucidates the activity of the processes which drive disease progression, adverse outcomes or, on the contrary, those that can be considered as a healing response. Given the insights provided by PET, this non-invasive imaging technology lends itself to the development of new therapies, providing a hope for the emergence of strategies that could have a profound impact on patient outcomes. In this narrative review, we discuss recent advances in cardiovascular PET imaging which have greatly advanced our understanding of atherosclerosis, ischemia, infection, adverse myocardial remodeling and degenerative valvular heart disease.

Disparity and Multimorbidity in Heart Failure Patients Over the Age of 80.

Background: Healthcare is currently struggling to provide access and coverage for an increasingly diverse aging population who frequently have multiple co-morbid conditions complicating their care and medical management. Methods: This retrospective study analyzed the prevalence and distribution of common co-morbid conditions (hypertension, dyslipidemia, dementia, and diabetes mellitus) in 316 elderly heart failure patients (age range 80-103; mean 87 ±4.9). Results: Chart review analysis showed a racial distribution of 65 African American versus 251 Caucasian patients (21 vs. 79%). Hypertension was comparable in both groups (98.5% African American vs. 92.4% Caucasian). Dyslipidemia, diabetes and dementia diagnoses were all approximately 20% higher in African American versus Caucasian patients. The concurrent presence of all four conditions was approximately three times more prevalent in African Americans (18.5%) versus Caucasians (7.2%). Conclusion: Our study is unique for studying disparity in octogenarian and nonagenarians residing in a rural setting. Our results also highlight the importance of making a special effort to engage older African American patients in seeking healthcare. In addition, strategies must be designed to reduce barriers that impede access and availability of resources and clinical care, especially in economically underserved regions of the country.

Correlation between electromechanical parameters (NOGA XP) and changes of myocardial ischemia in patients with refractory angina.

INTRODUCTION: Cell therapy has the potential to improve symptoms and clinical outcomes in refractory angina (RFA). Further analyses are needed to evaluate factors influencing its therapeutic effectiveness. AIM: Assessment of electromechanical (EM) parameters of the left ventricle (LV) and investigation of correlation between EM parameters of the myocardium and response to CD133+ cell therapy. MATERIAL AND METHODS: Thirty patients with RFA (16 active and 14 placebo individuals) enrolled in the REGENT-VSEL trial underwent EM evaluation of the LV with intracardiac mapping system. The following parameters were analyzed: unipolar voltage (UV), bipolar voltage (BV), local linear shortening (LLS). Myocardial ischemia was evaluated with single-photon emission computed tomography (SPECT). The median value of each EM parameter was used for intra-group comparisons. RESULTS: Global EM parameters (UV, BV, LLS) of LV in active and placebo groups were 11.28 mV, 3.58 mV, 11.12%, respectively; 13.00 mV, 3.81 mV, 11.32%, respectively. EM characteristics analyzed at global and segmental levels did not predict response to CD133+ cell therapy in patients with RFA (Global UV, BV and LLS at rest R = -0.06; R = 0.2; R = -0.1 and at stress: R = 0.07, R = 0.09, R = -0.1, respectively; Segmental UV, BV, LLS at rest R = -0.2, R = 0.03, R = -0.4 and at stress R = 0.02, R = 0.2, R = -0.2, respectively). Multiple linear regression of the treated segments showed that only pre-injection SPECT levels were significantly correlated with post-injection SPECT, either at rest or stress (p < 0.05). CONCLUSIONS: Electromechanical characteristics of the left ventricle do not predict changes of myocardial perfusion by SPECT after cell therapy. Baseline SPECT results are only predictors of changes of myocardial ischemia observed at 4-month follow-up.

Influence of Chronic Periodontitis on the Long-Term Mortality and Cardiovascular Events in Kidney Transplant Recipients.

Chronic periodontitis (CP) is associated with cardiovascular disease and mortality in different populations. The aim of this study was to examine an association of CP with hard endpoints in patients after kidney transplantation during a 15-year follow-up period. Study group consist of 117 patients (77M/40F, median age 44 years) divided into two subgroups: those with initially advanced CP (CPITN 3-4) and those with no or moderate CP (CPITN 0-2). All cardiovascular events, graft losses, and re-transplantations were recorded. All deaths were noted and verified, including those occurred after the return to dialysis therapy, the causes of death were identified. Cox regression with Firth's penalized maximum likelihood models were used for data analysis. During the observation period, 49 deaths occurred. Advanced CP (n = 35) was not associated with overall mortality but was associated with increased risk of death with functioning graft (DWFG) [HR 3.54 (1.20-10.45); p < 0.05]. Risk of graft loss was not associated with CP status. In conclusion, an advanced CP was independently associated with increased risk of DWFG, but not all-cause or cardiovascular mortality after renal transplantation.

Effects of trans-endocardial delivery of bone marrow-derived CD133+ cells on angina and quality of life in patients with refractory angina: A sub-analysis of the REGENT-VSEL trial.

BACKGROUND: The REGENT-VSEL trial demonstrated a neutral effect of transendocardial injection of autologous bone marrow (BM)-derived CD133+ in regard to myocardial ischemia. The current sub-analysis of the REGENT VSEL trial aims to assess the effect stem cell therapy has on quality of life (QoL) in patients with refractory angina. METHODS: Thirty-one patients (63.0 ± 6.4 years, 70% male) with recurrent CCS II-IV angina, despite optimal medical therapy, enrolled in the REGENT-VSEL single center, randomized, double-blinded, and placebo-controlled trial. Of the 31 patients, 16 individuals were randomly assigned to the active stem cell group and 15 individuals were randomly assigned to the placebo group on a 1:1 basis. The inducibility of ischemia, (≥ one myocardial segment) was confirmed for each patient using Tc-99m SPECT. QoL was measured using the Seattle Angina Questionnaire. Each patient completed the questionnaire prior to treatment and at the time of their outpatient follow-up visits at 1, 4, 6, and 12 months after cell/placebo treatment. RESULTS: The main finding of the REGENT-VSEL trial sub-analysis was that transendocardial injection of autologous BM-derived CD133+ stem cells in patients with chronic refractory angina did not show significant improvement in QoL in comparison to the control group. Moreover, there was no significant difference between cell therapy and placebo in a number of patients showing improvement of at least 1 Canadian Cardiovascular Society class during the follow-up period. CONCLUSIONS: Intra-myocardial delivery of autologous CD133+ stem cells is safe and feasible but does not show a significant improvement in the QoL or angina pectoris symptoms in patients with chronic myocardial ischemia.

Effects of Transendocardial Delivery of Bone Marrow-Derived CD133+ Cells on Left Ventricle Perfusion and Function in Patients With Refractory Angina: Final Results of Randomized, Double-Blinded, Placebo-Controlled REGENT-VSEL Trial.

RATIONALE: New therapies for refractory angina are needed. OBJECTIVE: Assessment of transendocardial delivery of bone marrow CD133+ cells in patients with refractory angina. METHODS AND RESULTS: Randomized, double-blinded, placebo-controlled trial enrolled 31 patients with recurrent Canadian Cardiovascular Society II-IV angina, despite optimal medical therapy, ≥1 myocardial segment with inducible ischemia in Tc-99m SPECT who underwent bone marrow biopsy and were allocated to cells (n=16) or placebo (n=15). Primary end point was absolute change in myocardial ischemia by SPECT. Secondary end points were left ventricular function and volumes by magnetic resonance imaging and angina severity. After 4 months, there were no significant differences in extent of inducible ischemia between groups (summed difference score mean [±SD]: 2.60 [2.6] versus 3.63 [3.6], P=0.52; total perfusion deficit: 3.60 [3.6] versus 5.01 [4.3], P=0.32; absolute changes of summed difference score: -1.38 [5.2] versus -0.73 [1.9], P=0.65; and total perfusion deficit: -1.33 [3.3] versus -2.19 [6.6], P=0.65). There was a significant reduction of left ventricular volumes (end-systolic volume: -4.3 [11.3] versus 7.4 [11.8], P=0.02; end-diastolic volume: -9.1 [14.9] versus 7.4 [15.8], P=0.02) and no significant change of left ventricular ejection fraction in the cell group. There was no difference in number of patients showing improvement of ≥1 Canadian Cardiovascular Society class after 1 (41.7% versus 58.3%; P=0.68), 4 (50% versus 33.3%; P=0.63), 6 (70% versus 50.0%; P=0.42), and 12 months (55.6% versus 81.8%; P=0.33) and use of nitrates after 12 months. CONCLUSION: Transendocardial CD133+ cell therapy was safe. Study was underpowered to conclusively validate the efficacy, but it did not show a significant reduction of myocardial ischemia and angina versus placebo. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01660581.

Intima-media thickness and other markers of atherosclerosis in patients with type 2 diabetes and periodontal disease.

BACKGROUND: Periodontal disease is an inflammatory process which results in increased cardiovascular risk in patients with type 2 diabetes mellitus (DM2). It is not clear, however, whether periodontal inflammation may be associated with increased markers of atherosclerosis in these patients. AIM: This cross-sectional study aimed to answer the question of whether periodontal disease in DM2 is associated with increased markers and risk factors of atherosclerosis. METHODS: One hundred and twenty one patients were included in the study. Sixteen were classified as periodontally healthy (BGI-H), 87 as having gingivitis (BGI-G), and 18 as having periodontitis with moderate bleeding (BGI-P2), according to the new Offenbacher classification. In all patients, intima-media thickness (IMT), pulse wave velocity (PWV), lipids, and C-reactive protein (CRP) were assessed. RESULTS: Patients with periodontitis and gingivitis had a higher IMT value compared to the BGI-H group (0.804 ± 0.112 and 0.772 ± 0.127 vs 0.691 ± 0.151 mm, p < 0.01 and p < 0.05, respectively, odds ratio 5.25 for having IMT ≥ 0.8 mm, 95% CI 1.1; 25). Patients from the BGI-P2 group also had higher blood pressure (BP) compared to the BGI-G and BGI-H groups, and higher CRP compared to the BGI-G group (4.6 ± 2.3 vs 3.8 ± 4.8 mg/L, p < 0.01). Lipid parameters and PWV were comparable in all the groups. CONCLUSIONS: Periodontal inflammation in patients with DM2 seems to be associated with increased IMT and BP, but not with greater arterial stiffness. These results support the hypothesis that periodontal disease may be associated with a vascular pathology.

Plasma adiponectin concentration and left ventricular hypertrophy in kidney transplant patients.

BACKGROUND: Low plasma adiponectin concentration is associated with more frequent occurrence of left ventricular hypertrophy (LVH) and more exaggerated intima-media thickness of common carotid artery (IMT). IMT is an early surrogate marker of atherosclerosis. This study aimed to assess the relationship between plasma adiponectin concentration and left ventricular mass index (LVMI) and IMT in kidney transplant patients (KTP). METHODS: In 88 adult KTP, plasma adiponectin concentration, LVMI, and IMT were estimated. LVH was defined as LVMI >110 or >125 g/m(2) for females and males, respectively. Data presented are means and 95% CI. RESULTS: Plasma adiponectin concentration was similar in KTP with (n = 42) or without LVH (n = 46) (13.5 [11.4-15.6] vs. 13.1 [11.6-14.6] µg/mL, respectively), as well as in KTP subgroups divided according to the IMT value tertiles (p = 0.42) (11.7 [10.0-13.3], 14.2 [11.7-16.6], and 14.0 [11.7-16.4] µg/mL in the lowest, middle, and highest tertiles, respectively). Plasma glucose concentrations were similar in KTPs with LVH or without LVH. No significant correlation was found between plasma adiponectin concentration and both LVMI (R = -0.02; p = 0.87) and IMT (R = 0.09; p = 0.38), respectively. CONCLUSION: Results of this cross-sectional study do not confirm the roles of low adiponectin and high glucose in the pathogenesis of LVH and atherosclerosis in KTP.

Blood pressure and left ventricular mass in subjects with type 2 diabetes and gingivitis or chronic periodontitis.

INTRODUCTION: This study aimed to answer the question of whether chronic periodontitis in subjects with type 2 diabetes mellitus is associated with increased left ventricular mass (LVM) and systemic and central blood pressure (CBP). MATERIAL AND METHODS: One hundred and fifty-five subjects with type 2 diabetes (67 F, 88 M, mean age 61.1±6.9 years, BMI 32.7±5.7 kg/m(2)) were divided according to their periodontal status into biofilm-gingival interface - healthy (BGI-H, 14 subjects), BGI-gingivitis (BGI-G, 119 subjects) and BGI-periodontitis (BGI-P, 22 subjects) groups. In all subjects, LVM, systemic and CBP were measured. The LVM index (LVMI) was calculated. RESULTS: (1) BGI-P and BGI-G subjects, respectively, had higher (mean; 95% CI) LVM (238.6 g; 206.6-267.4 and 222.8 g; 207.0-238.2) versus BGI-H subjects (170.3 g; 125.5-217.8).(2) BGI-P and BGI-G subjects, respectively, had higher (mean; 95% CI) LVM1 (95.2 g/m(2) ; 82.9-107.4) and 87.8 g/m(2) ; 81.5-94.1) versus BGI-H subjects (63.7 g/m(2) ; 45.2-62.3).(3) BGI-P subjects had higher central and systemic systolic and diastolic blood pressure than subjects from BGI-G and BGI-H groups. CONCLUSION: In subjects with type 2 diabetes, periodontitis and gingivitis are associated with increased LVM and periodontitis is associated with increased central and systemic blood pressure.

The influence of chronic periodontitis on serum TNF-alpha, IL-6 and hs-CRP concentrations, and function of graft and survival of kidney transplant recipients.

OBJECTIVE: The aim of the study is to analyze whether chronic periodontitis (CP) influences serum tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and high-sensitivity C-reactive protein (hs-CRP) concentrations in renal transplant recipients and patients or graft survival. BACKGROUND: CP is associated both with higher serum concentrations of cytokines and CRP and high cardiovascular risk. METHODS: One hundred and seventeen patients with a transplanted kidney (Tx) were divided according to the Community Periodontal Index of Treatment Needs (CPITN) into two subgroups: TxP+: severe CP (CPITN 3-4) and TxP-: no or moderate CP (CPITN 0-2). The control group (C) consisted of 36 subjects with no kidney disease and with no or moderate CP (CPITN 0-2). RESULTS: hs-CRP concentration was higher in TxP+ than in TxP- patients [2.0 mg/L (0.7-4.4) vs. 0.9 mg/L (0.3-1.9), p = 0.006]. There were no differences in serum TNF-alpha and IL-6 between TxP+ and TxP-. Significant positive correlation between CPITN score and hs-CRP concentration was found both in Tx and C. The hazard ratio of death was 7.17 (1.4-76.4) for TxP+ patients. CP status did not increase the risk of graft loss or doubling of serum creatinine. CONCLUSIONS: Severe CP is associated with increased serum hs-CRP concentration in patients after kidney transplantation. Severe periodontitis seems to increase the risk of patients' death after kidney transplantation.

Association of chronic periodontitis with left ventricular mass and central blood pressure in treated patients with essential hypertension.

BACKGROUND: The aim of the study was to answer the question whether chronic periodontitis (CP) in patients with essential hypertension is associated with increased aortic stiffness and increased central blood pressure (CBP), which may in turn increase left ventricular mass (LVM) in those patients. CP influences LVM in hypertensive and renal patients as well as in healthy subjects; however, mechanisms involved are not clear. METHODS: Fifty patients (23 men and 27 women, 51.4 +/- 5.2 years, body mass index (BMI) 29.5 +/- 4.4 kg/m(2)) with severe CP-Community Periodontal Index of Treatment Needs (CPITN) score 3-4, and 49 patients (20 men and 29 women, 49.3 +/- 5.5 years, BMI 29.9 +/- 4.8 kg/m(2)) with no or moderate CP (CPITN 0-2) were included. In all patients LVM, pulse wave velocity (PWV), and CBP were measured, and LVM index (LVMI) calculated. RESULTS: Patients with a CPITN of 3-4 had higher LVM (257.3 +/- 67.9 vs. 220.3 +/- 66.4 g, P < 0.01), LVMI (105.8 +/- 23.6 vs. 92.6 +/- 24.8 g/m(2), P < 0.01) and higher central systolic (124 +/- 17 vs. 116 +/- 15 mm Hg, P < 0.05) and pulse pressure (45 +/- 11 vs. 38.7 +/- 9.8 mm Hg, P < 0.05) as compared with patients with a CPITN of 0-2. In the univariate analysis, for the total group a positive association was observed between CPITN values and LVM, LVMI, age, aortic systolic, and pulse pressure, but not with systemic blood pressure. Linear regression analysis showed an association of borderline significance (P = 0.06) between LVMI and the CPITN value. In other model, a significant positive relationship between CBP and CPITN was observed. CONCLUSIONS: More severe forms of periodontitis are associated with increased CBP and LVM in patients with primary hypertension.

Seronegative arthritis in patient with solitary bone plasmacytoma.

We report a patient with localized focus of the bone destruction due to a rare disease, solitary bone plasmacytoma (SBP). The patient suffered from arthritis, mimicking seronegative rheumatoid arthritis. To our knowledge, it is the first description of coexistence of arthritis and SBP.

Association between chronic periodontal disease and left ventricular hypertrophy in kidney transplant recipients.

Periodontal disease (PD) may cause a systemic inflammatory reaction and contribute to left ventricular hypertrophy (LVH) in hypertensive subjects. This study aimed to assess whether chronic PD may contribute to LVH in patients after kidney transplantation. The study analyzed 99 patients divided according to Community Periodontal Index of Treatment Needs (CPITN) score into patients with advanced PD (CPITN 3-4) and patients without or with moderate periodontal lesions (CPITN 0-2). Patients with CPITN 3 to 4 were characterized by a significantly higher plasma high-sensitivity C-reactive protein (HS-CRP) concentration (6.2+/-2.2 vs. 1.7+/-0.3 mg/L, P<0.05) and left ventricular mass index (LVMI) (150+/-7 vs. 111+/-3 g/m, P<0.001) in comparison with patients with CPITN 0 to 2. In the multiple regression model, LVMI was dependent on CPITN (P<0.001), HS-CRP (P<0.05), serum cholesterol (P<0.05), and creatinine concentration (P<0.05). In conclusion, it appears that advanced PD in patients after kidney transplantation is associated with LVH.