Prognostic Value of Body Surface Area-Adjusted Oxygen Uptake Efficiency Slope in Heart Failure Patients.

Background: COVID-19 has been associated with a higher risk of developing heart failure (HF). Among the parameters derived from cardiopulmonary exercise testing (CPET), oxygen uptake efficiency slope (OUES) has become one of the most important parameters for predicting the prognosis of HF patients. However, the clinical utilization of OUES is limited owing to its variation with patient height and weight. This study aimed to evaluate the prognostic value of body surface area-adjusted OUES (OUES/BSA) in adults with HF. Methods: Thirty-six HF patients (mean age, 57 ± 12 years; 30 men) undergoing CPET between July 2019 and May 2020 who were followed up for 12 months were enrolled. The endpoints were major cardiovascular (CV) events, including hospitalization due to acute decompensated HF, left ventricular assist device implantation, heart transplantation, and cardiovascular-related death. We analyzed the correlations between clinical/CPET variables and major CV events. Results: Among the analyzed CPET variables, OUES/BSA had better correlation with maximal oxygen uptake (VO2max) than other variables. In univariate Cox proportional analysis, OUES/BSA and peak VO2 were both significant independent prognostic factors. The cutoff value of OUES/BSA was 595 ml/min/m2 with an area under the curve of 0.929. The patients with OUES/BSA < 595 ml/min/m2 had a lower CV event-free survival rate at 12 months of follow-up compared with the other group (33.3% and 100%, respectively; log-rank test, p < 0.001). Conclusions: BSA-adjusted OUES is an effective independent predictor for prognosis in HF patients and can be an alternative to peak VO2 for risk stratification in HF patients, regardless of exercise intensity. However, further large-scale studies are required to validate our findings.

Exercise-induced myocardial ischemia presenting as exercise intolerance after carbon monoxide intoxication and smoke inhalation Injury: case report.

BACKGROUND: Carbon monoxide intoxication and smoke inhalation injury can lead to severe disorders, and the current literature has elaborated on the importance of major cardiopulmonary impairment. Exercise intolerance has seldom been discussed, particular in patient with low cardiovascular risk. CASE PRESENTATION: Two young male fire survivors who presented with exercise intolerance after CO intoxication and smoke inhalation injury. Both received bronchodilator and glucocorticoid therapy, high-flow oxygen therapy, and hyperbaric oxygen therapy for airway edema and CO intoxication during acute care. Serum carboxyhemoglobin levels improved after treatment (8.2-3.9% in Case A and 14.8-0.8% in Case B). However, subjective exercise intolerance was noted after discharge. Cardiopulmonary exercise testing revealed exercise-induced myocardial ischemia during peak exercise (significant ST-segment depression on exercise electrocardiogram). They were instructed to exercise with precaution by setting the intensity threshold according to the ischemic threshold. Their symptoms improved, and no cardiopulmonary events were reported in the 6-month follow-up. CONCLUSION: The present case report raised the attention that exercise intolerance after carbon monoxide intoxication and smoke inhalation injury in low cardiovascular risk population may be underestimated. Cardiopulmonary exercise testing help physician to discover exercise-induced myocardial ischemia and set up the cardiac rehabilitation program accordingly.

Surge Capacity of Taipei's Regional Emergency Medical System during COVID-19: A System Dynamics Approach.

Background: The community transmission of COVID-19 has caused the breakdown of the regional emergency medical system (REMS), impacting the rights and care of regional patients with acute and severe conditions. This study proposes a model for the surge capacity of REMS to plan for readiness and preparedness during challenging events that overload capacity. Methods: The surge capacity of REMS during the COVID-19 pandemic was studied. The data collection included 26 hospitals that received the data. To simulate the dynamics of Taipei's REMS surge capacity, we observed its ability to treat COVID-19 patients with moderate to severe acute respiratory distress syndrome (ARDS). This will involve monitoring the stock of ventilators, physicians, and nurses within the subsystem loops. Results: Healthcare managers and administrators can use the overload model and hypothetical scenarios to develop new scenarios with different demands on surge capacity. The REMS system capacity model can be used as an aid to guide planning and cross-checking for address Prepare to plan. Conclusions: We combined data regarding the availability of ventilators, physicians, nurses, specialized beds, and general acute care beds in our simulations. Thus, our simulations, with support from a well-established regional command and management structure, could help REMS achieve the optimal surge capacity.

Relationship between quality of life and aerobic capacity of patients entering phase II cardiac rehabilitation after coronary artery bypass graft surgery.

BACKGROUND: This cross-sectional study examined the relationship between patients' aerobic fitness and general health perceptions and how they correspond with functional aerobic impairment (%FAI) and quality of life (QOL). METHODS: One hundred and two patients were administered a version of the World Health Organization Quality of Life brief form questionnaire (WHOQOL-BREF). Then, each patient underwent cardiopulmonary exercise tests to determine their aerobic fitness and %FAI. We performed Pearson's and Spearman's correlation analyses to assess the association between variables on the WHOQOL-BREF questionnaire and the each patient's aerobic fitness. RESULTS: Pearson's correlation coefficient demonstrated a significant association between WHOQOL-BREF scores and peak oxygen uptake (peak VO(2)) in the physical domain (p = 0.006) and environment domain (p = 0.011). Spearman's correlation coefficient also demonstrated a significant association between WHOQOL-BREF scores and the %FAI in the environmental domain (p = 0.036). CONCLUSION: QOL of patients who have undergone coronary artery bypass graft surgery is influenced not only by impaired aerobic fitness but also by poor physical and psychological well-being. The implementation of proper lifestyle modifications and the strengthening of social support networks following CABG surgery are very important for maximizing cardiovascular fitness and improving the QOL of these patients.

The relationship between quality of life and aerobic fitness in patients with rheumatoid arthritis.

Aerobic fitness is among the various aspects of rheumatoid arthritis (RA) patients' lives that may deteriorate as a result of the disease and, in doing so, influence patient attitudes toward their own general health. This cross-sectional study examined (1) relationships between patients' aerobic fitness and general health perceptions, (2) relationships between functional aerobic impairment and general health perceptions, (3) the impact of body mass index (BMI) on RA patients' cardiopulmonary functioning. Sixty-six RA patients (ten male and 56 female adults) participated in this study. Following maximum graded exercise tolerance testing to determine their subsequent aerobic fitness, they completed a version of the World Health Organization Quality of Life brief form (WHOQOL-BREF, short form) questionnaire. The one sample t test determined differences between the RA group and the reference data. We used Spearman's correlation analyses to assess the associations between variables of the WHOQOL-BREF questionnaire and patients' aerobic fitness. VO(2 peak) was on average 92.00% +/- 13.37% and 77.93% +/- 20.24% of that predicted for age-matched men and women, respectively. The female patients' BMI was significantly lower than that of the reference data (P < 0.0001). Spearman's correlation coefficient demonstrated a significant association between WHOQOL-BREF scores and VO(2 peak) in the physical (P = 0.002; mobility, work) and psychological (P = 0.009; self-esteem, body image, and negative feelings) domains for the female patients. It also demonstrated a significant association between the WHOQOL-BREF scores and functional aerobic impairment in the physical (P = 0.006; energy, mobility, activity), psychological (P = 0.008; self-esteem and body images), and environment (P = 0.035; finance, service) domains for the female patients. Our results indicated that impaired aerobic fitness, combined with poor physical and psychological well-being, influenced midlife transition in Taiwanese RA women.