Borg Index Research Articles

Effect of inspiratory muscle training in esophageal cancer patients receiving esophagectomy: A meta-analysis of randomized controlled trials.

To identify the clinical effect of inspiratory muscle training (IMT) among esophageal cancer patients undergoing esophagectomy based on randomized controlled trials (RCTs). Several databases were searched for relevant RCTs up to August 23, 2023. Primary outcomes were respiratory muscle function, including the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), and pulmonary function, including the forced expiratory volume in one second % (FEV1%), forced vital capacity% (FVC%), maximal ventilator volume (MVV), FEV1/FVC% and FVC. The secondary outcomes were exercise performance, including the six-minute walk distance test (6MWT) and Borg index; mental function and quality of life, as evaluated by the Hospital Anxiety Depression Scale (HADS) and Nottingham Health Profile (NHP) score; and postoperative complications. All the statistical analyses were performed with REVMAN 5.3 software. Eight RCTs were included in this meta-analysis, with 368 patients receiving IMT and 371 control subjects. The pooled results demonstrated that IMT could significantly enhance respiratory muscle function (MIP: MD = 7.14 cmH2O, P = 0.006; MEP: MD = 8.15 cmH2O, P<0.001) and pulmonary function (FEV1%: MD = 6.15%, P<0.001; FVC%: MD = 4.65%, P<0.001; MVV: MD = 8.66 L, P<0.001; FEV1/FVC%: MD = 5.27%, P = 0.03; FVC: MD = 0.50 L, P<0.001). Furthermore, IMT improved exercise performance (6MWT: MD = 66.99 m, P = 0.02; Borg index: MD = -1.09, P<0.001), mental function and quality of life (HADS anxiety score: MD = -2.26, P<0.001; HADS depression score: MD = -1.34, P<0.001; NHP total score: MD = -48.76, P<0.001). However, IMT did not significantly decrease the incidence of postoperative complications. IMT improves clinical outcomes, such as respiratory muscle function and pulmonary function, in esophageal cancer patients receiving esophagectomy and has potential for broad applications in the clinic.

Effect of One Session of Muscle Blood Flow Restriction Training Versus Normal Training on Blood Lactate Level.

Blood flow restriction training (BFRT) is useful for improving muscle strength. However, it involves a long training time and is unsuitable for vigorous exercise. Muscle blood flow restriction training (MBFRT), which uses multiple parallel pneumatic cuffs (MPCs) to compress large areas of the extremities and restrict blood flow, was subsequently developed to address these issues. This study compared the effects of MBFRT with normal training (NT). Ten healthy adults underwent low-intensity MBFRT. MPC pressure was increased to 200 mmHg just before training. The exercise was a bodyweight half-squat. Three sets of 30 squats were performed. Two weeks later, the participants underwent NT with the same exercise. Blood lactate levels were measured before the start of training and at 1 and 5 min after training. The Borg index was also measured at the end of the training. The blood lactate level was elevated at 1 min after MBFRT and NT. The elevated blood lactate level was maintained at 5 min after MBFRT, whereas the lactate level was significantly decreased at 5 min after NT. The Borg index at the end of the training was significantly higher in MBFRT than in NT. Lactic acid accumulates in the muscles during low-intensity MBFRT, thereby initiating type II fiber activity.

The first experience of treatment applied to patients with pulmonary embolism that developed on the COVID-19 background

The aim of the study was to evaluate the immediate results of treatment of high-risk PE developed against the background of COVID-19, and to analyze the features of the clinical course. Material and methods. The study is based on the experience of treatment applied to three patients with pulmonary embolism (PE) that developed against the background of COVID-19. The group under consideration is represented by males. The average age was 41 ± 3.1 years old. Verification of the primary diagnosis of COVID-19 was based on positive results of polymerase chain reaction, supplemented by the results of computed tomography. The formation of high-risk PE was noted on the 5th–7th day from the moment of hospitalization. There was also a decrease in SO2 below 85%, РаО2 — below 76 mm Hg, Borg index &gt; 8, which required non-invasive high-flow ventilation. Catheterization of the right chambers of the heart with a Swan–Ganz catheter revealed an increase in systolic pressure in the right ventricle to 57 ± 1.2 mm Hg, and diastolic pressure to 13 ± 0.34 mm Hg. Pulmonary hypertension increased up to 70 mm Hg. Changes in the biochemical analysis of blood consisted in increasing the level of troponin I to 0.65 ± 0.14 ng/ml, С reactive protein — to 5.42 ± 2.1 mg/l, and creatine phosphokinase — to 324 ± 23.1 units. An increase in the D-dimer level was observed (0.68 ± 0.11 mg/l). Systemic thrombolysis actilyse was performed in all the cases. Results. Positive clinical dynamics was observed up to 15 hours after thrombolytic therapy. The level of SO2 came back to the initial values and was in the range 93–96% and RaO2 — from 86–92 mm Hg by the end of the first day after the intervention. The average pressure gradient in the pulmonary artery was 32 ± 4.12 mm Hg at the time of discharge, and at the peak — 44 ± 5.3 mm Hg.

Identification of predictors of response to initial oral combination therapy in WHO-functional class II or III PAH patients: a post-hoc analysis of the AMBITION study

Abstract Background AMBITION Study (NCT01178073) provided the first long-term clinical evidence for initial combination therapy with ambrisentan and tadalafil (COMB) compared with monotherapy of either agent (MONO), and the results contributed to the ESC/ERS guidelines recommending initial combination therapy in PAH patients with low and intermediate risk. However, predictors of response to initial oral combination therapy to identify PAH patients who benefit most from it have not been assessed. Purpose To identify potential predictors of response to initial combination therapy with ambrisentan and tadalafil (COMB) in PAH patients with WHO-FC II or III in the AMBITION study. Methods We examined 302 COMB patients from the modified intention to treat (mITT) population enrolled in the AMBITION study (n=605). The mITT population includes PAH patients with risk factors related to heart failure with preserved ejection fraction (Ex-PAS) who were excluded from the primary analysis set (PAS). A responder (i.e. event-free subject) was defined as not having a clinical failure event. Univariate and multivariate analyses were performed to identify the factors associated with responders. Multivariate logistic regression analysis was used to determine independent risk for each factor that showed a significant difference between cohorts by interactive backward selection. Odds ratio (OR), 95% confidence intervals (CIs) and p-values are presented. Results Univariate analysis showed that responders tended to be lower age, female, typical PAH (i.e. PAS), absence of coronary artery disease, non-use of oxygen therapy, and have better baseline parameters (i.e., lower NT-proBNP, longer 6-minute walk distance, low Borg index, high SaO2, WHO-FC II). A multivariate logistic regression analysis showed that female gender (OR=2.669, 95% CI: 1.291–5.518, P=0.0081), use of aldosterone antagonist diuretics (OR=2.535, 95% CI: 1.027–6.257, P=0.0436), lower log NT-proBNP (OR=0.704, 95% CI: 0.524–0.944, P=0.0190), and longer 6-minute walk distance (OR=1.006, 95% CI: 1.002–1.010, P=0.0039) were independent predictors of response to initial combination therapy. Conclusion These findings suggest that initial combination therapy with ambrisentan and tadalafil is beneficial, especially in less severe typical PAH patients. It also demonstrates that there is a potential contributing factor (i.e. use of aldosterone antagonist diuretics) which is not listed in the risk assessment table of the ESC/ERS guidelines. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AMBITION study was funded by GlaxoSmithKline (GSK; study number 112565; trial registration number: NCT01178073) and Gilead Sciences, Inc. This analysis was funded by both companies.

Evaluation of compliance of pulmonary hypertension patients to the treatment with inhaled iloprost (Ventavis): results of prospective, multicenter, non-interventional IVENT study

Evaluation of compliance of pulmonary hypertension patients to the treatment with inhaled iloprost (Ventavis): results of prospective, multicenter, non-interventional IVENT study

Effects of comprehensive pulmonary rehabilitation therapy on pulmonary functions and blood gas indexes of patients with severe pneumonia.

In this study we try to observe the effects of comprehensive pulmonary rehabilitation therapy on pulmonary functions and blood gas indexes of patients with severe pneumonia during mechanical ventilation. A total of 120 patients with severe pneumonia were selected and divided into the experimental group (n=60) and the control group (n=60) through a random number table. Conventional therapy for severe pneumonia was applied to patients in both groups, and the experimental group was additionally treated with comprehensive pulmonary rehabilitation therapy, including warming-up exercise before training, respiratory function exercise, respiratory muscle training, health education, psychological support and nutritional intervention. The pulmonary function indexes, blood gas indexes, Borg index scores and 6-min walk distance (6MWD) of the two groups of patients were evaluated before treatment and at 6 months after treatment, respectively. In the control group, there were statistically significant differences only in forced expiratory volume in 1 sec (FEV1), ratio of FEV1 to forced vital capacity (FEV1/FVC), partial pressure of O2 (PaO2), arterial partial pressure of carbon dioxide (PaCO2), Borg index and 6MWD after treatment compared with those before treatment (P<0.05); as for intra-group comparisons, there were no significant improvements in other indexes compared with those before treatment, and the differences were not statistically significant (P>0.05). In the experimental group, all the indexes after treatment were statistically different from those before treatment and those after treatment in the control group (P<0.05); with regard to comparisons of the indexes between the control group and the experimental group, the differences were significant (P<0.05). Comprehensive pulmonary rehabilitation therapy is conducive to improving the pulmonary functions and blood gas indexes of patients with severe pneumonia during mechanical ventilation.

Patient-Reported Dyspnea Correlates Poorly with Aerobic Exercise Capacity Measured During Cardiopulmonary Exercise Testing.

Patient-reported dyspnea plays a central role in assessing cardiopulmonary disease. There is little evidence, however, that dyspnea correlates with objective exercise capacity measurements. If the correlation is poor, dyspnea as a proxy for objective assessment may be misleading. To compare patient's perception of dyspnea with maximum oxygen uptake (MaxVO2) during cardiopulmonary exercise testing (CPET). Fifty patients undergoing CPET for dyspnea evaluation were studied prospectively. Dyspnea assessment was measured by a metabolic equivalent of task (METs) table, Mahler Dyspnea Index, Borg Index, number of blocks walked, and flights of stairs climbed before stopping due to dyspnea. These descriptors were compared to MaxVO2. MaxVO2 showed low correlation with METs table (r=0.388, p=0.005) and no correlation with Mahler Index (r=0.24, p=0.093), Borg Index (r=-0.017, p=0.905), number of blocks walked (r=0.266, p=0.077) or flights of stairs climbed (r=0.188, p=0.217). When adjusted for weight (maxVO2/kg), there was significant correlation between MaxVO2 and METs table (r=0.711, p<0.001), moderate correlation with blocks walked (r=0.614, p<0.001), and low correlation with Mahler Index (r=0.488 p=0.001), Borg Index (r=-0.333 p=0.036), and flights of stairs (r=0.457 p=0.004). Subgroup analysis showed worse correlation when patients with normal CPET were excluded (12/50 excluded). Patients with BMI<30 had no correlation between Max VO2 and the assessment methods, while patients with BMI>30 had moderate correlation between MaxVO2 and METs table (r=0.568, p=0.002). Patient-reported dyspnea correlates poorly with MaxVO2 and fails to predict exercise capacity. Reliance on reported dyspnea may result in suboptimal categorization of cardiopulmonary disease severity.

THE EFFICACY OF SILDENAFIL THERAPY IN PATIENTS WITH PULMONARY HYPERTENSION OF DIFFERENT ETIOLOGY: INFLUENCE ON THE CLINICAL, FUNCTIONAL, HEMODYNAMIC STATUS, STRUCTURE AND FUNCTION OF THE RIGHT AND LEFT HEART, RIGHT VENTRICULAR-ARTERIAL COUPLING

Aim: to study the efficacy of sildenafil therapy in pulmonary hypertension of different etiology, its influence on the clinical, functional, hemodynamic status, structure and function of the right and left heart, right ventricular-arterial coupling (RVAC) in pts with idiopathic pulmonary hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH).Materials and methods: in the study we included 29 IPAH pts aged 42.8±10.6 yrs, 28 CTEPH pts aged 43.4±10.4 yrs II-IV functional class (FC) (WHO), receiving stable standard therapy (anticoagulants, diuretics, glycosides) and calcium channel blockers for at least 3 months. Sildenafil was started at the dose of 10 mg TID to assess the tolerability for further titration after 1 wk to 20 mg 3 times a day. The treatment duration was 16 wks. At baseline and at wk 16 FC (WHO), 6-minute walking test (6-MWT), transthoracic echocardiography (Echo) and right heart catheterization (RHC) were performed.Results: both groups were comparable in baseline functional parameters: FC, the distance in 6-MWT, Borg index. The analysis of baseline structural and functional cardiac parameters by Echo in IPAH and CTEPH pts revealed pronounced cardiac remodeling as compared to the control group. All pts had criteria precapillary PH by RHC with comparable systolic pulmonary artery pressure (SPAP), mean pulmonary artery pressure (PAPm), cardiac output (CO) and index (CI), pulmonary vascular resistance (PVR) except for diastolic PAP (DPAP), which was higher in IPAH group (38.3±13.7 mm Hg vs 31.5±8.9 mm Hg in CTEPH group (p&lt;0.05). Sildenafil therapy resulted in the marked improvement of functional and hemodynamic status, cardiac remodeling parameters in both groups. To wk 16 IPAH pts achieved the 114m increase in 6-MWT as compared with 108m in CTEPH group. IPAH pts demonstrated the significant decrease in SPAP, PAPm, reduce of right ventricular (RV) size and improvement of contractile function - FAC and TAPSE, increase of RVAC by reducing LV stiffness. Eccentricity index of LV improved significantly only in CTEPH pts. Positive dynamic in RHC data (significant decrease of SPAP, PAPm, DPAP, PVR, increase of CO,CI, stroke volume). CTEPH pts showed a greater reduction in PVR, SPAP and significant SvO2 improvement.Conclusion: 1. In pts with IPAH and CTEPH of comparable baseline clinical, functional and hemodynamic status we found no significant differences in the severity of cardiac remodeling, RV and LV systolic and diastolic function. Regardless of etiology RVAC was reduced due to the significant increase of LV stiffnessEs. 2. 16-wk sildenafil therapy in pts with IPAH and CTEPH resulted in the positive dynamic of 6-MWT distance, dyspnea index, Echo data including LV stiffness. 3. In CTEPH group as compared with IPAH pts we found the more marked reduction in PVR, PASP and significant improvement SvO2 by RHC. The significant decrease in Es was observed only in CTEPH pts.

Effect of Structured Physical Activity on Respiratory Outcomes in Sedentary Elderly Adults with Mobility Limitations.

To evaluate the effect of structured physical activity on respiratory outcomes in community-dwelling elderly adults with mobility limitations. Multicenter, randomized trial of physical activity vs health education, with respiratory variables prespecified as tertiary outcomes over an intervention period of 24-42months. Physical activity included walking (goal of 150min/week) and strength, flexibility, and balance training. Health education included workshops on topics relevant to older adults and upper extremity stretching exercises. Lifestyle Interventions and Independence in Elders (LIFE) Study. Community-dwelling persons aged 70-89 with Short Physical Performance Battery scores less than 10 (N=1,635). Dyspnea severity (defined as moderate to severe according to a Borg index >2 immediately after a 400-m walk), forced expiratory volume in 1second (FEV1) (<lower limit of normal (LLN) defined low breathing capacity), and maximal inspiratory pressure (MIP) (<LLN defined respiratory muscle weakness) were assessed at baseline and 6, 18, and 30months. Hospitalization for exacerbation of obstructive airways disease (EOAD) and pneumonia was also ascertained over the 42-month follow-up period. The randomized groups were similar in baseline demographics, including mean age (79) and sex (67% female). The effect of physical activity on dyspnea severity, FEV1, and MIP was no different from that of health education but was associated with higher likelihood of respiratory hospitalization, significantly for EOAD (hazard ratio (HR)=2.34, 95% confidence interval (CI)=1.19-4.61, P=.01) and marginally for pneumonia (HR=1.54, 95% CI=0.98-2.42, P=.06). In older persons with mobility limitations, physical activity was associated with higher likelihood of respiratory hospitalization than health education, but differences in dyspnea severity, FEV1, and MIP did not accompany this effect-indicating that higher hospital use could be attributable to greater participant contact.

Легочная артериальная гипертензия, ассоциированная с системной склеродермией, и идиопатическая легочная гипертензия: сравнительный анализ клинико- демографических особенностей и выживаемости по данным Российского национального регистра

Pulmonary arterial hypertension associated with systemic sclerosis (SSc-PAH) and idiopathic pulmonary arterial hypertension (IPAH) belong to group I in the clinical classification of PH, but there is evidence for significant differences in their survival due to current therapy. Objective: the objective of this report is to compare pts with (SSc-PAH) and (IPAH) based on data of Russian National Registry. Patients and methods: in the study we included 52 pts with IPAH and 50 with SSc-PAH. There were no differences in functional class (FC). Diagnosis was based on RHC. Results. At the moment of diagnosis average age of patients with SSc-PAH was 15 year higher (p<0.0001). 6MWD was somewhat more in IPAH group. Borg index was higher in SSc-APAH (4.2±2.1 vs 3.3±1.5); p<0.049. The degree of heart failure (HF) and respiratory failure (RF) did not differ. Dyspnea was the most common among the first symptoms (94% in SSc-PAH and 73% in IPAH). Syncope were observed only in IPAH. In both the diagnosis was verified quite late (in SSc-PAH group in 33 (13; 56.5mts), IPAH - in 30.5 (13.3; 76.3mts). Signs of HF were detected in both groups with equal frequency (76% and 65% respectively). Advanced stage of PAH including symptoms of HF were detected with equal frequency. Only ECHO revealed pericardial effusion more frequently in pts with SSc-PAH (56% vs 35%, p<0.05). Also they had more frequently weight lost (14% vs 2%, p<0.05). Hemodynamics estimation revealed significant haemodynamic differences: sRVP (73.4±19.1 mm Hg) and mPAP (49.1±11.5 mm Hg) in SSc-PAH were significantly lower, than in IPAH (85.9±25.6 mm Hg and 57.5±15.3 mm Hg). dRVP and mRVP were significantly higher in SSc (7.02±5.59 and 28.5±12.7 mm Hg), compared to 0.95±7.6 and 11.7±6.0 mm Hg respectively. Whereas CO values were equal, the average PVR was higher in IPAH (13.2 vs 10.6 WU, р<0.005). RAP levels were equal at both groups. FVC was within normal limits in groups, but DLCO was lower in SSc-PAH group (46.9±13.5% vs 68.5±12.8%). Hb in SSc-APAH group was significantly lower (136±22 g/l vs 149±19 g/l), erythrocyte count was almost same is both groups (4.9±0.6 and 5.1±0.7×1012/l). C-reactive protein in patients with SSc-PAH was higher (9.4±15.1 vs 1.1±1.0 mg/l); p<0.001. Significant decrease in survival during the second and third years of observation was revealed in SSc-PAH group. Difference in 5 years survival between the two groups was 15%, difference was close to statistically significant (p=0.06). Conclusion: although general clinical appearance of patients with SSc-APAH and IPAH looks similar, there are significant differences in hemodynamic indexes and laboratory signs between the two groups. This factor leads to difference in progress and outcome of the disease.

INNOVATION IN PHARMACEUTICAL TREATMENT OF PULMONARY ARTERIAL HYPERTENSION: STIMULATOR OF SOLUBLE GYANYLATE CYCLASE - RIOCIGUAT

Pulmonary arterial hypertension (PAH) is a rare disease, diagnosed at a late stage with low functional class III or IV (WHO). PAH leads to severe right heart failure and ultimately, death. The modern researches aim at exploring the potential therapeutic targets, as at developing new drugs that can affect the previously set target. Impaired NO production plays an important role in PAH pathogenesis; this is determined by the powerful vasodilatory action, as well as anti-inflammatory, anti-proliferative, and antiaggregatory effects. Riociguat is the first in a new class of soluble guanylatecyclase stimulators to have proved efficacy in phase II of clinical trials. In the randomized, double-blind, placebo-controlled phase III study PATENT-1 (Pulmonary Arterial Hypertension soluble Guanilatcyclase-Stimulator Trial) study, 443 patients with PAH symptoms were randomized to receive placebo of riociguat in a single dose of 2,5 mg (with a dose titration based on tolerability to 2,5 mg TID a day) or a dose of 1,5 mg (with a dose titration according to portability to 1,5 mg TID three times a day). The study included naïve patients treated with endothelin receptor antagonists or prostanoids (except for parenteral ones). To 12wk of riociguat treatment the mean distance in 6-MWT increased by an average of 30 m in the group treated with the maximum single dose of 2,5 mg TID, or decreased by an average of 6m in the placebo group (difference between groups, 36 m, 95% confidence interval 20-52 m, p p<0,001). Riociguat improved 6-MWT in patients not previously treated with PAH-specific therapy (38 m), and in patients, taking endothelin receptor antagonists or prostanoids (36 m). In riociguat groups compared with placebo a decrease in PVR and PAPm (p<0,01) was noted, as well as an increase in cardiac index (p<0,0001) , a reduction in NT-proBNP (p<0,0001) , FC (p=0,003) and in the Borg index (p=0,002), ), the time of development of clinical deterioration (p=0,005) prolonged as well. Riociguat therapy was also characterized by good tolerance. Efficacy of treatment was maintained during long-term observation of PATENT-2study. The mean value of 6-MWT changed to 51±74 м

Effect of short-term rehabilitation and long-term rehabilitation on the quality of life in patients with chronic obstructive pulmonary disease

Objective To explore the effect of short-term rehabilitation and long-term rehabilitation on the quality of life in patients with chronic obstructive pulmonary disease. Methods The patients with stable COPD were divided into two groups.In control group, the patients only received short-tern pulmonary rehabilitation training (for about 8-12 weeks). While the patients in observation group, after having received training, they were assessed again.They were asked to receive long-term pulmonary rehabilitation train according to long-term pulmonary rehabilitation plan.The indexes of the patients in observation group were significantly better than those in control group, such an the percentage of FEV1 before training, 3 months, 6 months and 12 months, 6MWT, Borg index, SGRQ score, the yearly changes in acute exacerbation. Results After short-term pulmonary rehabilitation, the percentage of the FEV1 rose; 6MWT rose; the index of SGRQ score and Borg both decreased.The 6MWT, SGRQ score, Borg index and the yearly times in acute exacerbation of the patients in observation group were better than those in control group. Conclusions The pulmonary rehabilitation therapy can improve the exercise capacity, breathing difficulty and quality of life of the COPD patients.The effect of long-term rehabilitation is better than that of short-term rehabilitation therapy. Key words: Pulmonary disease; Chronic obstructive; Quality of life; Short-term rehabilitation therapy; Long-term rehabilitation therapy

Impact of Adaptive Servo-Ventilation Support on Physical Exercise in a Patient with Refractory Heart Failure

A 42-year-old female with stage D heart failure (HF) due to dilated phase hypertrophic cardiomyopathy had been hospitalized repeatedly despite optimal medical therapy including cardiac resynchronization therapy. During outpatient cardiac rehabilitation, she could only tolerate very low intensity exercise prescription, leading to heavy deconditioning of skeletal muscle. Although she had felt fatigue and shortness of breath even a few minutes of conventional ergometer exercise, she could complete equivalent exercise for more than 30 minutes when adaptive servo ventilator (ASV) was supported for her breathing during exercise. The arterial oxygen saturation and Borg index for leg fatigue at maximum exercise were improved more with the simultaneous ASV use than those without (100% vs. 98%, 14 vs. 17, respectively). Portable electronic pupillometer showed that T5 was increased from -632 to 554 (msec) by using ASV, indicating lower sympathetic activity during exercise. ASV during physical exercise may be a useful tool to improve functional capacity without increasing risk in severely-impaired HF patients.

FEATURES OF PULMONARY ARTERIAL HYPERTENSION IN THE RUSSIAN REGISTER

The aim of the multicenter prospective open study: to assess demographic and clinical characteristics of PAH patients, regions of their accommodation, features of diagnostic and medical strategy, and survival. Materials and methods. In the study we included PAH patients (group 1) aged >18 years observed in 10 expert centers of the Russian Federation from 01.01.2012 to 30.04.2014. Patients' data were brought in the electronic forms on the registry site www.pul-hyp.medibase.ru. Results. 198 patients (160 women/38 men) from 44 regions of the country were included in the study: 55.0% - IPAH, 35.9% - PAH associated with congenital heart disease, 7,6% - PAH associated with connective tissue disease, 1.0% - heritable PAH, 0.5% - PAH associated with portal hypertension. At the time of including in the register the patients' age median was 38.1 (28.753.8) years, the disease duration median was 5.9 (2.3-13.7) years. The 6MW distance was 394.84 ± 111.10 meters, dyspnea Borg index - 3.34 ± 1.41 points. 9.2% had FC I, 43.7% of FC II, 36.2% of FC III, 10.9% of FC IV. According to RHC mean PAP was 55 (43.25-64.0) mm Hg, CV 3.5 (2.9-4.33) l/min, CI 2.0 (1.82.3) l/min/m 2 , PVR 1079 (762-1424.8) dinхс/см 5 . Positive acute vasodilator testing was found in 25% of patients. The spectrum of the most frequent associated diseases included gastrointestinal diseases (27%), arterial hypertension (14%), urolithiasis (9%) were. PAH-specific therapy was prescribed to 68% of patients (sildenafil - 75.4%, bosentan - 40.4%, iloprost - 9.5%). 9.6% of patients were observed in clinical trials. PAH monotherapy was prescribed to 66.7% of pts, the combined two-component therapy was recommended to 31.7% of pts, triple therapy- to 1.6% of pts. 51% of pts were treated with calcium channel blockers, 59% - diuretics, 82% - antitrombotic drugs. In PAH group the 1-y survival was 98%, the 2-y survival - 96%. Conclusion. Harmoniously built system network of expert centers will allow to improve early diagnostic of PAH, providing proper observation and lowering mortality rate.

Combined Reduced Forced Expiratory Volume in 1 Second (FEV1) and Peripheral Artery Disease in Sedentary Elders With Functional Limitations

ObjectivesBecause they are potentially modifiable and may coexist, we evaluated the combined occurrence of a reduced forced expiratory volume in 1 second (FEV1) and peripheral artery disease (PAD), including its association with exertional symptoms, physical inactivity, and impaired mobility, in sedentary elders with functional limitations. DesignCross sectional. SettingLifestyle Interventions and Independence in Elder (LIFE) Study. ParticipantsA total of 1307 sedentary community-dwelling persons, mean age 78.9, with functional limitations (Short Physical Performance Battery [SPPB] <10). MeasurementsA reduced FEV1 was defined by a z-score less than −1.64 (<lower limit of normal), whereas PAD was defined by an ankle-brachial index less than 1.00. Exertional dyspnea was defined as moderate to severe (modified Borg index) immediately after a 400-meter walk test (400MWT). Exertional leg symptoms were established by the San Diego Claudication Questionnaire. Physical inactivity was evaluated by percent of accelerometry wear-time with activity less than 100 counts per minute (top quartile established high sedentary time). Mobility was evaluated by the 400MWT (gait speed <0.8 m/s defined as slow) and SPPB (≤7 defined moderate-to-severe mobility impairment). ResultsA combined reduced FEV1 and PAD was established in 6.0% (78/1307) of participants. However, among those who had a reduced FEV1, 34.2% (78/228) also had PAD, whereas 20.8% (78/375) of those who had PAD also had a reduced FEV1. The 2 combined conditions were associated with exertional dyspnea (adjusted odds ratio [adjOR] 2.59 [1.20–5.60]) and slow gait speed (adjOR 3.15 [1.72–5.75]) but not with exertional leg symptoms, high sedentary time, and moderate-to-severe mobility impairment. ConclusionsIn sedentary community-dwelling elders with functional limitations, a reduced FEV1 and PAD frequently coexisted and, in combination, were strongly associated with exertional dyspnea and slow gait speed (a frailty indicator that increases the risk of deleterious outcomes).

Respiratory Impairment and Dyspnea and Their Associations with Physical Inactivity and Mobility in Sedentary Community‐Dwelling Older Persons

To evaluate the prevalence of respiratory impairment and dyspnea and their associations with objectively measured physical inactivity and performance-based mobility in sedentary older persons. Cross-sectional. Lifestyle Interventions and Independence for Elders Study. Community-dwelling older persons (n = 1,635, mean age 78.9) who reported being sedentary (<20 min/wk of regular physical activity and <125 min/wk of moderate physical activity in past month). Respiratory impairment was defined as low ventilatory capacity (forced expiratory volume in 1 second less than lower limit of normal (LLN)) and respiratory muscle weakness (maximal inspiratory pressure <LLN). Dyspnea was defined as moderate to severe ratings on the modified Borg index, immediately after a 400-m walk test (400-MWT). Physical inactivity was defined according to high sedentary time as the highest quartile of participants with accelerometry-measured activity of <100 counts/min. Performance-based mobility was evaluated using the Short Physical Performance Battery (≤ 7 defined as moderate to severe mobility impairment) and 400-MWT gait speed (<0.8 m/s defined as slow). Prevalence rates were 17.7% for low ventilatory capacity, 14.7% for respiratory muscle weakness, 31.6% for dyspnea, 44.7% for moderate to severe mobility impairment and 43.6% for slow gait speed. Significant associations were found between low ventilatory capacity and slow gait speed (adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) = 1.03-1.92), between respiratory muscle weakness and moderate to severe mobility impairment (aOR = 1.42, 95% CI = 1.03-1.95), and between dyspnea and high sedentary time (aOR = 1.98, 95% CI = 1.28-3.06) and slow gait speed (aOR = 1.70, 95% CI = 1.22-2.38). Respiratory impairment and dyspnea are prevalent in sedentary older persons and are associated with objectively measured physical inactivity and poor performance-based mobility. Because they are modifiable, respiratory impairment and dyspnea should be considered in the evaluation of sedentary older persons.

Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: The Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) Trial

AimsThe role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high- versus low-dose furosemide with or without low-dose dopamine infusion in this patient population. Methods and results161 ADHF patients (78years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n=50, 20mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n=56, 5mg/h and 5μgkg−1min−1 respectively), or c) low-dose furosemide (LDF, n=55, furosemide 5mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr)≥0.3mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P=0.74) or at one year (38.1%, 33.9% and 32.7%, P=0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P=0.55) or one year (60.0%, 50.0%, and 47%, P=0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P<0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P=0.27). No significant differences in adverse events were noted. ConclusionsIn ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high- vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.

Riociguatas the first innovative guanylatecyclase stimulators class drugs for pulmonary arterial hypertension patients treatment

Pulmonary arterial hypertension (PAH) drug therapy including prostanoids, endothelin receptor antagonists, type 5 phosphodiesterase inhibitors, can improve the possibilities for treatment and control of this progressive and irreversible disease. The modern research vector aims at exploring the potential therapeutic targets, as at developing new drugs that can affect the previously set target. NO synthase production disturbance plays an important role in PAH pathogenesis; this is determined by the powerful vasodylative action, as well as by anti-inflammatory, anti-proliferative, and antiaggregatory effects. Riociguat is the first in a new class of soluble guanylatecyclase stimulators to have proved effective in phase II of clinical trials. In a randomized, double-blind, placebo-controlled phase III of PATENT-1 (Pulmonary Arterial Hypertension soluble Guanilatcyclase-Stimulator Trial) study, 443 patients with PAH symptoms were randomized to receive placebo of riociguat in a single dose of 2,5 mg (with a dose titration based on tolerability to 2,5 mg three times a day) or a dose of 1,5 mg (with a dose titration according to portability to 1,5 mg three times a day). The study included patients not previously treated with PAH-specific therapy or those who have already taken endothelin receptor antagonists or prostanoids (except for parenteral ones). The primary endpoint of the PATENT-1 study was the distance dynamics in the 6-minute walk test (D6MH) to 12th treatment week. Secondary endpoints were: the dynamics of pulmonary vascular resistance (PVR), the level of NT-proBNP, functional class (FC) (WHO), the change in the time to developing of clinical deterioration, dyspnea (Borg index), indicators of quality of life and safety. By the 12th riociguat treatment week D6MH hasincreased by an average of 30 m in the group treated with the maximum single dose of 2,5 mg, or has decreased by an average of 6m in the placebo group (difference between groups, 36 m, 95% confidence interval 20–52 m, p

Influences of depression on exercise capacity of patients with chronic obstructive pulmonary disease in 6-minute walk test

Objective To investigate the influences of depression on exercise capacity of patients with chronic obstructive pulmonary disease (COPD) in 6-minute walk test (6MWT). Methods One hundred and twenty COPD patients, whose acute exacerbation was controlled, were enrolled in the study from September 2009 to April 2011. According to Hamilton depression scale (HAMD) scores, 48 patients with HAMD scores<7 were classified as non-depression group (control), 60 patients with HAMD scores≥17 were classified as depression group, patients with 7≤HAMD scores<17 were classified as uncertain depression and not included in the experiment. Six-minute walk testing was performed in patients. Blood pressure, heart rates, respiratory rates, Borg scores were measured before and after 6MWT; body mass index and lung function were also measured in all patients. Results The distances of walk in the depression group and control group were (259±91) and (312±71) meters, respectively (P<0.05). Heart rates, systolic blood pressure, respiratory rates and Borg index in depression group after testing were(108±11)/min, (148.7±15.4) mm Hg(1 mm Hg=0.133 kPa), (23.3±3.9) /min and (4.65±1.67), respectively; those for control group were (95±9) /min, (141.8±8.9) mm Hg, (20.2±3.7) /min and (2.59±1.52), respectively. There were significant differences between two groups (all P<0.05). Conclusions Depression may affect the exercise capacity of COPD patients, the psychological status of the patients should be under consideration when conventional treatment is taken. Key words: Pulmonary disease, chronic obstructive; Depression; Walking

INHALED NITRIC OXIDE: CLINICAL EFFECTS AND INFLUENCE ON THE PROFILE OF INFLAMMATORY MARKERS IN PATIENTS WITH IDIOPATHIC PULMONARY HYPERTENSION

Aim. To study the effect of treatment with inhaled nitric oxide (iNO) on the clinical status of patients with idiopathic pulmonary hypertension (IPH), and the profile of proinflammatory cytokines in peripheral blood. Material and methods. Patients with IPH (n=48) were included into the study. Evaluation of the IPH functional class (FC), the 6-minute walk test (6MWT) with the assessment of the Borg index, echocardiography , laboratory tests [blood count, evaluation of high-sensitivity C-reactive protein (hsCRP), interleukins (IL), interferon-γ (INFγ), tumor necrosis factor a (TNFa), macrophage inflammatory protein a (MIP1 a), soluble adhesion molecules (sICAM-1, sVCAM-1) in peripheral blood] were performed at baseline and on day 21 of iNO therapy course. The iNO course 40 ppm during 5 hours a day for 21 days was carried out additionally to the standard IPH therapy under the toxicity control by the PrinterNOx (England). Results. Increase in exercise tolerance, improvement of IPH FC (from 3.35±0.52 to 2.71±0.56; p=0.008), reduction in systolic pulmonary artery pressure (SPAP) by Doppler echocardiography (from 96.23±23.65 to 82.36±20.92 mmHg; p&lt;0.05) were found in IPH patients as a result of iNo therapy. The significance of inflammation in IPH pathogenesis was confirmed due to assessment of the initial levels of proinflammatory cytokines. iNO therapy resulted in significant decrease in proinflammatory cytokines-IL-1β, IL-6, IL-8, TNFa levels. iNO induced significant dynamics of IL-1β and sVCAM in patients with IPH FC II. It reduced IL-8 and TNFa and increase INFγ (p&lt;0.05) in patients with IPH FC III-IV. Changes in IL-1β and sVCAM levels (ΔIL-1β and ΔsVCAM) by the 21 day of iNO therapy in comparison with these at baseline correlated with ΔSPAP , and ΔIL-6 correlated with ΔFC and Δ6MWT distance (30.5 [21.0; 53.0] m; p&lt;0.001). This allows considering these indicators as markers of iNO treatment efficacy. Conclusions. 21-day iNO therapy in IPH patients resulted in significant improvement of functional status, reduce SPAP and caused the positive dynamics of proinflammatory cytokines blood levels.