Duke Activity Status Index Scores Research Articles

Aortic pulse wave analysis and functional capacity of heart transplantation candidates: a pilot study

We compared cardiovascular parameters obtained with the Mobil-O-Graph and functional capacity assessed by the Duke Activity Status Index (DASI) before and after Heart Transplantation (HT) and also compared the cardiovascular parameters and the functional capacity of candidates for HT with a control group. Peripheral and central vascular pressures increased after surgery. Similar results were observed in cardiac output and pulse wave velocity. The significant increase in left ventricular ejection fraction (LVEF) postoperatively was not followed by an increase in the functional capacity. 24 candidates for HT and 24 controls were also compared. Functional capacity was significantly lower in the HT candidates compared to controls. Stroke volume, systolic, diastolic, and pulse pressure measured peripherally and centrally were lower in the HT candidates when compared to controls. Despite the significant increase in peripheral and central blood pressures after surgery, the patients were normotensive. The 143.85% increase in LVEF in the postoperative period was not able to positively affect functional capacity. Furthermore, the lower values of LVEF, systolic volume, central and peripheral arterial pressures in the candidates for HT are consistent with the characteristics signs of advanced heart failure, negatively impacting functional capacity, as observed by the lower DASI score.

Relationship between New York functional class and duke activity status index with the severity of mitral valve stenosis and echocardiographic parameters: is left atrial strain a better predictor?

Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm2. All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r=-0.73) and MVA (r=-0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r=-0.62), LAV (r=-0.65), LAVI (r=-0.56), E (r=-0.46), A (r=-0.3), and PAP (r= -0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients.

Enhanced External Counterpulsation Outcomes Study: Retrospective Analyses of Data Obtained from Patients at a Single Medical Center in United States

AbstractThe aim was to explore the effectiveness of enhanced external counterpulsation (EECP) therapy in patients with severe angina pectoris/ chronic heart failure symptoms, who were not suitable candidates for invasive treatment. This retrospective study employed a comprehensive methodology that includes individualized treatment, continuous monitoring, and thorough pre- and postprogram evaluations to assess the efficacy of EECP therapy. The standard protocol involved 35 one-hour treatments, with flexibility for extensions based on therapeutic progress. When pre- and posttreatment results were analyzed, EECP improved the original functional class compared with pretreatment. The mean difference in the functional class was 1.32 (0.92), p < 0.0001. Six-minute walk (6MW) distance improved from 383.6 m (110.24) to 423.1 m (121.50) with mean difference of 37.1 (44.99), p < 0.0001. Duke Activity Status Index (DASI) score improved from 3.9 (2.75) to 6.0 (4.17) with mean difference of 2.16 (3.8), p < 0.0001. Training metabolic equivalents (METs) improved from 3.0 (0.74) to 4.0 (1.57) with mean difference of 1.04 (1.2), p < 0.0001. Weekly anginal events decreased from 13.1 (13.19) to 3.2 (7.38) with mean difference of –9.78 (11.7), p < 0.0001. EECP resulted in improvement of angina pectoris functional class, the 6MW distance, reduction in the number of hospitalizations in first year posttreatment, a significant decrease in sublingual nitroglycerin use, improvement of systolic and diastolic blood pressure, and improvement of DASI score.

Abstract 18268: Angina and Functional Capacity Among Women Presenting With Angina and Non-Obstructive Coronary Disease

Introduction: Approximately 75% of women that undergo coronary angiography for angina do not have obstructive disease. However, a significant number have persistent angina, which can reduce their functional capacity and performance, impacting patients’ quality of life. There is a need for further studies that accurately compare angina and functional capacity among women angina with non-obstructive coronary disease (ANOCA). Objective: We examined the association between perceived anginal symptoms and functional capacity in patients with ANOCA Methods: A the Women’s Heart Center at the Christ Hospital, all women completed the Duke Activity Status Index (DASI) and Seattle Angina Questionnaire-7 (SAQ7) at the initial visit. DASI score range from 0 to 58.2 and assess functional capacity using self-assessment and VO2 peak formula with higher scores indicating better functional capacity. SAQ7 assesses angina symptoms, physical limitation, and quality of life; the score is from 0-100, where a lower score indicates a higher frequency of angina, increased physical limitation, and poor quality of life. DASI and SAQ7 scores were correlated. Sperman correlation and Mcnemar chi-square were used to compare DASI and SAQ7 score results. Results: Among 225 women with ANOCA, the mean DASI score was 16.73, and the mean SAQ7 score was 43.79. 63.1% reported a low score of SAQ7, and 79.6% reported a low DASI score. SAQ7 and DASI were moderately correlated (Spearman correlation of +0.42). Further analysis with McNemar chi- square showed that women with lower SAQ7 (score 0-49.4) tends to corresponds with low DASI (score 0-24.5) (Specificity 86.6%), compared to women with higher SAQ7 (score 49.5-100) and high DASI (score 24.6-58.2) (Sensitivity 32.5%) (p<0.001). Discussion: Anginal symptoms are correlated with reduced functional capacity among women with ANOCA. Further prospective studies are needed to evaluate the correlation between angina improvement and functional capacity.

Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age?

BackgroundClinical outcomes and quality of life (QoL) indices are not well described after transcatheter aortic valve replacement (TAVR) in patients aged ≥ 90 years. MethodsWe conducted a retrospective cohort study of TAVR among nonagenarian patients between 2008 and 2020. The survival of TAVR patients among nonagenarians was compared to the provincial estimated survival for an age- and sex-matched general population. QoL was assessed up to 1 year postintervention, using standardized questionnaires. ResultsDuring the study period, n = 268 patients aged ≥ 90 years were evaluated for severe aortic stenosis. TAVR was performed in n = 171 (48% female; median [IQR] Rockwood Clinical Frailty Scale score: 4 [3-4]); n = 84 underwent medical therapy; and n = 13 underwent surgical aortic valve replacement. Survival was significantly better following TAVR, compared to that after MT (adjusted hazard ratio [95% CI]: 1.99 [1.37-2.88], P < 0.001). TAVR patients demonstrated a survival advantage compared with the general population, with an estimated relative mortality of 0.86 (0.75-0.87). TAVR patients showed sustained improvements in functional status and QoL up to 1 year compared to baseline (all P < 0.05): the 6-minute walk test results improved from 192 to 252 m; the Kansas City Cardiomyopathy Questionnaire score improved from 64 to 81; the Duke Activity Status Index score improved from 13 to 16; and the health state scale result of the Euro Quality of life - 5 Dimensions improved from 63% to 74%. ConclusionsNonagenarians undergoing TAVR experience a slightly better survival rate, compared to that of an age- and sex-matched general population, and they have significant improvements in functional status and several QoL indices following the procedure.

Functional capacity and quality of life in advanced heart failure patients assessment

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) is characterized by functional limitation and consequent loss of quality of life. These parameters can be measured through self-evaluated instruments, namely Duke activity status index (DASI) and Minnesota living with heart failure questionnaire (MLHFQ). In parallel, HF is also characterized by objective parameters measured by complementary diagnostic tests, namely NT-proBNP and left ventricular ejection fraction by echocardiogram. Patients with higher NT-proBNP value and worse ejection fraction may present with more symptoms and consequently functional impairment and worse quality of life. Aim To analyze if self-reported parameters present significant correlation with objective measured parameters and to understand if there are differences between gender in out-patients followed in advanced heart failure assessment. Methods During the year of 2022, a cohort of out-patients was analyzed. Data was collected regarding DASI, MLHFQ and disease stratification based on NT-proBNP and left ventricular ejection fraction by echocardiogram. Pearson's correlation was made between these parameters, trying to understand whether they were related to them and whether this relationship is in line with the patient's clinical presentation. An independent sample T-test was performed in order to understand any differences regarding the gender. Results A sample of 122 patients were evaluated; 97 (80%) were male, with a mean age of 63 years. New York Heart association functional class was between II and III and all patients had reduced left ventricular ejection fraction, with an average of 35% (min: 10% and max: 48%). NT-proBNP scores are quite high, presenting an average score of 1349.7±1482.5. Average score of MLHFQ was 13±15, meaning that patients present a good quality of life and DASI average score was 33.9±16.1, meaning a very acceptable functional capacity level. The DASI score correlates negatively with MLHFQ (r = -0.566, p = 0.003) and with NT-proBNP value (r = -0.783, p = 0.000); MLHFQ score is positively correlated with NT-proBNP value (r = 0.018, p = 0.000). A high DASI score corresponds to good functional capacity and, as such, better quality of life and lower physiological impact of the disease. Surprisingly, despite the lower MLHFQ and high DASI, patients present a quite increase level of NT-proBNP. There were no gender differences in relation to the DASI score (p = 0.077) and MLHFQ (p = 0.422). Conclusion The self-evaluated parameters correlate with the physiological parameters objectively measured. The perception of patients regarding their quality of life and functional capacity may not allow to infer about their physiological parameters, since a high NT-proBNP a low left ventricular ejection fraction normally indicates a worse functional level, which is not observed in this cohort of patients. Gender seems to have no impact on the level of quality of life or self-reported functional capacity.

Prognostic Value of Self-Reported Subjective Exercise Capacity in Patients With Acute Dyspnea

BackgroundSelf-reported exercise capacity is a well-established prognostic measure in stable ambulatory patients with cardiac and pulmonary disease. ObjectivesThe authors aimed to directly compare the prognostic accuracy of quantified self-reported exercise capacity using the Duke Activity Status Index (DASI) with the established objective disease-severity marker B-type natriuretic peptide (BNP) in patients presenting with acute dyspnea to the emergency department. MethodsThe DASI was obtained in a prospective multicenter diagnostic study recruiting unselected patients presenting with acute dyspnea to the emergency department. The prognostic accuracy of DASI and BNP for 90-day and 720-day all-cause mortality was evaluated using C-index. ResultsAmong 1,019 patients eligible for this analysis, 75 (7%) and 297 (29%) patients died within 90 and 720 days after presentation, respectively. Unadjusted hazard ratios (HRs) and multivariable adjusted hazard ratios (aHRs) for 90- and 720-day mortality increased continuously from the fourth (best self-reported exercise capacity) to the first DASI quartile (worst self-reported exercise capacity). For 720-day mortality the HR of the first quartile vs the fourth was 9.1 (95% CI, 5.5-14.9) vs (aHR: 6.1, 95% CI: 3.7-10.1), of the second quartile 6.4 (95% CI: 3.9-10.6) vs (aHR: 4.4, 95% CI: 2.6-7.3), while of the third quartile the HR was 3.2 (95% CI: 1.9-5.5) vs (aHR: 2.4, 95% CI: 1.4-4.0). The prognostic accuracy of the DASI score was high, and higher than that of BNP concentrations (720-day mortality C-index: 0.67 vs 0.62; P = 0.024). ConclusionsQuantification of self-reported subjective exercise capacity using the DASI provides high prognostic accuracy and may aid physicians in risk stratification. (Basics in Acute Shortness of Breath EvaLuation [BASEL V] Study [BASEL V]; NCT01831115)

The Effect of a Comprehensive Rehabilitation Program on Respiratory Function and Functional Capacity on Patients After 1 Month to Liver Transplantation

Physical exercise is prescribed in populations with chronic diseases, but data are scarce in the liver transplantation (LT) setting. The aim of this study was to evaluate changes in forced expiratory volume in the first second, forced vital capacity, maximal inspiratory pressure, maximal expiratory pressure, 6-minute walking test (6MWT), 6-minute step test (6MST), Duke Activity Status Index, VO2 (mL/kg/min), and health-related quality of life (in patients submitted to a rehabilitation program, comprising physical exercise training, breathing techniques, and educational sessions after LT. This cohort study enrolled patients to an 8-week period of thrice weekly comprehensive supervised rehabilitation program after 1 month of LT. A nonrandomized control cohort of LT patients were selected to match the rehabilitation group based on specific demographic data and severity of disease. The rehabilitation group, compared with the control group, showed a significant improvement in respiratory parameters (forced vital capacity [0.33L vs 0.13L,P < .01]); exercise capacity (6MWT and 6MST 71.1 vs 34.1 meters; and 30.5 vs 7.5 steps; respectively P < .01); Duke Activity Status Index scores and VO2 (21.3 vs 10.2 and 9 vs 4.3; respectively P < .01); respiratory muscle strength (maximal inspiratory pressure 21.1 vs 15.1 cmH2O and maximal expiratory pressure 21.2 vs 10.2 cmH2O; P < .01); and quality of life (SF-36 physical component summary 12.4 vs 2.9 P < .01). These data suggest that improvements in physical fitness, respiratory parameters, and quality of life are achieved with a comprehensive rehabilitation program initiated early after LT.

Abstract 12692: Central Sensitization in Women With Ischemia and No Obstructive Coronary Artery Disease: A Pilot Study

Introduction: Myocardial ischemia with no obstructive coronary arteries (INOCA) is more common in women and associated with adverse cardiovascular outcomes. INOCA patients have recurrent chest pain and reduced quality of life, and therapeutic strategies are poorly defined. Central nervous system factors can promote and maintain spontaneous clinical pain. We explored central sensitization in INOCA. Methods: Twenty-nine women diagnosed with INOCA based on coronary angiography were enrolled. Baseline demographics, risk factors, and angina burden by the Seattle Angina Questionnaire (SAQ) was assessed. Generalized pain hypersensitivity was assessed using the validated Central Sensitization Inventory (CSI), with scores ≥40 indicating the presence of central sensitization. Functional capacity was determined by Duke Activity Status Index (DASI). A DASI score ≤34 is prognostic of major adverse cardiac events. Depressive symptoms were assessed using the Beck Depression Inventory. Descriptive statistics and Pearson correlations were performed; p-value ≤.05 was considered significant. Results: Mean age was 55.4±10 years and body mass index (BMI) was 30.1±7 kg/m 2 . Cardiac risk factors were prevalent with 59% hypertension, 55% hyperlipidemia, and 21% diabetes. SAQ scores indicated a high angina burden: 49.3±25.7 (angina frequency) and 39.3±27.6 (angina stability). Mean CSI score was 40.5±17, and 62% had CSI scores ≥40, indicating central sensitization. Mean DASI score was 33.3±18.6. A majority (52%) had a DASI score ≤34, indicative of guarded prognosis. CSI scores correlated positively with depression (r=0.78, p=0.00001) and BMI (r=0.39, p=0.04), and negatively with DASI (r=-0.36, p=0.05), indicating impaired physical functioning in those with higher levels of central pain sensitivity. Conclusions: Nearly two-thirds of women with INOCA have central sensitization. Central pain amplification is associated with angina, depression, obesity, and a limited functional capacity in mid-life INOCA women. The role of the central nervous system in persistent chest pain should be further investigated and may lead to novel therapeutic strategies.

Assessment of functional capacity of patients with chronic heart failure by the use of echocardiography right atrial volume index

Introduction: Heart failure (HF) is a chronic syndrome that influences survival &amp; quality of life. over the past 20 years, hospitalizations for heart failure have almost tripled, making heart failure the most common cause of hospitalization. Objective: evaluation of relationship between functional capacity by duke activity status index(DASI) in chronic heart failure patients and the right atrial volume index. Materials and methods: study was conducted on 40 patients who were admitted in the hospital with heart failure.All patients were subjected to detailed history, physical examination, electrocardiography, laboratory investigations, 2D echocardiography &amp; tissue Doppler imaging and assessment of functional capacity using DASI. Results: Out of 40 patients, 10 (25%) had DASI&lt;10 and 30 (75%) patients had DASI&gt;10, according to functional capacity between the two groups, group I Vo2 peak (ml/min) mean is 12.98±1.45 and DASI score ranged from (4.5-9.95) with a median 8.6, in group II Vo2 peak (ml/min) mean is 21.89±4 and DASI score ranged from (23.3- 36.7) with a median 28.7with p value &lt;0.001. RAVI had a significant correlation between the two groups with p-value &lt;0.001. Also, DASI have a strong correlation with RAVI (r=1.139 &amp; p=0.029). Conclusions: RAVI predicts functional capacity in chronic stable heart failure patients.

Comprehensive Quality-of-Life Outcomes With Invasive Versus Conservative Management of Chronic Coronary Disease in ISCHEMIA.

ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) compared an initial invasive treatment strategy (INV) with an initial conservative strategy in 5179 participants with chronic coronary disease and moderate or severe ischemia. The ISCHEMIA research program included a comprehensive quality-of-life (QOL) substudy. In 1819 participants (907 INV, 912 conservative strategy), we collected a battery of disease-specific and generic QOL instruments by structured interviews at baseline; at 3, 12, 24, and 36 months postrandomization; and at study closeout. Assessments included angina-related QOL (19-item Seattle Angina Questionnaire), generic health status (EQ-5D), depressive symptoms (Patient Health Questionnaire-8), and, for North American patients, cardiac functional status (Duke Activity Status Index). Median age was 67 years, 19.2% were female, and 15.9% were non-White. The estimated mean difference for the 19-item Seattle Angina Questionnaire Summary score favored INV (1.4 points [95% CI, 0.2-2.5] over all follow-up). No differences were observed in patients with rare/absent baseline angina (SAQ Angina Frequency score >80). Among patients with more frequent angina at baseline (SAQ Angina Frequency score <80, 744 patients, 41%), those randomly assigned to INV had a mean 3.7-point higher 19-item Seattle Angina Questionnaire Summary score than conservative strategy (95% CI, 1.6-5.8) with consistent effects across SAQ subscales: Physical Limitations 3.2 points (95% CI, 0.2-6.1), Angina Frequency 3.2 points (95% CI, 1.2-5.1), Quality of Life/Health Perceptions 5.3 points (95% CI, 2.8-7.8). For the Duke Activity Status Index, no difference was estimated overall by treatment, but in patients with baseline SAQ Angina Frequency scores <80, Duke Activity Status Index scores were higher for INV (3.2 points [95% CI, 0.6-5.7]), whereas patients with rare/absent baseline angina showed no treatment-related differences. Moderate to severe depression was infrequent at randomization (11.5%-12.8%) and was unaffected by treatment assignment. In the ISCHEMIA comprehensive QOL substudy, patients with more frequent baseline angina reported greater improvements in the symptom, physical functioning, and psychological well-being dimensions of QOL when treated with an invasive strategy, whereas patients who had rare/absent angina at baseline reported no consistent treatment-related QOL differences. URL: https://www. gov; Unique identifier: NCT01471522.

Body weight and physical fitness in women with ischaemic heart disease: does physical fitness contribute to our understanding of the obesity paradox in women?

AimsBody mass index (BMI) defined obesity is paradoxically associated with lower all-cause mortality in patients with known cardiovascular disease. This study aims to determine the role of physical fitness in the obesity paradox in women with ischaemic heart disease (IHD).Methods and ResultsWomen undergoing invasive coronary angiography with signs/symptoms of IHD in the Women’s Ischemia Syndrome Evaluation (WISE) prospective cohort (enrolled 1997–2001) were analysed. This study investigated the longer-term risk of major adverse cardiovascular events (MACE) and all-cause mortality associated with BMI and physical fitness measured by Duke Activity Status Index (DASI). Overweight was defined as BMl ≥25 to 30 kg/m2, obese as BMI ≥30 kg/m2, unfit as DASI scores <25, equivalent to ≤7 metabolic equivalents. Among 899 women, 18.6% were normal BMI-fit, 11.4% overweight-fit, 10.4% obese-fit, 15.3% normal BMI-unfit, 23.8% overweight-unfit, and 30.4% obese-unfit. In adjusted models compared to normal BMI-fit, normal BMI-unfit women had higher MACE risk [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.17–2.32; P = 0.004]; whereas obese-fit and overweight-fit women had lower risk of mortality (HR 0.60, 95% CI 0.40–0.89; P = 0.012 and HR 0.62, 95% CI 0.41–0.92; P = 0.018, respectively).ConclusionTo address the paradox of body weight and outcomes in women, we report for the first time that among women with signs/symptoms of IHD overweight-fit and obese-fit were at lower risk of long-term all-cause mortality; whereas normal BMI-unfit were at higher risk of MACE. Physical fitness may contribute to the obesity paradox in women, warranting future studies to better understand associations between body weight, body composition, and physical fitness to improve cardiovascular outcomes in women.

Construct validity and responsiveness of the Duke Activity Status Index (DASI) as a measure of recovery after colorectal surgery.

Returning to preoperative levels of physical function is highly valued by patients recovering from surgery. The Duke Activity Status Index (DASI, a 12-item questionnaire) may be a simple yet robust tool to assess postoperative recovery of functional capacity. This study assessed construct validity and responsiveness of the DASI as a measure of recovery after colorectal surgery. Data from a trial on early mobilization after colorectal surgery were analyzed. Patients completed the DASI questionnaire preoperatively and at postoperative weeks (POW) 2 and 4. Construct validity was assessed by testing the primary a priori hypotheses that postoperative DASI scores (1) are higher in patients without vs with postoperative complications and (2) correlate with six-minute walk test distance (6MWD). Exploratory analyses assessed the association between DASI scores and (1) preoperative physical status [higher (ASA ≤ 2) vs lower (ASA > 2)], (2) stoma creation (no stoma vs stoma), (3) age [younger (≤ 75years) vs older (> 75years)], (4) time to readiness for discharge [shorter (≤ 4days) vs longer (> 4days)], and (5) surgical approach (laparoscopic vs open). Responsiveness was assessed by testing a priori hypotheses that DASI scores are higher (1) preoperatively vs at POW2 and (2) at POW4 vs POW2. Mean differences in DASI scores were obtained using linear regression. The association between DASI and 6MWD was assessed via Pearson correlation. We analyzed data from 100 patients undergoing colorectal surgery (mean age 65; 57% male; 81% laparoscopic). Mean DASI scores were 47.9 ± 12.1 preoperatively, 22.4 ± 12.7 at POW2, and 33.2 ± 15.7 at POW4. The data supported our two primary construct validity hypotheses, as well as 3/5 exploratory hypotheses. Both responsiveness hypotheses were supported. Our findings support that the DASI questionnaire can be a useful tool to assess postoperative recovery of functional capacity in research and clinical practice.

Preoperative incremental shuttle walk test for morbidity and mortality prediction in elective major colorectal surgery.

Background and Aims:The incremental shuttle walk test (ISWT) is a simple reproducible and non-invasive test for assessing cardiopulmonary function. The maximum oxygen consumption is less than 10 ml/kg/min for ISWT distance of less than 250 m. This study aimed to evaluate the effectiveness of ISWT in predicting morbidity and mortality in elective colorectal oncosurgery and to find the correlation of ISWT with the Duke Activity Status Index (DASI), Borg dyspnoea score, and peak oxygen uptake (VO2 max).Methods:This prospective study involved 46 patients aged more than 60 years with American Society of Anesthesiologists physical status I and II undergoing elective colorectal surgery under general anaesthesia with an epidural block. ISWT was conducted preoperatively and patients were monitored for 30 days postoperatively. For a comparative analysis, patients were divided into two groups: group 1– who could walk 250 m and group 2 – could not walk 250m. Categorical data were evaluated using the Chi-square test, while continuous data were evaluated using the Student’s t-test. The strength of correlation was determined using Pearson’s correlation coefficient.Results:Postoperative complications (P = 0.001) and lengthy stay in hospital and intensive care unit (P = 0.001) were experienced by all patients who were unable to complete the ISWT distance of 250 m. ISWT distance of 250 m corresponds to a DASI score of 10.5, which is equivalent to a calculated VO2 max of 14.1ml/kg/min.Conclusion:The ISWT with a cutoff distance of 250 m is a reliable predictor of postoperative morbidity in patients undergoing colorectal oncosurgery.

Quantification of metabolic equivalents (METs) by the MET-REPAIR questionnaire: A validation study in patients with a high cardiovascular burden

Study objectiveQuantifying functional capacity is a core component of preoperative cardiovascular risk assessment. Lower metabolic equivalents (METs) are associated with higher morbidity/mortality in non-surgical and surgical populations. However, actually measuring METs preoperatively is rare. We sought to determine the correlation of self-reported METs using the questionnaire of the MET: REevaluation for Perioperative cArdIac Risk (MET-REPAIR) study and objectively measured METs by gold-standard cardiopulmonary exercise testing (CPET). DesignSingle-center prospective validation study. SettingUniversity hospital. PatientsWe enrolled adult patients aged ≥45 undergoing out-patient cardiac rehabilitation. INTERVENTION: Patients completed the MET-REPAIR Questionnaire and the Duke Activity Status Index (DASI), had blood samples drawn, and underwent undergoing routine CPET. MeasurementsWe compared measured METs by CPET to 1) self-reported METs (the MET-REPAIR Questionnaire), 2) the DASI score, 3) stand-alone questions, and 4) N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations. Main results140 patients were recruited. Measured METs by CPET correlated with 1) self-reported METs by the MET-REPAIR Questionnaire (ρ = 0.489, “fair”), 2) self-reported physical activity by the DASI (ρ = 0.487, “fair”), 3) the self-reported continual stair climbing ability (one of the stand-alone questions; ρ = 0.587, “fair”) and 4) NT-proBNP concentrations (ρ = −0.353, “poor”).The area under the receiver operating characteristic curve (AUROC) for the ability to perform more than 4 METs were: highest for flights of stairs (0.841 [95%CI 0.735–0.948], p < 0.05 to rest, optimum: 3 flights), not significantly different between MET-REPAIR Questionnaire and DASI (0.666 [95%CI 0.551–0.781], optimum: 6 METs vs. 0.704 [95%CI 0.578–0.829], optimum: 32.2 points or 6.7 METs, p = 0.405), and not significant for NT-proBNP: (0.623 [95%CI 0.483–0.763]). ConclusionsThe MET-REPAIR Questionnaire correlates with measured METs; all utilized forms of self-reported physical activity overestimate measured METs. NT-proBNP correlates poorly with measured METs.

Impaired health status is independently associated with persistently elevated NT-proBNP levels despite medical therapy for heart failure with reduced ejection fraction

Abstract Background Impaired health status as measured by standardized tools such as Kansas City Cardiomyopathy Questionnaire (KCCQ), Duke Activity Status Index (DASI) and six-minute walk test (6MWT) has been shown to predict hospitalization and mortality in patients with chronic heart failure. However, prognostic implications of these measurements in response to guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) remained to be elucidated. Purpose We hypothesized that impaired health status were predictive of persistently elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) after 6 and 12 months of therapeutic optimization in HFrEF. Methods Data on the GUIDE-IT trial that included protocolized HFrEF drug titration were analyzed. Patients who did not have NT-proBNP at 12 months were excluded. KCCQ overall and clinical summary scores, and DASI scores at baseline and 6 months were calculated. Six-minute walk test (6MWT) distance at baseline were also available. Response to medical therapy was defined as having NT-proBNP at 12 months of less than 1,000 pg/mL. Median value of each measurement was used as a cutoff. Multivariate logistic regression analysis was used to determine independent associations between different QOL scores and NT-proBNP response after adjustment for age, comorbidities, baseline EF, NYHA functional class, and NT-proBNP. Results There were 193 (43%) responders. Compared with those who responded to the medical therapy, non-responders were older, and more likely to have comorbidities including coronary artery disease, stroke, PAD, AF, hypertension, COPD, DM, CKD, and dyslipidemia, as well as lower EF, NHYA functional class and higher baseline NT-proBNP. After adjustment for baseline characteristics, lower KCCQ (either overall or summary) scores at baseline and 6 months, and lower DASI scores at 6 months (but not baseline) were independently associated with lower likelihood of response to GDMT (Table). In contrast, baseline 6MWT distance did not predict non-response to GDMT after adjustments. Conclusions Only impaired baseline KCCQ scores were predictive of persistently elevated NT-proBNP, while lower KCCQ and DASI scores at 6 month were predictive of persistently elevated NT-proBNP. Funding Acknowledgement Type of funding sources: None. Health Status Score below Median and ORs

Prognostic value of the Duke Activity Status Index (DASI) in patients undergoing colorectal surgery.

Complications are common after colorectal surgery and remain a target for quality improvement. Lower preoperative physical functioning is associated with poor postoperative outcomes, but assessment often relies on subjective judgment or resource-intensive tests. Recent literature suggests that self-reported functional capacity, measured using the Duke Activity Status Index (DASI), is a strong predictor of postoperative outcomes. This study aimed to estimate the extent to which DASI predicts 30-day complications after colorectal surgery. In this observational study, 100 patients undergoing colorectal resection [median age 63, 57% men, 81% laparoscopic, 37% rectal surgery] responded to DASI two weeks preoperatively. Complications were classified according to Clavien-Dindo and quantified using the comprehensive complication index (CCI). Our primary analysis targeted the relationship between preoperative DASI and odds of complications. Secondary analyses focused on 30-day severe complications, CCI, readmissions, and length of stay (LOS). We also explored the predictive ability of DASI with scores dichotomized based on a previously validated threshold (≤ 34). Mean preoperative DASI was 48 ± 12. Forty-six patients (46%) experienced 30-day complications (8% severe, CCI 9.6 ± 15). Lower DASI scores were associated with higher odds of complications (OR 1.08, 95%CI 1.03-1.14; p = 0.001). Preoperative DASI was also an independent predictor of severe complications, CCI, and readmissions. The predictive ability was supported when scores were dichotomized at ≤ 34. DASI is a significant predictor of postoperative complications after colorectal surgery. This questionnaire can be easily implemented in clinical practice to identify patients with low preoperative functional capacity and target interventions to those at higher risk.

Assessment of functional status by the Duke Activity Status Index in stable bronchiectasis

ABSTRACT Introduction Bronchiectasis is a growing global health problem. Objective and Methods To evaluate the functional status of stable bronchiectasis patients recruited from a terciary hospital in Fortaleza, Brazil.The patients were submitted to spirometry, six minute walking test (6MWT), step test (6MST), measurement of fibrinogen,E-FACED scores(incorporates FEV1 ,age,colonisation by Pseudomonas,radiological extension, dyspnoea and exarcebation) and Duke Activity Status Index(DASI) test.Each item of DASI scored proportionally to the metabolic equivalentes(METs). The sum of DASI scores was applied for an estimation of oxygen consumption(VO2). Results The sample comprised 101 patients.Patients with post-tuberculosis bronchiectsis had the lowest level of functional parameters than those with others etiologies[DASI(19.9 ±10.9 vs 31.2±14.4 p<0.001); VO2 (18.1 ± 4.7 vs 23.1 ± 6.1 p< 0.001 respectively)]. DASI scores and estimated VO2 correlated with E-FACED(r= -0.44 p=0.001; and r= -0.44 p=0.001 respectively) and 6MST r= 0.37 p<0.001 and r=0.40 p<0.001 respectively). Conclusion After multivariate analysis , bronchiectasis post-TB , E-FACED and 6MWT explained the impact on performance in bronchiectasis patients.

Evaluation of Postoperative Complication with Medically Necessary, Time-Sensitive Scoring System During Acute COVID-19 Pandemic: A Prospective Observational Study

BackgroundHigh scores in the Medically Necessary, Time-Sensitive (MeNTS) scoring system, used for elective surgical prioritization during the coronavirus disease 2019 pandemic, are assumed to be associated with worse outcomes. We aimed to evaluate the MeNTS scoring system in patients undergoing elective surgery during restricted capacity of our institution, with or without moderate or severe postoperative complications.Study DesignIn this prospective observational study, MeNTS scores of patients undergoing elective operations during May and June 2020 were calculated. Postoperative complication severity (classified as Group Clavien-Dindo < II or Group Clavien-Dindo ≥ II), as well as Duke Activity Index, American Society of Anesthesiologists (ASA) physical status, presence of smoking, leukocytosis, lymphopenia, elevated C-reactive protein (CRP), operation and anesthesia characteristics, intensive care requirement and duration, length of hospital stay, rehospitalization, and mortality were noted.ResultsThere were 223 patients analyzed. MeNTS score was higher in the Clavien-Dindo ≥ II Group compared with the Clavien-Dindo < II Group (50.98 ± 8.98 vs 44.27 ± 8.90 respectively, p < 0.001). Duke activity status index (DASI) scores were lower, and American Society of Anesthesiologists physical status class, presence of smoking, leukocytosis, lymphopenia, elevated CRP, and intensive care requirement were higher in the Clavien-Dindo ≥ II Group (p < 0.01). Length of hospital stay was longer in the Clavien-Dindo ≥ II Group (15 [range 2–90] vs 4 [1–30] days; p < 0.001). Mortality was observed in 8 patients. Area under the receiver operating characteristic curve of MeNTS and DASI were 0.69 and 0.71, respectively, for predicting moderate/severe complications.ConclusionsAlthough significant, MeNTS score had low discriminating power in distinguishing patients with moderate/severe complications. Incorporation of a cardiovascular functional capacity measure could improve the scoring system.

Microvascular Assessment of Ranolazine in Non-Obstructive Atherosclerosis: The MARINA Randomized, Double-Blinded, Controlled Pilot Trial.

Microvascular dysfunction is known to play a key role in patients with angina and nonobstructive coronary artery disease. We investigated the impact of ranolazine among patients with angina and nonobstructive coronary artery disease. In this randomized, double-blinded, placebo-controlled pilot trial, 26 patients with angina once weekly or more, abnormal stress test, and nonobstructive coronary artery disease (<50% stenosis by angiography and fractional flow reserve >0.80) were randomized 1:1 to ranolazine or placebo for 12 weeks. Primary end point was ΔSeattle Angina Questionnaire (SAQ) angina frequency score. Baseline and 3 months follow-up SAQ, Duke Activity Status Index scores along with invasive fractional flow reserve, coronary flow reserve (CFR), hyperemic myocardial resistance, and cardiopulmonary exercise testing measurements were performed. No significant differences in ΔSAQ angina frequency scores (P=0.53) or Duke Activity Status Index (P=0.76) were observed between ranolazine versus placebo, although patients on ranolazine had lesser improvement in SAQ physical limitation scores (P=0.02) compared with placebo at 3 months. There were no significant differences in ΔCFR or Δhyperemic myocardial resistance between ranolazine and placebo groups. Patients treated with ranolazine, compared with placebo, had no significant improvement in maximum rate of oxygen consumption measured during incremental exercise (VO2 max) and peak metabolic equivalents of task. Interestingly, in the ranolazine group, patients with baseline CFR<2.0 demonstrated greater gain in CFR compared with those with baseline CFR≥2.0 (P=0.02). Ranolazine did not demonstrate improvement in SAQ angina frequency score, invasive microvascular function, or peak metabolic equivalent compared with placebo at 3 months. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02147067.