Exercise Capacity Index Research Articles

Sarcopenia in COPD: relationship with COPD severity and prognosis.

Objective: To evaluate the prevalence of sarcopenia in COPD patients, as well as to determine whether sarcopenia correlates with the severity and prognosis of COPD. Methods: A cross-sectional study with COPD patients followed at the pulmonary outpatient clinic of our institution. The patients underwent dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was made on the basis of the skeletal muscle index, defined as appendicular lean mass/height2 only for low-weight subjects and adjusted for fat mass in normal/overweight subjects. Disease severity (COPD stage) was evaluated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The degree of obstruction and prognosis were determined by the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index. Results: We recruited 91 patients (50 females), with a mean age of 67.4 ± 8.7 years and a mean BMI of 25.8 ± 6.1 kg/m2. Sarcopenia was observed in 36 (39.6%) of the patients, with no differences related to gender, age, or smoking status. Sarcopenia was not associated with the GOLD stage or with FEV1 (used as an indicator of the degree of obstruction). The BMI, percentage of body fat, and total lean mass were lower in the patients with sarcopenia than in those without (p < 0.001). Sarcopenia was more prevalent among the patients in BODE quartile 3 or 4 than among those in BODE quartile 1 or 2 (p = 0.009). The multivariate analysis showed that the BODE quartile was significantly associated with sarcopenia, regardless of age, gender, smoking status, and GOLD stage. Conclusions: In COPD patients, sarcopenia appears to be associated with unfavorable changes in body composition and with a poor prognosis.

The relationship between anthropometric indicators and walking distance in patients with chronic obstructive pulmonary disease.

BackgroundExercise intolerance is a major issue affecting many people with COPD. Six-minute walking distance (6MWD) is a widely used indicator of exercise capacity in patients with COPD. The process is strenuous and time-consuming, especially for patients who have muscle wasting. Anthropometric indicators that reflect body lean mass, such as body mass index (BMI), mid-arm circumference (MAC), and calf circumference (CC), may have value in predicting exercise intolerance.PurposeThis study attempted to determine the abilities of simple anthropometric indicators including BMI, MAC, and CC in reflecting the exercise intolerance of COPD patients.MethodsWe recruited 136 nonhospitalized ambulatory COPD patients without acute conditions from a general hospital in Taiwan. Each subject’s BMI, MAC, and CC were measured, and they were examined with pulmonary function tests and a 6-minute walk test.ResultsAmong the three anthropometric indicators examined, CC showed the strongest correlation with the 6MWD, followed by MAC and BMI. CC was also strongly associated with functional capacity, followed by MAC, according to the receiver operating characteristic curves. CC and MAC, but not BMI, were significantly associated with exercise intolerance according to logistic regression models that controlled for potential confounders.ConclusionAmong the three variables examined, CC and walking distance may have the strongest association in COPD patients. CC may have value in serving as an adjunct to 6MWD in evaluating exercise intolerance of patients with COPD.

Pulmonary rehabilitation in chronic obstructive pulmonary disease: Outcomes in a 12 week programme

Objective. The optimal time-frame for pulmonary rehabilitation (PR) in patients diagnosed with chronic obstructive pulmonary disease (COPD) is still debated. A 12 week programme was designed looking at whether the benefits were reached at or before a 12 week period of PR for COPD patients. Method. Seventy-five patients (59 males, 16 females) aged 40 75 years were referred from the local general hospital in Malta. Baseline assessments were carried out on all patients 2 weeks before initiation of the programme. Sixty patients were eligible to start a twice-weekly, 12 week multidisciplinary programme delivered after the screening process. The Six-Minute Walk Test (6MWT), dyspnoea score using the Borg scale, spirometry testing, plethysmography, COPD Assessment Tool (CAT) score, St George's Respiratory Questionnaire (SGRQ) and Hospital and Anxiety scale score were monitored at 4 weekly intervals throughout the 12 weeks of PR for these COPD patients. Results. The 6MWT distance increased by a mean total of 132.45 m (p < 0.001) by 12 weeks, with the highest change recorded in the first 4 weeks for the milder COPD patients. Lung function test improvements were marginal. Borg scale readings at rest and following exertion decreased significantly from weeks 0 to 4 but remained fairly constant thereafter. The Body mass index, airway Obstruction, Dyspnoea, and Exercise capacity (BODE) index, SGRQ and CAT score values decreased significantly throughout the weeks irrespective of the initial Medical Research Council score. Anxiety scoring decreased significantly by 12 weeks, while the depression rating improved by 8 weeks. Conclusion. These findings show that 12 weeks of PR in this cohort of COPD patients resulted in clinically significant changes in functional outcome measures which are supported by statistically significant changes in health-related quality of life measures. In milder COPD cases, by 4 weeks of PR gains in exercise tolerance had already resulted. The more severe group required more time to obtain improvements. Therefore, hospitals could organize shorter PR programmes for larger numbers of patients with milder COPD.

Contributions of the Body Mass Index, Obstruction, Dyspnea and Exercise Capacity or BODE index to Chronic Obstructive Pulmonary Disease

Contributions of the Body Mass Index, Obstruction, Dyspnea and Exercise Capacity or BODE index to Chronic Obstructive Pulmonary Disease

Contributions of the Body Mass Index, Obstruction, Dyspnea and Exercise Capacity or BODE index to Chronic Obstructive Pulmonary Disease

Contributions of the Body Mass Index, Obstruction, Dyspnea and Exercise Capacity or BODE index to Chronic Obstructive Pulmonary Disease

Investigation of exercise capacity after renal transplantation

Background:Patients presenting for renal transplantation are physically inactive and have low levels of exercise capacity. Exercise capacity is an independent predictor ofmortality in a number of clinical populations. Although mortality and quality of life improve after transplantation, only a few studies have reported the effects of transplantation on exercise capacity in this population. In addition, there are little studies to investigate factors that affect exercise capacity after renal transplantation. Purpose: To examine the change in exercise capacity, muscle strength, nutritional and mental status preand postrenal transplantation. Methods:BetweenDecember 2012 and July 2014, twenty four consecutive renal transplant recipients who underwent symptom-limited cardiopulmonary exercise testing (CPX) before and after 6 months of transplantation were enrolled in this study. We evaluated peak oxygen uptake (peakVO2) as an index of exercise capacity, VE–VCO2 slope as a ventilator response to exercise from CPX data. We measured grip as an upper muscle strength and knee extension torque as a lower muscle strength. Laboratory data (albumin, hemoglobinA1c: HbA1c) were evaluated as a nutritional condition. Hospital anxiety and depression scale (HADS) was used to know a mental status. Age, gender, body mass index (BMI), diabetes mellitus (DM), left ventricular ejection fraction (LVEF), hemodialysis (HD) and duration of HD, hemoglobin (Hgb) were adopted as a patients characteristics. All data were measured before and after 6 months of transplantation. The subjectswere divided into twogroups according to the change of peakVO2 from baseline to after 6 month; recovery group (RG) and non-recovery group (NRG). These indices were compared between the two groups. Patient received supervised exercise training after transplantation during hospitalization. After discharge, unsupervised home based exercise prescribed in each patients. Results: There were no significant deference between two groups (NRG vs RG) in age (53.5± 8.3 years, 49.0± 12.0 years), gender (male: 38.5%, 63.6%), BMI (22.3± 3.3 kg/m2, 22.0± 3.8 kg/m2), DM (n= 4, 3), LVEF (60.7± 11.4%, 62.3± 8.0%), HD (n= 9, 4), Hgb (11.1± 1.1 g/dl, 10.4± 1.5 g/dl). PeakVO2 changed 17.1± 4.1ml/kg/min to 16.4± 4.2ml/kg/min in NRG, 17.2± 3.8ml/kg/min to 20.4± 4.0ml/kg/min in RG. Compared with RG, lower peakVO2 (p= 0.028) and lower albumin (0.279± 0.420 g/ml, p= 0.019) were found in NRG at 6 month after transplantation. HD patients had longer duration of HD (29.0± 33.2 months, p= 0.022) in NRG. In addition, HbA1c tend to be worse (p= 0.083) in this group. Furthermore, albumin was positively correlated with peakVO2 (p= 0.020, r= 0.472) at 6 months after transplantation. In contrast, duration of HD was negatively correlated with peakVO2 (p= 0.010, r=−0.518). Conclusion(s): Poor nutritional condition (low albumin, high HbA1c) was the feature of NRG. Nutritional status might be as important as exercise to improve peakVO2 for patients with renal transplantation. Besides, duration of HD might be influence the recovery of exercise capacity. Implications: Low exercise capacity after renal transplantation might be need to combine exercise training and nutritional advice like a cardiopulmonary rehabilitation. And duration of HD is also important to predict recovery of exercise capacity in this populations.

Exercise Heart Rates in Patients With Hypertrophic Cardiomyopathy

The exercise heart rate (HR) profile and its relation to cardiac function and arrhythmias were investigated in patients with hypertrophic cardiomyopathy (HC). Chronotropic response (CR) and heart rate recovery (HRR) were computed during and after treadmill exercise testing in 273 patients with HC and 95 age-matched healthy controls. Patients with HC had higher prevalence of chronotropic incompetence and lower HRR1-5min compared with controls. Exercise capacity, diastolic function (assessed by E/e') and left atrial volume index were associated with HRR1min and CR in HC. Septal myectomy was associated with reduction in chronotropic incompetence but did not affect HRR1min. In conclusion, impaired CR and HRR1min are associated with advanced disease and do not appear to be independent clinical markers indicating high-risk status in HC. Improving CR by titrating doses of negative chronotropic agents, myectomy, and atrial pacing may be useful to increase exercise capacity in patients with HC.

Lung flute improves symptoms and health status in COPD with chronic bronchitis: A 26week randomized controlled trial.

BackgroundChronic obstructive pulmonary disease (COPD) is characterized by mucus hypersecretion that contributes to disease related morbidity and is associated with increased mortality. The Lung Flute® is a new respiratory device that produces a low frequency acoustic wave with moderately vigorous exhalation to increase mucus clearance. We hypothesized that the Lung Flute, used on a twice daily basis will provide clinical benefit to patients with COPD with chronic bronchitis.MethodsWe performed a 26 week randomized, non-intervention controlled, single center, open label trial in 69 patients with COPD and Chronic Bronchitis. The primary endpoint was change in respiratory symptoms measured with the Chronic COPD Questionnaire (CCQ). Secondary endpoints included health status, assessed by the St. George Respiratory questionnaire (SGRQ), BODE (Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity)index score and exacerbation frequency.ResultsWhile the control patients did not demonstrate any significant changes in the primary endpoint (CCQ change at 26 weeks of +0.01, p = 0.8), a trend (p = 0.08) to decrease (improvement) in the CCQ (-0.23 at 26 weeks) was seen with the Lung Flute. Furthermore, a significant improvement in the symptom domain of the CCQ was seen only with the lung flute (-0.42, p = 0.004). Health status (SGRQ) improvement, was also only seen with the Lung Flute (-3.23, p = 0.03). The BODE score increased in the control group (3.31 at baseline, 4.14 at 26 weeks), however it remained stable in the Lung Flute arm (3.16 at baseline and 26 weeks), with the changes from baseline being significantly different between the 2 arms (p = 0.01). There was a trend for less exacerbations in the Lung Flute group (p = 0.07). Adverse effects were minor, with only 1 patient discontinuing treatment because of lack of efficacy. Serious adverse effects seen were all determined to be unrelated to the device use.ConclusionsThe Lung Flute is a safe and effective treatment in COPD with chronic bronchitis, providing a wide array of benefits.ClinicalTrials.gov IdentifierNCT01186822

Vitamin D replacement therapy in patients with cardiac syndrome X.

The aim of present study was to assess whether vitamin D, with proven beneficial effects on the cardiovascular system, has any effect on angina and exercise-induced ischemia in patients with cardiac syndrome X and low serum vitamin D. Patients with cardiac syndrome X and low serum vitamin D3 were studied before and after treatment with an intramuscular injection of vitamin D3 (300,000 units, every other week for 2 months). We determined the angina episode (per day) and several indices of exercise capacity. At the end of the treatment course (75±6 day), a significant increase of serum vitamin D3 occurred and was within the normal range (45±8 ng/ml) and the frequency of angina improved significantly (p=0.003). Exercise duration and maximal work capacity increased significantly (p<0.001). Maximal ST-segment depression (mm) decreased significantly (p=0.001). The calculated Duck treadmill score improved significantly (p=0.001). Our findings show that vitamin D replacement therapy in patients with cardiac syndrome X and vitamin D deficiency dramatically improves symptoms and signs of ischemia.

Value of quality of life evaluation in prognosis of chronic obstructive pulmonary disease

To evaluate the quality of life in patients with chronic obstructive pulmonary disease (COPD) by COPD Assessment Test (CAT) and Body Mass Index, Airflow Obstruction, Dyspnea, Exercise Capacity Index (BODE). One hundred patients with stable COPD admitted in Putuo People's Hospital were recruited in the study. CAT and BODE index were measured for each patient.The deaths and frequency of exacerbations were recorded during 3-year follow-up period,and the correlation between CAT and BODE in evaluating COPD prognosis was analyzed. There were 28, 30, 29 and 13 patients with CAT score of 1, 2, 3 and 4, respectively; while there were 31, 29, 28 and 12 cases with BODE scores of 1, 2, 3 and 4. CAT scores were well correlated with BODE evaluation in terms of overall score and scores of 4 items (r= -0.237, -0.772, 0.789, -0.767, 0.888, respectively, Ps<0.05). COPD exacerbation incidence and mortality increased with the increasing CAT levels. The rank sum test showed that there were no significant differences between CAT and BODE index in the frequency of acute exacerbation(P<0.05); and in the death toll, the difference was not significant(1 group Χ2=0.919, 2 group Χ2=0.001, 3 group Χ2=0.177,4 group Χ2=0.322, Ps>0.05). CAT is relevant to BODE in evaluating incidence of exacerbation and mortality for patients with COPD and CAT is more easily to be applied.

Personality Traits and Exercise Capacity in Male Athletes and Non-Athletes

To investigate the relationships between personality traits and athletic capacity, this study compared a sample of 376 young adult men (169 athletes, 207 non-athletes; M age = 23.8 yr., SD = 3.9). 26 lab-based exercise capacity parameters were measured, as well as the Big Five major personality traits using the NEO Five-Factor Inventory. The results indicated that athletes scored higher than non-athletes for Conscientiousness but scores were not statistically different between groups for other personality traits. Team sport athletes scored higher on Extraversion than endurance athletes. All the personality traits were associated with some of the exercise capacity indices; however, these correlations were rather weak (rs < .2).

Evaluation of the chronic obstructive pulmonary disease assessment test in Japanese outpatients

The Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) is a quality-of-life (QOL) questionnaire that proved to correlate with St. George's Respiratory Questionnaire. Correlations between CAT scores and other COPD parameters have not been thoroughly evaluated in Japanese outpatients. Cross-sectional study of 85 outpatients with COPD at a Japanese community-based hospital. We observed 70 men and 15 women, whose average age was 72.0 ± 9.0 years. Mean forced expiratory volume in 1 s (FEV1) (% predicted) was 45.8 ± 14.7%. Mean CAT score was 10.1 ± 7.9 (range: 0-31). We calculated Spearman's rank correlation coefficient for CAT score and the following variables: r=0.81 for 'the Body Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity Index'; r=-0.05 for body mass index; r=-0.56 for FEV1 (% predicted); r=0.88 for Modified Medical Research Council Dyspnea Scale; r=-0.71 for 6-min walk distance; r=0.68 for 'the Age, Dyspnoea,and Airflow Obstruction Index'; and r=-0.40 for oxygen saturation in artery. Each COPD parameter, except for body mass index, had a significant (P<0.001) correlation with the CAT score. The CAT score, which is obtainable by a simple questionnaire originally designed for QOL assessment, had strong correlations with airflow obstruction, dyspnea, exercise tolerance, prognostic index and oxygenation in Japanese outpatients.

Clinical Utility of Computed Tomographic Lung Volumes in Patients with Chronic Obstructive Pulmonary Disease

Background: Published data concerning the utility of computed tomography (CT)-based lung volumes are limited to correlation with lung function. Objectives: The aim of this study was to evaluate the clinical utility of the CT expiratory-to-inspiratory lung volume ratio (CT V_ratio) by assessing the relationship with clinically relevant outcomes. Methods: A total of 75 stable chronic obstructive pulmonary disease (COPD) patients having pulmonary function testing and volumetric CT at full inspiration and expiration were retrospectively evaluated. Inspiratory and expiratory CT lung volumes were measured using in-house software. Correlation of the CT V_ratio with patient-centered outcomes, including the modified Medical Research Council (MMRC) dyspnea score, the 6-min walk distance (6MWD), the St. George's Respiratory Questionnaire (SGRQ) score, and multidimensional COPD severity indices, such as the BMI, airflow obstruction, dyspnea, and exercise capacity index (BODE) and age, dyspnea, and airflow obstruction (ADO), were analyzed. Results: The CT V_ratio correlated significantly with BMI (r = −0.528, p < 0.001). The CT V_ratio was also significantly associated with MMRC dyspnea (r = 0.387, p = 0.001), 6MWD (r = −0.459, p < 0.001), and SGRQ (r = 0.369, p = 0.001) scores. Finally, the CT V_ratio had significant correlations with the BODE and ADO multidimensional COPD severity indices (r = 0.605, p < 0.001; r = 0.411, p < 0.001). Conclusion: The CT V_ratio had significant correlations with patient-centered outcomes and multidimensional COPD severity indices.

Prognostic Validation of the Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity (BODE) Index in Inoperable Non–Small-Cell Lung Cancer

To investigate the prognostic utility of the body mass index, severity of airflow obstruction, measures of exertional dyspnea, and exercise capacity (BODE) index in patients with inoperable non-small-cell lung cancer (NSCLC). One hundred consecutive patients with inoperable NSCLC and performance status 0 to 3 completed pulmonary function testing, the modified Medical Research Council dyspnea scale, a 6-minute walk test, and body mass index-the multidimensional 10-point BODE index. Cox proportional models were used to estimate the risk of all-cause mortality according to the BODE index with or without adjustment for traditional prognostic factors. Median follow-up was 31.5 months; 61 deaths (61%) were reported during this period. There was a significant univariate association between the BODE index score and mortality (adjusted p(trend) = 0.027). Compared with patients with a BODE index of 0, the adjusted hazard ratio for risk of death was 1.37 (95% confidence interval [CI], 0.74-2.55) for a BODE index of 1, 1.22 (95% CI, 0.45-3.25) for a BODE index of 2, and 2.44 (95% CI, 1.19-4.99) for a BODE index more than 2. The BODE index provided incremental prognostic information beyond that provided traditional markers of prognosis (adjusted p(trend) = 0.051). Every one-point increase in the BODE index, the risk of death increased by 25% (hazard ratio = 1.25; 95% CI, 1.27-4.64). The BODE index is a strong independent predictor of survival in inoperable NSCLC beyond traditional risk factors. Use of this multidimensional tool may improve risk stratification and prognostication in NSCLC.

Relationship between plasma asymmetric dimethylarginine concentrations and aerobic exercise capacity in postmenopausal women

Background: Asymmetric dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthase, an enzyme responsible for generation of NO. Plasma concentration of ADMA increases in elderly people and in postmenopausal women. Elevated ADMA leads to endothelial dysfunction and increases risk for cardiovascular disease. Habitual aerobic exercise has a favorable effect on vascular aging. However, the relationship between ADMA and aerobic exercise capacity is unknown. The aim of this study was to determine whether plasma ADMA concentrations are associated with aerobic exercise capacity. Methods: Thirty healthy, postmenopausal women aged from 50 to 76 years, participated in this study. We measured plasma concentrations of ADMA, and oxygen consumption at ventilatory threshold (VO2VT), an index of aerobic exercise capacity. Plasma ADMA concentrations was measured by enzyme-linked immunosorbent assay. VO2VT was measured during an incremental cycle ergometer exercise with a respiratory gas analyzer. Each individual VO2VT was determined using regression analysis of the slopes of CO2 production, O2 uptake, and the minute–ventilation plot. Relationship between plasma ADMA concentrations and VO2VT was analyzed using Pearson's correlation. Stepwise regression analysis was used to identify independent associations of plasma ADMA concentrations. Results: There was negative correlation between plasma ADMA concentration and VO2VT (R=−0.532, P b 0.01). In addition, stepwise regression analysis showed that plasma ADMA concentration was significantly associated with VO2VT. Conclusion: We found that plasma ADMA concentrations were associated with aerobic exercise capacity in postmenopausal women. These results suggest that habitual aerobic exercise may decrease plasma ADMA concentrations.

Experience of fatigue, and its relationship to physical capacity and disease severity in men and women with COPD

IntroductionSeveral differences have been reported in the clinical characteristics of chronic obstructive pulmonary disease (COPD) between men and women. Differences have been found in the association between respiratory symptoms and lung function, and in the factors associated with dyspnea. This raises the question of whether there are differences between the sexes in the relationship between fatigue, the second most prevalent symptom, and the variables of physical capacity and disease severity.ObjectivesTo examine the experience of fatigue and its relationship to physical capacity and disease severity in men and women with COPD.MethodsIn a cross-sectional study 121 patients with COPD (54 men and 67 women), the experience of fatigue (frequency, duration, and severity) and physical capacity (lung function, 6-minute walk distance [6MWD], grip strength, and timed-stand test) were assessed. Disease severity was graded according to the Body mass index, airway Obstruction, Dyspnoea and Exercise capacity (BODE) index. Two multiple logistic regression models were tested, both of which were performed separately in men and women, to examine the association between the experience of fatigue and variables of physical capacity and the BODE index.ResultsEighty-nine (73.6%) patients experienced fatigue, with similar proportions in men and women. The men with fatigue had worse physical capacity and more severe disease than did the men without fatigue: for men with and without fatigue, respectively, the percent of predicted forced expiratory volume in 1 second (FEV1) (mean [standard deviation]) was 47 (14) vs 64 (17); the 6MWD (mean [standard deviation]) was 398 (138) vs 539 (105) m; and the BODE index (median [quartile 1–3]) was 3 (2–5) vs 1 (0–1) (P<0.01). In women, only higher leg fatigue post-6MWD was seen among those experiencing fatigue compared with women without fatigue: for women with and without fatigue, respectively, leg fatigue (median [quartile 1–3]) was 4 (3–5) vs 2 (0–3) (P<0.001). The regression models showed that the 6MWD and the BODE index were associated with fatigue in both men and women, but in women, leg fatigue remained an independent associate in both models.ConclusionExercise capacity and disease severity were associated with fatigue in both men and women. In women, leg fatigue was strongly associated with fatigue, which warrants further investigation.

Levels of physical activity and predictors of mortality in COPD.

OBJECTIVE: To compare the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index scores and its individual components between COPD patients with and without severe physical inactivity, as well as to correlate the number of steps/day with scores of physical activity questionnaires, age, and the BODE index (including its components). METHODS: We included 30 patients, who were evaluated for body composition, pulmonary function (FEV1), perception of dyspnea (modified Medical Research Council scale), and exercise capacity (six-minute walk distance [6MWD]). The patients also completed the International Physical Activity Questionnaire (IPAQ), short version, and the modified Baecke questionnaire (mBQ). The level of physical activity was assessed by the number of steps/day (as determined by pedometer), using the cut-off of 4,580 steps/day to form two groups: no severe physical inactivity (SPI−) and severe physical inactivity (SPI+). We used the Mann-Whitney test or t-test, as well as Pearson's or Spearman's correlation tests, in the statistical analysis. RESULTS: In comparison with the SPI− group, the SPI+ group showed more advanced age, higher mBQ scores (leisure domain), lower 6MWD (in m and % of predicted), and lower IPAQ scores (metabolic equivalent-walk/week domain and total). The IPAQ scores showed weak correlations with steps/day (r = 0.399), age (r = −0.459), and 6MWD-in m (r = 0.446) and in % of predicted (r = 0.422). CONCLUSIONS: In our sample, the cut-off of 4,580 steps/day was not sensitive enough to identify differences between the groups when compared with the predictors of mortality. The IPAQ, short version score correlated with steps/day.

Twitch Mouth Pressure and Disease Severity in Subjects With COPD

Patients with COPD have impaired respiratory muscle strength. Twitch mouth pressure (Ptw,m) in response to magnetic stimulation of the cervical nerve has been suggested to clinically reflect inspiratory muscle strength. However, studies on Ptw,m values and their relationship with disease severity are limited. Thus, we tested the Ptw,m values of subjects with COPD and investigated the relationship of these values with disease severity. We recruited 75 COPD patients and 63 age-matched controls. All participants were tested for Ptw,m, sniff nasal pressure (SNIP), and maximum static inspiratory mouth pressure (PImax ); the BODE (body mass index, air flow obstruction, dyspnea, exercise capacity) index was evaluated for overall severity assessment and the 6-min walk distance (6MWD) was used to determine the exercise capacity of subjects with COPD. Subjects with COPD had markedly lower Ptw,m values compared with the controls (10.00 ± 2.17 vs 13.66 ± 2.20 cm H2O for males, 8.83 ± 0.89 vs 11.81 ± 1.98 cm H2O for female; each with P < .001). The Ptw,m values decreased with increasing COPD severity, and similar trends were observed in the SNIP and PImax values. Regression correlation analysis showed that Ptw,m values were significantly correlated inversely with the BODE index (R = 0.65, P < .001) but positively correlated with 6MWD (R = 0.59, P < .001) in the COPD group; the SNIP values of subjects with COPD were also correlated inversely with their BODE index (R = 0.49, P < .001) but positively correlated with their 6MWD (R = 0.33, P < .005). Ptw,m values are 26.8% lower in male subjects with COPD and 25.3% lower in female subjects with COPD compared with the controls. The Ptw,m values of subjects with COPD decrease with increasing disease severity. Ptw,m was better correlated with the BODE index and exercise capacity than SNIP and PImax , which suggests that Ptw,m more accurately reflects the overall severity and burden of COPD.

Insomnia symptoms, objectively measured sleep, and disease severity in chronic obstructive pulmonary disease outpatients

BackgroundSleep disturbances are known to have a negative impact on a range of clinical outcomes in chronic obstructive pulmonary disease (COPD). We examined the associations of insomnia symptoms and objectively measured sleep parameters to a composite score for body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index (a multidimensional index of COPD severity), arterial blood gases, nocturnal respiratory disturbances, periodic limb movements (PLM), psychologic distress, pain, age, and sex. MethodsThe sample comprised 73 COPD outpatients (mean age, 63.6years; standard deviation {SD}, 7.5; range 47–85years; 41.1% women). Insomnia symptoms were measured with the Bergen Insomnia Scale (BIS) and sleep efficiency (SE), slow-wave sleep (SWS), and total sleep time (TST) were assessed with clinical polysomnography (PSG). ResultsBODE index was positively associated with composite BIS score (P=.040). Patients with more severe COPD presented more complaints of nonrestorative sleep compared to patients with less severe COPD (P=.010). In multivariate analysis, the composite BIS score was independently associated with PLM (P<.001), nocturnal respiratory disturbances (P=.001), pain (P=.031), and psychologic distress (P=.044) but not with the BODE index. Objectively measured sleep variables were not associated with any of the health-related variables. ConclusionInsomnia symptoms in COPD patients result from a wide range of health-related factors. More severe COPD may be associated with a subjective experience of nonrestorative sleep but not with objectively measured sleep variables.

Ivabradine in chronic diastolic heart failure

Background: Ivabradine has proved effective in patients with systolic heart failure improving survival and hospitalization rate from heart failure deterioration. Its main action is to reduce heart rate, ameliorating diastolic filling of the ventricles and improving cardiac output. This mechanism could play an important role in patients with heart failure due to left ventricular diastolic dysfunction. Purpose: The aim of the present study is to evaluate prospectively the effect of ivabradine on diastolic function in addition to optimum guideline-based treatment, and its impact on exercise capacity and echocardiographic indexes of diastolic heart failure. Methods: We enrolled 30 patients with diastolic heart failure (mean age 55±11yrs), NYHA class II/III with mean heart rate ≥75bpm and optimal medical treatment. Ivabradine was prescribed to these patients initially at a dose of 5mg bid and gradually uptitrated to 7,5mg bid. Before the initiation of ivabradine and three months later the patients underwent clinical evaluation, cardiopulmonary test to evaluate exercise capacity (exercise duration ED, peak oxygen uptake V02max) and echocardiographic evaluation (assessment of E-wave deceleration time EDT, isovolumic relaxation time IVRT, tissue Doppler assessment at the mitral annulus E/Em). Results: After 3 months of follow up heart rate has decreased from 85±5 t0 68±3bpm and NYHA has improved from class III to class II. Exercise capacity ameliorated (ED from 6,1±1,9 vs 7.3±1,4, P<0.05, PeakVO2 ml/kg/min from 15,6±2,1 to 17,9±2,8 P<0.05). Echocardiographic indexes have also improved EDT from 257±12 ms to 240±12ms p<0.02, IVRT from 83±9ms to 75±13ms, p<0.05, E/Em from 12,2±2,2 to 10,5±1,6 p<0,05). Conclusion: Addition of ivabradine to optimum medical treatment seems to improve functional status, exercise capacity and echocardiocardiographic indexes of diastolic function in patients with diastolic heart failure.