Function In Outpatients Research Articles

Specific Association Between Religiosity and Cognitive Functions in Alzheimer's Disease.

This study aimed to identify the specific relationship between subdomains of religious variables and cognitive functions in outpatients with Alzheimer's disease (AD). We recruited 325 patients with AD from a psychiatry outpatient clinic. The Korean version of the Consortium to Establish a Registry for Alzheimer's Disease and the Duke University Religion Index were used to assess cognitive functions and religiosity. We performed structural equation modeling and partial correlation analysis after controlling for demographic data. The model in which religiosity beneficially affects cognitive functions showed acceptable model fit (root-mean-square error of approximation = 0.076, Tucker-Lewis index = 0.921, comparative fit index = 0.947). In the partial correlation analysis, organizational religious activity demonstrated positive relationships with memory ( r = 0.144, P = .010), language ( r = 0.149, P = .007), and constructional ability ( r = 0.191 P = .001). Nonorganizational religious activity and intrinsic religiosity were positively associated with memory ( r = 0.115, P = .040; r = 0.140, P = .012) and constructional ability ( r = 0.207, P = .000; r = 0.136, P = .015). The findings suggest that religiosity positively affects cognitive functions and that each religious variable is related differently to the subdomains of cognitive functions in patients with AD.

Renal Function During an Open-Label Prospective Observational Trial of Sitagliptin in Patients With Diabetes: A Sub-Analysis of the JAMP Study.

BackgroundThe aim of the study was to determine the effects of sitagliptin on renal function in a diabetic population including patients with normal renal function.MethodsWe analyzed the association between 12-month, 50 mg/day sitagliptin and renal function in outpatients with type 2 diabetes mellitus and poor blood glucose control in a subset of patients in the larger Januvia Multicenter Prospective Trial in Type 2 Diabetes observational study. Stratified analyses of changes in estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were performed. Factors associated with changes in eGFR at 3 months were examined by multivariate regression analysis.ResultsOf the 779 patients enrolled, 585 were followed up for 12 months. eGFR decreased significantly from baseline at 3 and 12 months in patients with a baseline eGFR of ≥ 90 mL/min/1.73 m2 and in those with a baseline eGFR of ≥ 60 to < 90 mL/min/1.73 m2. Conversely, eGFR tended to increase at 3 and 12 months in patients with a baseline eGFR of ≥ 45 to < 60 mL/min/1.73 m2 and in those with a baseline eGFR of ≥ 30 to < 45 mL/min/1.73 m2. UACR decreased significantly (-21.6 (-46.8, 7.8)) at 3 months in patients with a baseline UACR of ≥ 30 mg/g Cre. Multivariate regression analysis of factors associated with changes in eGFR at 3 months revealed that higher baseline eGFR and greater decline in UACR were associated with more conspicuous decreases in eGFR.ConclusionsIn this group of diabetic patients receiving sitagliptin, eGFR declined in patients with high baseline eGFR, but not in those with a low baseline eGFR.

Lung function in severe pediatric asthma: a longitudinal study in children and adolescents in Brazil

BackgroundIn severe asthma, high doses of inhaled corticosteroids (ICS) are used in order to achieve clinical and functional control. This study aimed to evaluate lung function in outpatients (children and adolescents) with severe asthma in Brazil, all of whom were treated with high doses of ICS. We evaluated all spirometry tests together and by ICS dose: 800 and > 800 µg/day.MethodsThis was a 3-year longitudinal study in which we analyzed 384 spirometry tests in 65 severe asthma patients (6–18 years of age), divided into two groups by the dose of ICS (budesonide or equivalent): 800 and > 800 µg/day.ResultsAt baseline, the forced expiratory volume in one second (FEV1) and the FEV1/forced vital capacity (FVC) ratio were both < 80% of the predicted values in 50.8% of the patients. The median age of the patients was 10.4 years (interquartile range 7.8–13.6 years). In the sample as a whole, there were significant increases in FEV1% and in the FEV1/FVC% ratio (p = 0.01 and p < 0.001, respectively) over the course of the study. In the > 800 µg/day group, there were no statistical increases or decreases in FEV1, the FEV1/FVC ratio, or forced expiratory flow between 25 and 75% of the FVC (FEF25–75%), when calculated as percentages of the predicted values. However, the z-score for FEF25–75% showed a statistically significant reduction, in the sample as a whole and in the > 800 µg/day group. Also in the > 800 µg/day group, there was a significant reduction in the post-bronchodilator FEV1% (p = 0.004).ConclusionsThe fact that the spirometric parameters (as percentages of the predicted values) remained constant in the > 800 µg/day group, whereas there was a gain in lung function in the sample as a whole, suggests an early plateau phase in the > 800 µg/day group. However, there was some loss of lung function in the > 800 µg/day group, as evidenced by a decrease in the z-score for FEF25–75%, suggesting irreversible small airway impairment, and by a reduction in the post-bronchodilator FEV1%, suggesting reduced reversibility of airway obstruction. Among children and adolescents with severe asthma, the use of ICS doses higher than those recommended for age does not appear to improve lung function.

A 12-week randomized controlled trial of twice-daily intranasal oxytocin for social cognitive deficits in people with schizophrenia

Social cognition is impaired in people with schizophrenia and these deficits are strongly correlated with social functioning. Oxytocin is a hypothalamic peptide that contributes to maternal infant bonding and has diverse pro-social effects in adults. This study tested the hypothesis that 12weeks of intranasal oxytocin will improve social cognitive function in outpatients with schizophrenia and schizoaffective disorder. Sixty-eight eligible participants were randomized to oxytocin (24IU twice daily) or placebo. Social cognitive function was assessed using the Emotion Recognition-40, Brüne Theory of Mind, Reading the Mind in the Eyes test, Trustworthiness task and Ambiguous Intentions Hostility Questionnaire at baseline, 6weeks and 12weeks. In addition, social function was assessed using the Specific Levels of Functioning Scale and a role-play test, and psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). Fifty-five participants completed the 12-week trial. The study found no evidence for a differential advantage of oxytocin over placebo on social cognition. Among secondary outcomes, there was a modest advantage for oxytocin over placebo on a component of social functioning, although there was also evidence that the placebo group outperformed the oxytocin group on the role-play task. No between-group differences emerged on measures of psychopathology in pre-specified comparisons, but oxytocin showed significant within-group reduction in PANSS negative symptoms and significant between-group improvement in negative symptoms in the schizophrenia subgroup. Further testing is needed to clarify whether oxytocin has therapeutic potential for social cognitive deficits and/or negative symptoms in people with schizophrenia.

Effects of Fluvoxamine on Cognitive Function in Outpatients with Depression in Remission: Results of an Open-Label Pilot Study

A prospective, non-comparative, single-centre, single-group study was conducted in 50 adult patients with currently remitted recurrent depressive disorder according to the criteria of the International Classification of Diseases, 10th revision in order to assess changes in cognitive function during preventive therapy with fluvoxamine. Responses to therapy were evaluated using the Stroop Color and Word Test as the primary efficacy outcome. The revised Addenbrooke’s Cognitive Examination, Frontal Assessment Battery, Hamilton Rating Scale for Depression and Social Adaptation Self-evaluation Scale were used as secondary indices. Fluvoxamine was administered at doses of 50–150 mg/day for 24 weeks. Fluvoxamine therapy was associated with a range of ‘pro-cognitive’ responses that resulted in improvement in executive functions, including improved voluntary regulation of inhibitory control and restoration of verbal fluency. No dose relation was apparent for these effects. The incidence of treatmentrelated adverse events was low and no serious or severe events were recorded. These findings indicate that further studies of fluvoxamine are warranted and feasible to characterize possible beneficial effects on cognitive processes in patients with depression

Functional impact of different muscle localization techniques for Botulinum neurotoxin A injections in clinical routine management of post-stroke spasticity

ABSTRACTBackground: Treatment options for spasticity include intramuscular botulinum neurotoxin A (BoNT-A) injections. Both ultrasound (US) or electromyographic (EMG) guided BoNT-A injections are employed to isolate muscles. To date, most studies have included patients naïve to BoNT-A or following a prolonged wash out phase.Objective: To determine the impact of US/EMG guided BoNT-A injections on function in outpatients with spasticity receiving an established re-injection regime.Methods: Thirty patients post-stroke were investigated in a single-blinded, randomized controlled trial using a cross-over design for the EMG and US and a parallel design for the control group. The Modified Ashworth (MAS), Disability Assessment (DAS), Quality of Life (EQ-5D), self-rating scale and Barthel Index were assessed pre- and post-BoNT-A injections of upper limb muscles by a to the injection technique blinded person.Results: MAS improved in arm, finger and upper limb 4 weeks after BoNT-A treatment. The improvement showed no significant differences between the three injection techniques. Barthel Index, DAS and EQ-5D remained unchanged in all groups.Conclusions: This pilot study questions the impact of the instrumental guided injection techniques on everyday functionality in a routine clinical setting with established re-injection intervals. Larger trials are warranted with patients who are under long-term treatment on a regular basis.

Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients

BackgroundB-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up. Methods and resultsIn 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF=30%), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF=33%). Propensity score, matching several confounding baseline variables, was used to match pairs based on treatment strategy. The median follow-up was 37.4months. After propensity matching, a lower incidence of death (HR 0.45, 95%CI: 0.30–0.67, p<0.0001), and death or worsening renal function (HR 0.49, 95%CI 0.36–0.67, p<0.0001) was apparent in echo-BNP-guided group compared to clinically-guided group. Worsening of renal function (≥0.3mg/dl increase in serum creatinine) was observed in 9.8% of echo-BNP-guided group and in 21.4% of clinical assessed group (p<0.0001). The daily dose of loop diuretics did not change in echo-BNP-guided group, while it increased in 65% of patients in clinically-guided group (p<0.0001). ConclusionsEcho and BNP guided management may improve the outcome and reduce worsening of renal function in outpatients with chronic HFrEF.

Prognostic Value of Left Atrial Strain in Outpatients with De Novo Heart Failure

Left atrial (LA) dysfunction has been related to symptom onset in patients with heart failure (HF). However, the potential prognostic role of LA function has been scarcely studied in outpatients with new-onset HF symptoms. Consecutive outpatients with suspected HF onset evaluated at a one-stop clinic were screened. HF diagnosis was performed according to current guidelines. LA function was analyzed in patients in sinus rhythm by speckle-tracking echocardiography, determining LA peak strain rate after atrial contraction (LASRa) as a surrogate of atrial contractile function. Yearly prospective follow-up was conducted to report cardiovascular hospital admission or death. Patients without HF in sinus rhythm were followed as a control group. Survival curves were estimated using the Kaplan-Meier method. One hundred fifty-four outpatients were included (mean age, 74±10years; 67% women) with a median follow-up duration of 44.4months (interquartile range, 31-58months). Final diagnosis was 29.9% non-HF and 70.1% HF. More than two in five patients with HF (44.4%) had AF (n=48), and 55.6% (n=60) were in sinus rhythm. The latter were divided according to LASRa tertile: highest, -1.93±0.39sec-1; middle, -1.08±0.21sec-1; and lowest, -0.47±0.18sec-1. At the end of follow-up, patients with atrial fibrillation had a low event-free survival rate (56.3%), similar to those in the lower LASRa tertile (55.0%). The non-HF group had the best prognosis, and the higher and middle LASRa tertiles had intermediate prognoses (event-free survival, 85%, 75%, and 70%, respectively). The study of contractile LA function in outpatients with new-onset HF provides prognostic stratification. The early identification of patients at higher risk on the basis of their atrial function would allow focusing on them independently of their final diagnoses.

Efficacy of the Social Cognition Training Program in a Sample of Outpatients with Schizophrenia.

Social cognition is recognized to be a deficit in individuals suffering from schizophrenia. Numerous studies have explored the relationship between social cognition and social functioning in outpatients with schizophrenia through the use of different social cognition training programs. This study examines the efficacy of the Social Cognition Training Program (PECS in Spanish) in adults with a diagnosis of schizophrenia. Data were derived from a sample of 44 non-hospitalized adult patients who presented with a DSM-IV-TR Axis I diagnosis of schizophrenia and 39 healthy controls. The 44 patients were divided into an experimental group (n=20) and a control task group (n=24) that received cognitive training. Healthy controls did not receive any treatment. Sociodemographic and clinical variables correlates were computed. The 2-way ANOVA was conducted to examine differences between groups in pre- and post-treatment measures. Intragroup differences were explored using the paired-samples t-test. At the end of the training, patients in the experimental group showed a higher performance compared to patients in the control task group in the Hinting Task Test and in the emotion recognition of sadness, anger, fear, and disgust. The PECS proved to be effective in the improvement of some areas of theory of mind and emotion recognition in outpatients with schizophrenia. The PECS is one of the first programs developed in Spanish to train social cognition, and the data obtained support the importance of expanding the social cognition programs to non-English language samples.

Intrarater and Interrater Reliability of the Hierarchical Balance Short Forms in Patients With Stroke

ObjectiveTo examine the intrarater and interrater reliability of a quick balance measure, the Hierarchical Balance Short Forms (HBSF), in outpatients with stroke receiving rehabilitation. DesignA repeated-assessments design (1wk apart) was used to examine the intrarater and interrater reliability of the HBSF. The HBSF was administered by a single rater in the intrarater reliability study and by 2 raters in the interrater reliability study. The raters had sufficient working experience in stroke rehabilitation. SettingSeven teaching hospitals. ParticipantsTwo independent groups of outpatients (N=106; each group, n=53) with stroke in chronic stages and in stable medical condition were recruited. InterventionsNot applicable. Main Outcome MeasureHBSF. ResultsFor the intrarater reliability study, the values of the intraclass correlation coefficient (ICC), minimal detectable change (MDC), and percentage of minimal detectable change (MDC%) were .95, 1.02, and 16.3%, respectively, for the HBSF. The 95% limits of agreement (LOA) of the HBSF ranged from −.69 to 1.19. For the interrater reliability study, the values of the ICC, MDC, and MDC% were .91, 1.22, and 18.3%, respectively, for the HBSF. The 95% LOA of the HBSF ranged from −1.01 to 1.35. ConclusionsOur results suggest that the HBSF has satisfactory intrarater and interrater reliability for assessing balance function in outpatients with stroke. The MDC values of the HBSF are useful for both researchers and clinicians to determine whether the change in balance function of an individual patient is real when administered by an individual rater or by different raters.

Cognitive function and risperidone long-acting injection vs. paliperidone palmitate in schizophrenia: a 6-month, open-label, randomized, pilot trial.

BackgroundRecently, long-acting injection (LAI) of second-generation antipsychotics has become a valuable strategy for the treatment of schizophrenia. However, few studies have compared the effects of different LAI antipsychotics on cognitive functions so far. The present study aimed to compare the influence of risperidone LAIs (RLAI) and paliperidone palmitate LAIs (PP) on cognitive function in outpatients with schizophrenia.MethodsIn this 6-month, open-label, randomized, and controlled study, 30 patients with schizophrenia who were treated with RLAIs were randomly allocated to the RLAI-continued group or the PP group. At baseline and 6 months, the patients were evaluated using the Brief Assessment of Cognition in Schizophrenia (BACS) that was the primary outcome of the study. The Subjective Well-being under Neuroleptic drug treatment-Short form (SWNS), the Positive and Negative Syndrome Scale (PANSS), and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) scores were secondary outcome variables and they were tested at the same time points.ResultsThe two groups did not differ in terms of PANSS, DIEPSS, or SWNS total score changes. However, the BACS score for the attention and processing speed item showed higher improvement in the PP group than the RLAI group (p = 0.039).ConclusionsThe results of this preliminary study suggest that PPs may improve attention and processing speed more than RLAIs. Anyway, a replication in a larger and double-blind study is needed.Trial registrationUMIN000014470. Registered 10 July 2014Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0883-9) contains supplementary material, which is available to authorized users.

The relation between insulin resistance and lung function: a cross sectional study.

BackgroundImpaired lung function and insulin resistance have been associated and thereby have also been indicated to be powerful predictors of cardiovascular mortality. Therefore, the co-existence of insulin resistance and impaired lung function accompanied with cardiovascular risk factors should induce cardiovascular mortality even in patients without known respiratory disease in a cumulative pattern. It could be useful to determine the lung function of patients with insulin resistance in order to decrease cardiovascular mortality by means of taking measures that minimize the risk of decline in lung function. However, no prior studies have been done on association between insulin resistance and lung function in adults in Turkey. We aimed to determine if insulin resistance plays a detrimental role in lung function in outpatients admitted to internal medicine clinics in adults from Turkey.MethodsA total of 171 outpatients (mean ± SD) age: 43.1 ± 11.9) years) admitted to internal medicine clinics were included in this single-center cross-sectional study, and were divided into patients with (n = 63, mean ± SD) age: 43.2 ± 12.5) years, 83.5 % female) or without (n = 108, mean ± SD) age: 43.0 ± 11.6) years, 93.5 % female) insulin resistance. All patients were non-smokers. Data on gender, age, anthropometrics, blood pressure, blood biochemistry, metabolic syndrome (MetS), and lung function tests were collected in each patient. Correlates of insulin resistance were determined via logistic regression analysis.ResultsInsulin resistance was present in 36.8 % of patients. Logistic regression analysis revealed an increase in the likelihood of having insulin resistance of 1.07 times with every 1-point increase in waist circumference, 1.01 times with every 1-point increase in triglycerides, 0.93 times with every 1-point decrease in HDL (high density lipoprotein) cholesterol, and 0.86 times with every 1-point decrease in percentage of FEV1/FVC pre (FEV1%pre: Forced expiratory volume in the first second of expiration for predicted values; FVC%pre.: Forced vital capacity for predicted values).ConclusionsInsulin resistance should also be considered amongst the contributing factors for decline in lung function.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0125-9) contains supplementary material, which is available to authorized users.

Screening for impaired renal function in outpatients before iodinated contrast injection: Comparing the Choyke questionnaire with a rapid point-of-care-test

Rationale and purposeTo determine the usefulness of the Choyke questionnaire with a creatinine point-of-care test (POCT) to detect impaired renal function amongst outpatients receiving intravenous iodinated contrast in a tertiary centre. Materials and methodsBetween July and December 2012, 1361 outpatients had their serum creatinine determined by POCT and answered the Chokye questionnaire just before their examination. ResultsFour hundred and eighty (35.2%) patients had at least one ‘Yes’ response. Forty-four patients (3.2%) had estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 and 14 patients (1.0%) have eGFR <45mL/min/1.73m2. Sensitivity, specificity, positive predictive value and negative predictive value of the Choyke criteria in detecting patients with eGFR <60mL/min/1.73m2 are respectively: 65.9%, 65.8%, 6.0% and 98.3% and to detect eGFR <45mL/min/1.73m2: 92.9%, 65.3%, 2.7% and 99.9%. Only ‘Yes’ responses to ‘Have you ever been told you have renal problems?’ and ‘Do you have diabetes mellitus?’ were statistically significant in predicting eGFR <45mL/min/1.73m2, with odds ratio 98.7 and 4.4 respectively. ConclusionThe Choyke questionnaire has excellent sensitivity and moderate-to-good specificity in detecting patients with <45mL/min/1.73m2, below this level it has been shown that risk of contrast induced nephropathy increases significantly, making it an effective screening tool. Also the use of POCT can potentially reduce waiting time.

Effectiveness and cost-effectiveness of cognitive adaptation training as a nursing intervention in long-term residential patients with severe mental illness: study protocol for a randomized controlled trial.

BackgroundDespite the well-known importance of cognitive deficits for everyday functioning in patients with severe mental illness (SMI), evidence-based interventions directed at these problems are especially scarce for SMI patients in long-term clinical facilities. Cognitive adaptation Training (CAT) is a compensatory approach that aims at creating new routines in patients’ living environments through the use of environmental supports. Previous studies on CAT showed that CAT is effective in improving everyday functioning in outpatients with schizophrenia. The aim of this study is to evaluate the effect of CAT as a nursing intervention in SMI patients who reside in long-term clinical facilities.Methods/DesignThis is a multicenter cluster randomized controlled trial comparing CAT (intervention group) as a nursing intervention to treatment as usual (control group). The primary goal is to evaluate the effectiveness of CAT on everyday functioning. Secondary outcomes are quality of life, empowerment and apathy. Further, an economic evaluation will be performed. The study has a duration of one year, with four follow-up assessments at 15, 18, 21 and 24 months for the intervention group.DiscussionThere is a need for evidence-based interventions that contribute to the improvement of the functional recovery of long-term residential patients. If our hypotheses are confirmed, it may be recommended to include CAT in the guidelines for SMI care and to implement the method in standardized care.Trial registrationNederlands Trial Register (identifier: NTR3308). Date registered: 12 February 2012.

整形外科外来患者における床からの立ち上がり所要時間と身体機能との関連性

〔目的〕整形外科外来患者において床からの立ち上がり所要時間（立ち上がり時間）と，身体機能や痛みとの関連性を検討することとした．〔対象〕整形外科外来通院高齢者88名とした．〔方法〕年齢，性別，痛みを有する部位の総数（痛み総数）を聴取し，立ち上がり時間，BMI，筋力（握力，膝伸展筋力），バランス能力（FRT），柔軟性（FFD）を測定した．〔結果〕年齢，性別，BMIで調整した重回帰分析の結果，痛み総数，膝伸筋力，FRT，FFDが立ち上がり時間と有意に関連していた．〔結語〕立ち上がり時間の遅延は身体機能低下の一指標となり，さらに痛みとの関連性を示すことから新たに痛みの管理の重要性が示唆される．

Renal function largely influences Galectin-3 prognostic value in heart failure

BackgroundGalectin-3 (Gal-3) has been associated with cardiac remodeling and heart failure (HF) prognosis. Renal function is also a well known HF prognostic indicator. The link between renal insufficiency, HF, and Gal-3 is not completely elucidated. Methods and resultsWe explored the association between Gal-3 and renal function in a cohort of 876 consecutive ambulatory patients with HF (mean age: 68years; mean left ventricular ejection fraction [LVEF]: 36%), 52.2% had HF etiology of ischemic heart disease. Circulating Gal-3 was highly correlated with estimated glomerular filtration rate (eGFR), calculated with either the chronic kidney disease-epidemiology (CKD-EPI) equation (r=−0.64) or the CKD-EPI-cystatin-C equation (r=−0.59) and with Cystatin-C levels (r=0.70), after adjusting for age, sex, New York Heart Association (NYHA) functional class, LVEF, and HF etiology (all p<0.001). Patients were stratified by CKD-EPI-eGFR (ml/min/1.73m2), as follows: ≥60 (n=218), 30 to 59 (n=434), and <30 (n=224). In these strata, Gal-3 significantly increased (median [IQR]: 12.3 [10.4–15.6]; 16.1 [13–19.8]; and 24.5 [20–33.8] ng/ml, respectively; trend p<0.001). This was independent of NYHA functional class (I–II and III–IV) and LVEF (<45% and ≥45%). Gal-3 was associated with mortality in univariate analyses, but after adjusting for CKD-EPI-eGFR, the hazard ratios were 1.10 (95% CI: 0.89–1.34, p=0.39) for all cause death, and 0.90 (95% CI: 0.68–1.21, p=0.50) for cardiovascular death. Similar results were obtained with eGFRs calculated with the CKD-EPI-cystatin-C equation. ConclusionCirculating Gal-3 was highly associated with renal function in outpatients with HF. The value of Gal-3 for HF prognosis declined after adjusting for renal function.

Influence of renal impairment on myocardial function in outpatients with systolic heart failure: An echocardiographic and cardiac biomarker study

BackgroundRenal dysfunction (RD) is associated with poor outcome in systolic heart failure (HF). Left ventricular ejection fraction (LVEF) is not depressed to a greater extent in patients with RD compared to patients with normal renal function, but it is relatively unknown whether other measures of myocardial function are impaired by RD. The objective of the present study is to evaluate whether RD in systolic HF is associated with excessive impairment of myocardial function, evaluated by strain analysis and cardiac biomarkers. MethodsPatients with LVEF <0.45% were enrolled from an outpatient HF clinic. The patients underwent advanced echocardiography. Glomerular filtration rate was estimated by the CKD-EPI equation (eGFR) and patients grouped by eGFR: eGFRgroup-I, ≥90ml/min/1.73m2; eGFRgroup-II, 60–89ml/min/1.73m2; and eGFRgroup-III, ≤59ml/min/1.73m2. Multivariate regression models were developed to evaluate the associations between eGFR groups, echocardiographic measures and cardiac biomarkers. ResultsA total of 149 patients participated in the study. Median age was 69years, 26% were female; LVEF was 33%. Patients with a low eGFR were older (P<0.001), but there were no differences in frequency of atrial fibrillation, hypertension, diabetes and ischemic heart disease between eGFR groups (P>0.05 for all). RD was associated with impaired global longitudinal strain (P=0.018), increased E/e′ (P=0.032), larger left atria (P=0.038) and increased levels of proANP (P<0.001), NT-proBNP (P<0.001) and troponin I (P=0.019) after adjustment for traditional confounders. ConclusionsEchocardiographic measures and biomarkers reflecting different aspects of myocardial function are impaired in systolic HF patients with RD and the increased mortality risk in these patients may partly be explained by a depressed cardiac function.

Left atrial dysfunction relates to symptom onset in patients with heart failure and preserved left ventricular ejection fraction.

Pathophysiology of heart failure (HF) with preserved ejection fraction (HFPEF) remains unclear. Left atrial (LA) function has been related to HF symptoms. Our purpose is to analyse LA function in outpatients with new onset symptoms of HF. An observational study was performed including 138 consecutive outpatients with suspected HF referred to a one-stop clinic. Final diagnosis [HF with reduced EF (HFREF), HFPEF, or non-HF] was established according to current recommendations. Echocardiography was performed in all patients. LA function was analysed using strain derived from speckle tracking in sinus rhythm patients (n = 83). Results were analysed with ANOVA and Bonferroni statistical tests. Receiver operating characteristic (ROC) curves were constructed to investigate the predictive ability of LA parameters for the final diagnosis of HF. Patients were 75 ± 9 years and 63% women. Final diagnosis was 23.2% HFREF, 45.7% HFPEF, and 31.2% non-HF. Left ventricular strain rate showed no differences between non-HF and HFPEF groups, but both groups showed differences with the HFREF group. LA strain rate (A- and S-waves) was significantly reduced in both HF groups (without differences among them) when compared with the non-HF group. LA strain rate and indexed volume showed significant accuracy for HF diagnosis in ROC curves. In outpatients with new-onset symptoms of HF, LA dysfunction was observed. It might be the initial mechanism in the development of symptoms in HFPEF patients. These findings support the relationship of LA dysfunction with HFPEF, suggesting that the analysis of LA function may be useful in sinus rhythm patients with new-onset dyspnoea.

Prognostic value of worsening renal function in outpatients with chronic heart failure

Introduction and objectivesRenal function impairment predicts poor survival in heart failure. Attention has recently shifted to worsening renal function, based mostly on serum creatinine and estimated glomerular filtration rate. We assessed the prognostic effect of worsening renal function in ambulatory heart failure patients. MethodsData from 306 ambulatory patients were abstracted from medical files. Worsening renal function was based on the change in estimated glomerular filtration rate, serum creatinine and urea within 6months of referral. Prognosis was assessed by the composite endpoint all-cause death or heart failure hospitalization, censored at 2years. Hazard ratios were estimated for worsening renal function, adjusted for sex, age, diabetes, New York Heart Association class, left ventricular systolic dysfunction, medications and baseline renal function. ResultsThe agreement among definitions was fair, with kappa coefficients generally not surpassing 0.5. Worsening renal function was associated with poor outcome with adjusted hazard ratios (95% confidence interval) of 3.2 (1.8–5.9) for an increase of serum creatinine >0.3mg/dl; 2.2 (1.3–3.7) for an increase in serum urea >20mg/dl and 1.9 (1.1–3.3) for a decrease in estimated glomerular filtration rate >20%, independent of baseline renal function. The 2-year risk of death/heart failure hospitalization was approximately 50% in patients with an increase in serum creatinine or in serum urea; this positive predictive value was higher than for decreasing estimated glomerular filtration rate. ConclusionsIn conclusion, worsening renal function was significantly associated with a worse outcome. Different definitions identified different patients at risk and increasing creatinine/urea performed better than decreasing estimated glomerular filtration rate.

Efficacy of the Social Cognition Training Program in a sample of schizophrenic outpatients.

Objective: Social cognition is recognized to be a deficit in individuals suffering from schizophrenia. Numerous studies have explored the relationship between social cognition and social functioning in outpatients with schizophrenia through the use of different social cognition training programs. This study examines the efficacy of the Social Cognition Training Program (PECS in Spanish) in adults with a diagnosis of schizophrenia. Methods: Data were derived from a sample of 44 non-hospitalized adult patients, who presented with a DSM-IV-R Axis I diagnosis of schizophrenia, and 39 healthy controls. Patients were divided into an experimental group and a control task group, that received cognitive training. Healthy controls did not receive any treatment. Sociodemographic and clinic variables correlates were computed. 2-way ANOVA was conducted to examine differences between groups in pre and post-treatment measures. Intragroup differences were explores using the paired-samples t-test. Results: At the end of the training, patients in the experimental group showed a higher performance compared to patients in the control task group, in the Hinting Task Test and in the emotion recognition of sadness, anger, fear, and disgust. Conclusions: The PECS proved to be effective in the improvement of some areas of theory of mind and emotion recognition, in outpatients with schizophrenia. The PECS is one of the first programs developed in Spanish to train social cognition, and the data obtained support the importance of expand the social cognition programs to non-English language samples.