Predictor Of Functional Capacity Research Articles

Type 2 diabetes mellitus negatively affects the functional performance of 6-min step test in chronic heart failure: a 3-year follow-up study

BackgroundType 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) present a decrease in functional capacity due to the intrinsic nature of both pathologies. It is not known about the potential impact of T2DM on functional capacity when assessed by 6-min step test (6MST) and its effect as a prognostic marker for fatal and non-fatal events in patients with CHF.Objectiveto evaluate the coexistence of T2DM and CHF in functional capacity through 6MST when compared to CHF non-T2DM, as well as to investigate the different cardiovascular responses to 6MST and the risk of mortality, decompensation of CHF and acute myocardial infarction (AMI) over 36 months.MethodsThis is a prospective cohort study with 36 months of follow-up in individuals with T2DM and CHF. All participants completed a clinical assessment, followed by pulmonary function testing, echocardiography, and 6MST. The 6MST was performed on a 20 cm high step and cardiovascular responses were collected: heart rate, systemic blood pressure, oxygen saturation, BORG dyspnea and fatigue. The risk of mortality, acute myocardial infarction and decompensation of CHF was evaluated.ResultsEighty-six participants were included. The CHF-T2DM group had a significantly lower functional capacity than the CHF non-T2DM group (p < 0.05). Forced Expiratory Volume in one second (L), ejection fraction (%), gender and T2DM influence and are predictors of functional capacity (p < 0.05; adjusted R squared: 0.419). CHF-T2DM group presented a higher risk of mortality and acute myocardial infarction over the 36 months of follow-up (p < 0.05), but not to the risk of decompensation (p > 0.05).ConclusionT2DM negatively affects the functional performance of 6MST in patients with CHF. Gender, ejection fraction (%), FEV1 (L) and T2DM itself negatively influence exercise performance.

Growth Differentiation Factor-15 as a Predictor of Functional Capacity, Frailty, and Ventricular Dysfunction in Patients With Aortic Stenosis and Preserved Left Ventricular Ejection Fraction

In aortic stenosis (AS), left ventricular (LV) remodeling often occurs before symptom onset, and early intervention may be beneficial. Risk stratification remains challenging and identification of biomarkers may be useful. We evaluated the association between growth differentiation factor-15 (GDF-15) and soluble suppression of tumorigenicity 2 (sST2) and known markers of poor prognosis in AS. Baseline plasma GDF-15 and sST2 levels were measured in 70 patients with moderate-severe AS (aortic valve area <1.5 cm2) and preserved LV ejection fraction (>45%). Patients were categorized into "low GDF-15" versus "high GDF-15" and "low sST2" versus "high sST2" groups. Groups were compared for differences in cardiovascular risk factors, 6-minute walk test, 5 m gait speed, cognitive function (Montreal Cognitive Assessment), and echocardiographic parameters. Overall, 44% of patients were deemed asymptomatic by New York Heart Association class, 61% had severe AS (aortic valve area <1 cm2) and all patients had preserved LV ejection fraction. GDF-15 levels were not predictive of AS severity. However, high GDF-15 (>1,050 pg/ml) was associated with LV dysfunction as shown by lower indexed stroke volume (p <0.01), worse LV global longitudinal strain (p=0.04), greater mean E/e' (p=0.02) and indexed left atrial volume (p <0.01). It was also associated with decreased functional capacity with shorter 6-minute walk test (p=0.01) and slower 5 m gait speed (p=0.02). Associations between sST2 levels and markers of poor prognosis were less compelling. In this study of patients with moderate to severe AS, elevated GDF-15 levels are associated with impaired functional capacity, poorer performance on fragility testing, and LV dysfunction. In conclusion, GDF-15 may integrate these markers of adverse outcomes into a single biomarker of poor prognosis.

The Six-Minute Step Test as a Predictor of Functional Capacity according to Peak VO2 in Cardiac Patients.

ResumoFundamento:O teste do degrau de seis minutos (TD6) é uma forma simples de avaliar a capacidade funcional, embora tenha sido pouco estudado em pacientes com doença arterial coronariana (DAC) ou insuficiência cardíaca (IC).Objetivo:Analisar a associação entre o TD6 e o consumo de oxigênio de pico (VO2pico) e desenvolver uma equação que estime o VO2pico com base no TD6, bem como determinar um ponto de corte para o TD6 que preveja um VO2pico ≥ 20 mL.kg-1.min-1Métodos:Nos 171 pacientes submetidos ao TD6 e a um teste de exercício cardiopulmonar, análises da curva ROC, de regressão e de correlação foram usadas, e um p < 0,05 foi admitido como significativo.Resultados:A idade média foi 60±14 anos, e 74% eram do sexo masculino. A média da fração de ejeção ventricular esquerda foi 57±16%; 74% apresentavam DAC, e 28%, IC. A média do VO2pico foi 19±6 mL.kg-1.min-1, e o desempenho médio do TD6 foi 87±45 passos. A associação entre o TD6 e o VO2pico foi r 0,69 (p < 0,001). Os modelos VO2pico = 19,6 + (0,075 x TD6) – (0,10 x idade) para homens e VO2pico = 19,6 + (0,075 x TD6) – (0,10 x idade) – 2 para mulheres poderiam prever o VO2pico com base nos resultados do TD6 (R ajustado 0,72; R2 ajustado 0,53). O ponto de corte mais acurado para que o TD6 preveja um VO2pico ≥ 20 mL.kg-1.min-1 foi de > 105 passos [área sob a curva 0,85; intervalo de confiança de 95% 0,79 - 0,90; p < 0,001].Conclusão:Uma equação que preveja o VO2pico com base nos resultados do TD6 foi derivada, e foi encontrada uma associação significativa entre o TD6 e o VO2pico. O ponto de corte do TD6, que prevê um VO2pico ≥ 20 mL.kg-1.min-1, foi > 105 passos. (Arq Bras Cardiol. 2021; 116(5):889-895)

Predictors of functional capacity as measured by the Glittre activities of daily living test in women with rheumatoid arthritis.

Although pulmonary involvement is the most common extra-articular manifestation of rheumatoid arthritis (RA), traditional pulmonary function tests (PFTs) do not show a good correlation with the field tests usually performed in these patients. In recent decades, measurement of ventilation distribution heterogeneity through the nitrogen single-breath washout (N2SBW) test and evaluation of functional capacity during exercise using the Glittre activities of daily living test (GA-T) have been increasingly used. Therefore, the objective of this study was to evaluate predictors of GA-T outcomes in women with RA considering demographic, anthropometric, clinical, functional variables, and chest computed tomography (CT) findings. Forty-three women with RA underwent the GA-T, the N2SBW test, spirometry, measurement of the diffusing capacity for carbon monoxide (DLco), measurement of respiratory muscle strength, and evaluation of physical function of the lower and upper limbs through the Health Assessment Questionnaire Disability Index (HAQ-DI). Chest CT scans were analyzed retrospectively. The GA-T time showed significant correlations with the DLco (rs=-0.397, P=0.008), forced vital capacity/DLco (rs=0.307, P=0.044), phase III slope of the N2SBW test (SIIIN2, rs=0.644, P<0.0001), and the HAQ-DI (rs=0.482, P=0.001). Disease extent as assessed by chest CT was associated with the GA-T time. On multiple regression analysis, the SIIIN2 and HAQ-DI were the only predictors of the GA-T time, explaining 40% of its variability. Thus, ventilation distribution heterogeneity and worse physical function substantially explain the variability in GA-T time in women with RA and varying extents of disease on chest CT.

Significance of pulmonary hypertension probability in predicting six-minute walking distance in uncorrected acyanotic grown-up congenital heart disease at Sanglah General Hospital, Bali

Background: Pulmonary hypertension may cause impairment of functional capacity, which is a predictor of survival and quality of life in a patient with uncorrected acyanotic grown-up congenital heart disease. A six-minute walking test (6MWT) is a submaximal exercise test to measure these patients' functional capacity. This study aims to determine the significance of echocardiography parameters, such as Pulmonary Hypertension (PH) probability and Mean Pulmonary Artery Pressure (MPAP), as a predictor of functional capacity by 6MWT measurement.Methods: Analytic observational study was used to determined walking distance as a measurement of functional capacity in acyanotic CHD patients. The probability of (PH) and MPAP was obtained from echocardiography and divided into three categories (low, intermediate, and high probability) based on guidelines defined by PH 2015. MPAP measured the d using the pulmonary valve acceleration time formula (90 – 0.62*PVAT). The relationship between 6MWT distance with MPAP and probability of PH was measured using pearson correlation and one-way ANOVA. We included 43 patients from the Grown-Up Congenital Heart Disease (GUCH) registry who fulfills the inclusion criteria (age more than 18 years whom defect correction has not been done). All participants were given informed consent. Data were analyzed using SPSS version 20 for Windows.Results: Forty-three patients were included in this study, with 35 females (81.4%) and 8 males with age range 18-75 years old. The most prevalent GUCH was an atrial septal defect (69.8%). Twenty-one (48%) patient was classified as high PH probability. There was a significant difference between the mild probability of PH with intermediate (MD=94.3 meters; p &lt; 0.001) and high probability (MD=141.9 meters; p&lt;0.001). MPAP shows a strong correlation with walking distance (r=-0.68; p&lt;0.001).Conclusion: GUCH patients with high and intermediate PH probabilities from echocardiography had a shorter walking distance and lowered functional capacity. MPAP is a reliable measurement to predict 6MWT in these patients.

Matrix metalloproteinase-12 cleaved fragment of titin as a predictor of functional capacity in patients with heart failure and preserved ejection fraction

Objectives Serum levels of matrix metalloproteinase-12 cleaved fragment of titin (TIM), a novel circulatory biomarker specific for cardiac titin degradation, has emerged as a potential biomarker in cardiovascular diseases. In this work, we aimed to evaluate the association between TIM and maximal functional capacity assessed by the percentage of predicted peak exercise oxygen uptake (pp-peakVO2) in patients with heart failure and preserved ejection fraction (HFpEF). Design. In this post-hoc study, we included 46 stable symptomatic (New York Heart Association II-III) HFpEF patients enrolled in the TRAINING-HF study (NCT02638961). pp-peak-VO2 was calculated from baseline values. Baseline circulating levels of TIM were measured by competitive ELISA in serum from the TRAINING-HF patients. The independent association between TIM and pp-peakVO2 was evaluated by multivariate linear regression analysis. Results. The mean age of the sample was 73.8 ± 8.7 years, 56.5% were females, and 76.1% were on NYHA II. The medians of pp-peakVO2 and TIM were 60.9% (50.4–69.3), and 130.1 ng/mL (98.1–159.5), respectively. The median of NT-proBNP was 912 pg/mL (302–1826). pp-peakVO2 was significant and inversely correlated with TIM (r= −41, p = .005). In multivariate analysis, after adjusting for NYHA class, hypertension, body mass index, and glomerular filtration rate, higher TIM was significantly associated with lower pp-peak VO2 (p = .029). Conclusions. In this sample of stable and symptomatic HFpEF patients, higher serum levels of TIM identified patients with worse functional status.

&lt;p&gt;Association Between the Predictors of Functional Capacity and Heart Rate Off-Kinetics in Patients with Chronic Obstructive Pulmonary Disease&lt;/p&gt;

BackgroundThe heart rate (HR) kinetics as well as other predictors of functional capacity such as the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT), the Duke Activity Status Index (DASI) and the handgrip strength (HGS) represent important tools in assessing the impact of COPD on exercise performance and health status of individuals with COPD.PurposeTo verify the relationship between functional capacity, measured using the six-minute walking test (6MWT), with the HR off-kinetics, HGS and the DASI and CAT scores.MethodsFor this cross-sectional study, 29 subjects with COPD underwent body composition, pulmonary function and cardiac function tests. Subsequently, the DASI and CAT questionnaires and HGS test were performed. The beat-to-beat R-R intervals (IRR) were collected in rest, during the test and in recovery after the 6MWT. The HR off-kinetics was obtained during a 360-second period in post-exercise recovery through the HR mono-exponential decay.ResultsModerate correlations were observed between: 1) walked distance (WD) in the 6MWT and the CAT and DASI scores (r= −0.58, p=0.001 and r= 0.58, p=0.001, respectively); 2) WD and HGS (r=0.37, p=0.05); 3) and WD and HR off-kinetics (τ; r= −0.54, p=0.002 and MRT; r= −0.55, p=0.002, respectively).ConclusionThe 6MWT performance is a direct measurement to evaluate functional capacity. Additionally, it is related to other direct and indirect markers for functional evaluation in patients with COPD. These results suggest the application of these tools in clinical practice, based on the accessibility, non-invasive character and easy applicability of these methods.

The Impact of Anticholinergic Burden on Functional Capacity in Persons With Schizophrenia Across the Adult Life Span.

Anticholinergic burden (ACB) from medications impairs cognition in schizophrenia. Cognition is a predictor of functional capacity; however, little is known about ACB effect on functional capacity in this population. This study assesses the relationship between ACB and functional capacity across the life span in individuals with schizophrenia after controlling for ACB effect on cognition. A cross-sectional analysis was performed with data collected from 6 academic tertiary health centers. Two hundred and twenty-three community-dwelling participants with schizophrenia or schizoaffective disorder were included in this study. Main variables were ACB, antipsychotic olanzapine equivalents, functional capacity, cognition, and negative symptoms. Simultaneous linear regression analyses were performed to assess the association between ACB, functional capacity, and cognition and then between ACB and cognition. A mediation analysis was then performed to examine whether cognition mediated ACB effect on functional capacity if there was an association between ACB and cognition. Mean age of participants was 49.0 years (SD = 13.1, range 19-79), and 63.7% of participants had severe ACB, ie, a total score of 3 or above. Regression analyses revealed that ACB, age, education, and cognition independently predicted functional capacity and that ACB predicted cognition among those aged 55 years and older. Mediation analysis showed that cognition did partially mediate the effect of ACB on functional capacity in this older cohort. In conclusion, people with schizophrenia are exposed to severe ACB that can have a direct negative impact on functional capacity after controlling for its impact on cognition. Reducing ACB could improve functional capacity and potentially real-world function in schizophrenia.

Characterising recovery from renal transplantation and live-related donation using cardiopulmonary exercise testing

Background An association between end-stage renal failure and exercise intolerance exists. Whether live kidney donation impacts on exercise tolerance is unknown. Here recovery post renal transplant and donation using cardiopulmonary exercise testing is investigated. Methods Renal donors (n = 28) and recipients (n = 24) undertook a cardiopulmonary exercise test, Duke activity score index and patient reported health score questionnaires pre-operatively and in the 7th and 14th week post-operatively. Anaerobic threshold, peak oxygen uptake and ventilatory equivalents were measured in relation to activity and reported health scores. Haemoglobin and renal function was recorded. Results Recipients showed impaired cardiopulmonary function compared to donors with lower anaerobic threshold (10.5 vs. 14.4 ml/kg/min) and peak oxygen uptake (18.5 vs 23.0 ml/kg/min). Post-operatively the anaerobic threshold of recipients improved and normalised by the 14th week, whereas that in donors fell by ∼20% by the 7th (mean 11.4 ml/kg/min), recovering by the 14th (mean 15.6 ml/kg/min). Reported health but not activity scores showed similar changes. Conclusions Recovery following renal transplantation and donation differ. Transplantation improves renal function resulting in an increase in anaerobic threshold and peak oxygen uptake which essentially normalise by the 14th week post-operatively. Donors suffer a 20% reduction in cardiopulmonary reserve post-operatively, which recovers by the 14th week, suggesting no associated chronic exercise intolerance. IMPLICATIONS FOR REHABILITATION Cardiopulmonary exercise testing is a real-time predictor of functional capacity and thus is used as a pre-operative tool to measure physiological fitness and predict outcomes. Renal failure is associated with exercise intolerance and transplantation is transformational in terms of quality of life, longevity and healthcare cost. Live – related renal donation is increasingly available but whether donation itself carries a long-term health burden has not been previously well established. This study suggests that renal donation is not associated with long-term cardiopulmonary compromise and patients who donate their kidneys recover their previous fitness within 14 weeks.

LEFT ATRIAL STRAIN BY SPECKLE TRACKING ECHOCARDIOGRAPHY IS NOT PREDICTED FUNCTIONAL CAPACITY IN HYPERTENSIVE POPULATION WITH PRESERVED SYSTOLIC FUNCTION AND NORMAL RESTING LEFT ATRIAL PRESSURE

Abstract&#x0D; Background: Hypertension is associated with diastolic dysfunction and impaired exercise capacity. LA has a substantial role to provides an optimal left ventricle diastolic filling. In this study, we aimed to assess the left atrial strain through STE as a predictor of functional capacity in the hypertensive population.&#x0D; Methods: A total of 43 hypertensive women (mean age 50 ± 5.2 y.o; BMI 28.5± 4.1 Kg/m2) consecutively enrolled in this study. Patients with LVEF &lt;50% or significant valvular pathology excluded. Two-dimensional STE performed to asses LA strain parameters, including PALS , PACS, and conduit strain. Functional capacity assessed by treadmill stress test using Bruce protocol.&#x0D; Result: Mean PALS, PACS, and conduit strain in this study was lower than reference normal value 25.8%&lt; 39%; 12.4% &lt;17%; 13.5% &lt;23%, respectively). All of the subjects had a preserved systolic function (mean LVEF 72.5 ± 7.6%) and normal resting LA pressure (mean PCWP 11.96 ± 2.09). Left atrial strain parameters value in the low-fair functional capacity group was not significantly different to average-good functional capacity group (p&gt;0.05). Left atrial strain parameters value was not significantly correlated to exercise duration and achieved METS (P&gt;0.05). &#x0D; Conclusion: LA strain value in this study was below the standard reference limit. LA strain cannot predict functional capacity in the hypertensive population with preserved ejection fraction and normal resting LA pressure.

Comparison of predictive equations of lean mass in young and postmenopausal women

The lean mass (LM) is a predictor of functional capacity, quality of life, and mortality. In this way, the LM should be measured by reliable methods. However, it presents high cost and generally predictive equations are used in clinical practice, but little is known which is the best predictive equation of LM in women. The purpose of the present study was to verify which predictive equation of LM correctly estimates the LM in young and postmenopausal women. Eighty-one women aged 19-81 years were evaluated. Body weight, height, waist circumference, and skin folds (bicipital, tricipital, subscapular and suprailiac) were measured. The LM was evaluated by DXA and also estimated using the predictive equations of Hume I, Hume II, Salamat, Kulkarni I, and Kulkarni II. Bland-Altman analysis was performed to evaluate the over/underestimation of the LM by predictive equations. The equations of Salamat, Kulkarni II, Hume I and Kulkarni I overestimated the LM by 0.0 (7.0; -6.9) kg; 2.3 (7.5; -3.0) kg; 5.1 (9.0; 0.4) kg; and 9.7 (16.3, 3.1) kg, respectively; whereas Hume II equation underestimated the LM by -16.9 (-11.5; -22.2) kg. The equation that presented a better prediction of LM was Salamat. However, it should be used with caution in clinical practice since this equation showed elevated confidence intervals and limits of agreements, and can lead to significant errors for some individuals.

P558Left atrial strain as a predictor of functional capacity in preserved left ventricular function patients

P558Left atrial strain as a predictor of functional capacity in preserved left ventricular function patients

Neurocognitive predictors of social cognition in subjects with schizophrenia and their first-degree relatives

IntroductionSocial cognition is a complex construct that refers to the functions required to understand other people's mental states and behavior. In people with schizophrenia, social cognition deficits account for a proportion of variance in functional outcome, independent of symptomatology. However, the relationships among social cognition, neurocognitive functioning and functional outcome are still unclear. Previous investigations had several limitations including small sample size, heterogeneous and limited measures of social cognition and neurocognitive functions.AimsWithin the study of the Italian Network for Research on Psychoses, we investigated factors influencing outcome in patients with schizophrenia and their unaffected relatives. Psychopathology, including depression, neurocognition, social cognition and outcome were assessed using instruments designed to overcome some of the previous limitations.MethodsStructural equation modeling was used to test direct and indirect effects of neurocognition, social cognition and functional capacity on vocational and interpersonal functioning. Tests of facial emotion recognition, emotional intelligence and theory of mind were included to assess social cognition. The MATRICS Consensus Cognitive Battery (MCCB) was used to investigate neurocognition.ResultsIn both subjects with schizophrenia and their first-degree relatives, social cognition was found to be independent of negative symptoms and to have a direct impact on outcome. Neurocognition was a predictor of functional capacity and social cognition, which both mediated its impact on outcome. Social cognition was independent of functional capacity and negative symptoms.ConclusionsBetter understanding of how neurocognitive dysfunction and social cognition deficits relate to one another may guide efforts toward targeted treatment approaches.Disclosure of interestAM received honoraria or advisory board/consulting fees from the following companies: Janssen Pharmaceuticals, Otsuka, Pfizer and Pierre Fabre SG received honoraria or advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter.All other Authors declare no potential conflict of interest.

Exploring functioning in schizophrenia: Predictors of functional capacity and real-world behaviour

Impairment in daily functioning still represents a major treatment issue in schizophrenia and a more in-depth knowledge of underlying constructs is crucial for interventions to translate into better outcomes. This study aims to model factors influencing both functional capacity and real-life behaviour in a sample of outpatients with chronic schizophrenia, through a comprehensive assessment including evaluations of psychopathology, cognitive and social cognitive abilities, premorbid adjustment, family environment and early childhood experiences. No significant correlation was observed between functional capacity and real-life behaviour. Functional capacity was significantly predicted by IQ, while real-life behaviour was significantly predicted by empathy, affect recognition and symptoms. Functional capacity seems mainly related to neurocognition, whereas real-life behaviour appears more complex, requiring the integration of different factors including symptoms, with a major role of empathy. Results thus support a divergence between the two constructs of functioning and their underlying components and highlight the need to target both dimensions through individualized sequential rehabilitation programs in order to optimize functional outcome.

Qualidade muscular, mas não espessura, é reduzida em diferentes grupos etários em idosas ativas

The aim of this study was to compare the muscle thickness (MT), muscle quality (MQ), and functionality of two different age groups of active elderly women. Twenty seven older women (between 60 and 80 years old), physically active was dividing in two age groups: old 60-66 years (Old) and old 73-80 years (Older) volunteered for the present study. Knee extension isometric peak torque (PT) was obtained during a muscle isometric voluntary contraction (MIVC), and the value was normalized by MT. The Quadriceps Echo Intensity (QEI) was defined as the mean Echo Intensity (EI) value founded in all quadriceps muscle portions in ultrasound imaging. Was found MIVC increased (p=0.024) in the O1 (120.26±24.77 N/m) group when compared with the O2 (99.25±20.95 N/m) group, but when the MIVC was normalized the difference did not exist between groups (p≥0.05). The QEI was found increased in the Older group (97.10±17.35 a.u.) when compared with the Old group (80.18±14.95 a.u.) (p<0.05). Contrary to that, the QMT did not differ significantly between the groups (p≥0.05). The Old group presented a significant higher number of repetitions in the 30SS (14.13±2.29 repetitions) when compared to Older group (11.25±1.95 repetitions) (p<0.05). We observed that even without significantly greater muscle size, the Old group presented the results of 30SS significantly greater when compared with the older group. Besides that, the QEI was found increased in the older group and suggests that EI may be the best predictor of functional capacity than muscle quantity in active older woman.

Cognitive Performance as a Predictor of Functional Capacity in Schizophrenia

Introduction: Schizophrenia is a severe mental illness characterized by cognitive deficits as well as vocational impairment and interpersonal difficulties. This study examined the link between Continues Performance and everyday living skills. Methodes: Sample was 20 Schizophrenia (11 male and 9 female) selected using convenience sampling among individual with Schizophrenia diagnostic and 20 (10 male and 10 female) were matched with them as control group considering sex, age, marriage and education . Instruments were used in this study include: UCSD Performance-Based Skills Assessment Test (UPSA) and Continues Performance Test (CPT). Results: MANOVA showed a significant main effect for five domain of UPSA and four domain of UPSA. CPT predicted UPSA in schizophrenia. Conclusions: Individuals with schizophrenia would perform significantly worse in everyday living skills and on CPT. In fact poorer performance in CPT predicted basic skills performance in schizophrenia. This will help to determine what specifically needs to be targeted in rehabilitation of cognitive symptoms for those with schizophrenia, and that may reveal remediation in functional capacity as well. DOI: 10.5901/mjss.2015.v6n2s1p141

Predictors of Functional Capacity in Patients with Pulmonary Hypertension

Introduction: The 6-minute walk test (6 MWT) distance is frequently used in the prediction of pulmonary hypertension (PH) prognosis. However, potential surrogates of this measure have not been established. We aim to describe the clinical, echocardiographic, and laboratorial criteria determining the 6 MWT distance in patients with PH. Methods: In 22 consecutive PH patients, functional capacity was evaluated by the 6 MWT distance and compared with levels of neurohormonal activation biomarkers and echocardiographic parameters for right ventricular (RV) function. Results: A correlation between the 6 MWT distance and several clinical parameters was found: Borg’s pre-test classification (R=-0.46; p=0.038); WHO functional class (p=0.029). Patients with higher levels of aldosterone (R=-0.46; p=0.030), renin (R=-0.43; p=0.046) and mid-regional pro-adrenomedullin (MR-proADM, R=-0.53; p=0.009) had worse 6 MWT performance. The opposite was true for natremia levels (R=0.55; p=0.006). There was a positive correlation between the 6 MWT distance and RV global longitudinal peak systolic strain rate and early diastolic strain rate (R=0.49; p=0.038 and R=-0.55; p=0.018, respectively). On multivariate analysis, only natremia and early diastolic strain rate were predictors of the 6 MWT distance. Conclusion: The 6 MWT distance correlated with renin-angiotensin-aldosterone system activation and parameters for RV myocardial deformation. The new biomarker MR-proADM proved to be useful in the prediction of the functional capacity.

AB1165-HPR Relationship between Anterior Knee Pain Severity, Functional Capacity, Frontal Plane Projection Angle, Trunk and Hip Strength in Patellofemoral Pain

BackgroundPatellofemoral Pain Syndrome (PFPS) is characterized by anterior knee pain most commonly on the patella lateral facet. Although the increased Frontal Plane Projection Angle (FPPA), core deficit and hip strength...

Exercise stress echocardiography in patients with aortic stenosis: impact of baseline diastolic dysfunction and functional capacity on mortality and aortic valve replacement.

Patients with aortic stenosis (AS) often undergo exercise echocardiography. Diastolic dysfunction (DD) is frequently associated with AS but little is known about its impact on functional capacity (FC). We sought to determine the relationship between DD and FC and their impact on mortality and need for aortic valve replacement (AVR) in patients with AS. Data was analyzed for consecutive patients with any degree of AS undergoing exercise stress echocardiography between 2000 and 2010 at our institution. The primary endpoint was a composite of death or need for AVR. We identified 1,267 patients [mean age 67±11 years, ejection fraction (56±7)%, mean aortic valve gradient 19±12 mmHg, mean maximal metabolic equivalents (METs) achieved 8±2.6]. The proportion with normal, stage 1, and ≥ stage 2 diastology was 195 (15%), 928 (73%), 144 (12%). A total of 475 (37.5%) patients had a primary outcome with 164 deaths (mean follow up 5.6±4.1 years) and 341 AVR (mean follow up 2.4±2.6 years). Predictors of FC were age, gender, body mass index, Bruce protocol, heart rate recovery (HRR), ejection fraction, mean aortic valve gradient, and diabetes but not baseline DD. Baseline DD [HR 1.82, 95% CI (1.17, 2.82), P=0.008] and FC [HR 0.93, 95% CI (0.88, 0.98), P=0.003] were independent predictors of death or AVR. For patients with AS undergoing exercise echocardiography, baseline DD was not predictive of FC. However, both baseline DD and FC were independent predictors of death or need for AVR.

Right ventricular wall hypertrophy predicts functional capacity in pulmonary hypertension. A cardiac magnetic resonance study

Purpose: Right ventricular (RV) dilatation and wall hypertrophy is a compensatory mechanism to pressure and volume overload occurring in patients with pulmonary arterial hypertension (PAH). The aim of our study is to investigate the relationship between RV dimensions and wall thickness as accessed with cardiac magnetic resonance (CMR) and distance walked in 6-minute walking test (6MWD) in adult patients with PAH. Methods: All patients underwent 6 minute walking test (6MWT) and CMR on the same day. RV end diastolic (RVEDa) and end systolic area (RVESa) was obtained in short axis at the level of the papillary muscles at end diastole and end systole respectively and RV anterior wall thickness (RVWT) was measured at the same level at end diastole. Results: Our study included 14 patients with PAH (12 women, mean age 46.64±13.4 years), that walked 485.1±108.0 m in 6MWT. After controlling for confounding parameters as age, sex and body surface index, a negative correlation between distance walked in 6 minutes and RVWT (r=-0.671, p<0.001), RVESa (r=-0.660, p<0.01) and RVEDa (r=-0.704, p<0.005) was observed. Multivariate regression analysis showed that only RVWT is an independent predictor of 6MWD (B=-0.267, p<0.05) in the studied population (Table). View this table: Conclusions: The degree of RV hypertrophy may be used as a predictor of functional capacity of patients with PAH.