Shorter 6-minute Walk Distance Research Articles

The impact of type 2 diabetes on short term myocardial morphological, functional, and energetic recovery post coronary artery bypass surgery in patients with ischemic heart disease

Abstract Background Type 2 diabetes (T2D) confers three times higher mortality in patients with ischemic heart disease (IHD). Moreover, amongst patients with IHD those with diabetes were shown to have higher long-term mortality from heart failure despite angiographic or surgical revascularisation with coronary artery bypass grafting (CABG). Impaired myocardial structural, functional, and energetic recovery may underpin this epidemiological observation. Consequently, using cardiovascular magnetic resonance and phosphorus-magnetic resonance spectroscopy scans, we aimed to assess the effect of T2D comorbidity on myocardial structural, functional, perfusion, and energetic recovery post-CABG in patients with IHD. Methods Seventy-seven IHD patients with (n=39) and without T2D (n=38) awaiting CABG were recruited. One-month pre- and 6-months post-CABG, cardiac phosphocreatine to ATP ratio (PCr/ATP), global longitudinal shortening (GLS) and 6-minute walk-distance (6MWD) were assessed in the study cohorts. The rest and adenosine-stress myocardial blood flow (MBF) assessments were only performed 6-months post-CABG. Results Pre-CABG, IHD-T2D patients had higher LV concentricity (LV mass to LV end diastolic volume ratio) (IHD-T2D:0.84[0.74,0.93],IHD-noT2D:0.72[0.67,0.77]g/mL,P=0.03]. worse PCr/ATP T2D (IHD-T2D:1.5[1.4,1.7],IHD-noT2D:1.8[1.6, 2.0];P=0.03) and shorter 6-minute walk distance (IHD-T2D:338[307,370],IHD-noT2D:399[364,434]m,P=0.007). There were no significant differences in LV volumes, ejection fraction or GLS between the two groups pre-CABG. Post-CABG, there was no longer a significant difference in cardiac energetics or 6-minute walk distances between the two groups due to a significant improvement in PCr/ATP in the IHD-T2D group. LV concentricity remained significantly elevated in the IHD-T2D group post CABG (IHD-T2D:0.82[0.75,0.88],IHD-noT2D:0.73[0.68,0.79]g/mL,P=0.04). Neither group showed a significant change in LVEF or GLS from the pre-CABG values, and post-CABG there were no differences in the rest or stress myocardial blood flows between the two groups. Conclusions Six months after CABG, neither IHD patients with T2D, nor IHD patients without T2D show any significant changes in LV structural remodelling or in contractile function. T2D does not jeopardise the short-term recovery in myocardial energetics or exercise distance post-CABG, with IHD patients with T2D showing more pronounced improvements post-CABG in both these assessments than patients without T2D. Larger longitudinal studies are needed to better understand the mechanisms of adverse longer-term cardiovascular outcomes suggested by epidemiological studies in IHD patients with T2D.

Differential effects of balloon pulmonary angioplasty on chronic thromboembolic pulmonary disease

BackgroundDecreased diffusing capacity of the lungs for carbon monoxide (DLco) is associated with microvascular damage in chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) is an effective treatment for...

The impact of cardiovascular and lung comorbidities in patients with pulmonary arterial hypertension: A systematic review and meta-analysis

BackgroundContemporary patients with pulmonary arterial hypertension (PAH) are older and exhibit cardiovascular and/or lung comorbidities. Such patients have typically been excluded from major PAH drug trials. This systematic review compares baseline characteristics, hemodynamic parameters, and mortality rate between PAH patients with significant number of comorbidities compared to those with fewer or no comorbidities. ΜethodsA systematic literature search in PubMed and Cochrane databases was conducted searching for studies comparing PAH patients with more than two cardiovascular comorbidities and/or at least a lung comorbidity against those with fewer comorbidities. ResultsSeven observational studies were included. PAH patients with comorbidities were older, with an almost equal female-to-male ratio, shorter 6-minute walk distance, higher NT-proBNP levels, and lower lung diffusion for carbon monoxide. In terms of hemodynamics, they had higher mean right atrial pressure and pulmonary artery wedge pressure, lower mean pulmonary arterial pressure, pulmonary vascular resistance and mixed venous oxygen saturation. Pooled analysis of six studies demonstrated a higher mortality risk for PAH patients with comorbidities compared to those without (HR 1.86, 95% CI 1.20 to 2.89, p<0.001, I²=92%), with the subgroup of PAH patients with lung comorbidities having an even higher mortality risk (test for subgroup differences: p<0.001). Combination drug therapy for PAH was less frequently used in patients with comorbidities. ConclusionsCardiovascular and lung comorbidities impact the clinical characteristics and outcomes of PAH patients, highlighting the need for optimal phenotyping and tailored management for this high-risk population.

Oscillometry-Defined Small Airway Dysfunction in Patients with Chronic Obstructive Pulmonary Disease.

The prevalence of small airway dysfunction (SAD) in patients with chronic obstructive pulmonary disease (COPD) across different ethnicities is poorly understood. This study aimed to estimate the prevalence of SAD in stable COPD patients. We conducted a cross-sectional study of 196 consecutive stable COPD patients. We measured pre- and post-bronchodilator (BD) lung function and respiratory impedance. The severity of COPD and lung function abnormalities was graded in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. SAD was defined as either difference in whole-breath resistance at 5 and 19 Hz &gt; upper limit of normal or respiratory system reactance at 5 Hz &lt; lower limit of normal. The cohort consisted of 95.9% men, with an average age of 66.3 years. The mean forced expiratory volume 1 second (FEV1) % predicted was 56.4%. The median COPD assessment test (CAT) scores were 14. The prevalence of post-BD SAD across the GOLD grades 1 to 4 was 14.3%, 51.1%, 91%, and 100%, respectively. The post-BD SAD and expiratory flow limitation at tidal breath (EFLT) were present in 62.8% (95% confidence interval [CI], 56.1 to 69.9) and 28.1% (95% CI, 21.9 to 34.2), respectively. COPD patients with SAD had higher CAT scores (15.5 vs. 12.8, p&lt;0.01); poor lung function (FEV1% predicted 46.6% vs. 72.8%, p&lt;0.01); lower diffusion capacity for CO (4.8 mmol/min/kPa vs. 5.6 mmol/min/kPa, p&lt;0.01); hyperinflation (ratio of residual volume to total lung capacity % predicted: 159.7% vs. 129%, p&lt;0.01), and shorter 6-minute walk distance (367.5 m vs. 390 m, p=0.02). SAD is present across all severities of COPD. The prevalence of SAD increases with disease severity. SAD is associated with poor lung function and higher symptom burden. Severe SAD is indicated by the presence of EFLT.

Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis

BackgroundFrailty has been increasingly identified as a risk factor of adverse outcomes in chronic obstructive pulmonary disease (COPD). The prevalence and impact of frailty on health outcomes in people with COPD require clarification.MethodsPubMed, Embase, The Cochrane Library and Web of Science (January 1, 2002, to July 1, 2022) were comprehensively searched to identify studies related to frailty and COPD. Comparisons were made between people who did and did not have frailty for pulmonary function, dyspnea severity, 6-minute walking distance, activities of daily life, and mortality.ResultsTwenty studies (9 cross-sectional, 10 cohort studies,1 clinical trial) from Europe (9), Asia (6), and North and South America (4), Oceania (1) involving 11, 620 participants were included. The prevalence of frailty was 32.07% (95% confidence interval (CI) 26.64–37.49) with a range of 6.43–71.70% based on the frailty tool used. People with frailty had lower predicted forced expiratory volume in the first second (mean difference − 5.06%; 95%CI -6.70 to -3.42%), shorter 6-minute walking distance (mean difference − 90.23 m; 95%CI -124.70 to -55.76), poorer activities of daily life (standardized mean difference − 0.99; 95%CI -1.35 to -0.62), higher CAT(COPD Assessment Test) score(mean difference 6.2; 95%CI 4.43 to 7.96) and mMRC (modified Medical Research Council) grade (mean difference 0.93; 95%CI 0.85 to 1.02) compared with those who did not (P < 0.001 for all). Meta-analysis showed that frailty was associated with an increased risk of long-term all-cause mortality (HR 1.68; 95% CI 1.37–2.05; I2 = 0%, P < 0.001).ConclusionFrailty is prevalent in people with COPD and linked with negative clinical outcomes including pulmonary function, dyspnea severity, exercise capacity, quality of life and mortality.

Abstract 9537: Preliminary Analysis of the Impact of IV Iron Repletion in Patients With Iron Deficiency Anemia and Chronic Thromboembolic Pulmonary Hypertension Undergoing Pulmonary Thromboendarterectomy

Introduction: Iron deficiency anemia (IDA) is associated with worse functional class, shorter 6-minute walk distance (6MWD), and higher mortality in heart failure. The associations of IDA with chronic thromboembolic pulmonary hypertension (CTEPH) have not been established. Methods: Retrospective chart review of 95 patients with CTEPH who underwent pulmonary thromboendarterectomy (PTE) and had iron studies. We determined the prevalence of IDA and the impact of IV iron repletion in the perioperative period. Results: Of the 95 patients, the mean age was 56 years, 55% were female, 52% were White, and 28% were Black. Thirteen (13.6%) had IDA and received IV iron perioperatively when admitted for PTE. Those who had IDA were younger (50.3 vs 57.7 years, p=0.09) and female (69.2%). Of the females, 3 (33.3%) had uterine fibroids. Baseline hemoglobin was lower in the group requiring IV iron (10.5 vs 13.1 g/dL, p=0.0004). The patients received 1-5 days of IV iron. Cardiac index (CI) pre-PTE was not different between IDA versus non-IDA groups (2.4 vs 2.2 L/min, p=0.35) and the PVR was non-statically different (8.4 vs. 7.2 WU, p=0.63). Post-PTE, CI were normal in both groups (2.4 vs 2.7 L/min, p=0.03). The IDA group had worse baseline NYHA functional class (75% class III or higher, p=0.66) than the non IDA group (90% class II or lower, p=0.66). Those with IDA had lower baseline 6MWD of 277 vs 343 meters (p=0.14; Fig 1), despite a similar baseline PVR and CI. Post PTE and after IV iron repletion, 6MWD were similar between the IDA and non IDA group 385 vs 348 meters; p=0.75, respectively. Conclusion: Our results suggest younger and female CTEPH patients may have a higher incidence of IDA. IDA contributes to the functional capacity of patients with precapillary CTEPH. There is a trend towards improvement of the functional impairment in the CTEPH patients when they receive IV iron repletion in the perioperative period of PTE, in groups that have similar baseline CI and PVR, and normal CI in the post-PTE period.

Six minute walk test for predicting postoperative pulmonary complications in high risk patients undergoing major abdominal elective surgery

The morbidity and mortality of patients are increased when postoperative pulmonary complications occurs. To prevent postoperative pulmonary complications, thorough preoperative cardiopulmonary functional assessment is required.To study was the preoperative 6-minute walk test (6MWT) and to determine the association of 6 minute walk distance with postoperative pulmonary complications (PPC) in patients undergoing elective abdominal surgery under general anaesthesia. The study was done in 60 adult high risk patients who were undergoing planned elective abdominal surgery under general anaesthesia. Patients having acute coronary disease, NYHA IV, unable to walk etc. were excluded. Preoperatively 6MWT was conducted according to the American Thoracic Society guidelines and patients were observed for PPC until they discharged from the hospital or died. Statistical analysis was done using SPSS software A total of 60 patients were recruited into the study. 6MWT was done completely in all cases without any complications. Out of the 60 patients, 32 patients had no PPC (group 1) and 28 patients had PPC (group 2). The 6MWD of group with PPCs was significantly less (344 ± 61.927 m) compared to the group without PPCs (442.28 ± 83.194 m, P value = 0.001). The cut off 6MWD obtained was 390 m, which correlated with longer duration of hospital stay and ICU stay (P = 0.001).A multiple regression analysis showed elderly, smoker and shorter 6-minute walk distance (6MWD) were the independent factors associated with PPC. 6MWT is a reliable predictor of postoperative pulmonary complications with a cutoff 6MWD of 390m in the high risk elderly patients posted for upper abdominal surgery patients.

Diastolic Dysfunction Is Associated with Impaired Cardiopulmonary Exercise Performance in Sickle Cell Disease

▪Background:Left ventricular diastolic dysfunction is associated with increased mortality in sickle cell disease (SCD). Diffuse myocardial fibrosis is common in patients with SCD and is associated with diastolic dysfunction. Measurement of functional capacity by cardiopulmonary exercise test (CPET) has prognostic value in several cardiac diseases. Exercise impairment is common in SCD, but the causes and correlates are not well understood. Diastolic dysfunction is associated with a shorter 6-minute walk distance in SCD, but the effect of diastolic dysfunction and myocardial fibrosis on CPET has not been studied before.Methods:As part of a prospective study to characterize the cardiomyopathy of SCD (NCT02410811), children and adults with SCD underwent cardiac MRI (CMR), echocardiography and cycle ergometer CPET. Diffuse myocardial fibrosis was assessed by CMR-based measurement of extracellular volume fraction (ECV) from pre- and post-gadolinium T1 maps. Cardiac chamber sizes and cardiac performance were evaluated using CMR, and diastolic parameters were measured by echocardiography. Patients were classified to have diastolic dysfunction if they had left atrial enlargement and abnormalities in two diastolic parameters (E/e' ratio and e'). The following measures were recorded during CPET: percent predicted VO2 at maximum exercise (VO2 max) and ventilation efficiency (VE/VCO2 slope at maximum exercise (VE/VCO2 max). Reduced exercise capacity was defined by VO2 max <80% and classified as mild (VO2max 60-80%) or moderate to severe (VO2 max <60%).Results:Fifteen patients with SCD have completed the study (age range 8-38 years). No adverse events were reported within one month of CPET. Only one patient did not reach maximum exercise due to muscular fatigue. Fourteen patients (93%) had reduced exercise capacity; four of them (28%) had mild impairment and 10 (71%) had moderate to severe impairment. Four patients had diastolic dysfunction and none had systolic dysfunction. Patients with diastolic dysfunction had lower exercise capacity compared to patients with normal diastolic function as measured by lower VO2 max (46.6 ± 5.9% vs 59.2 ± 11.5%; p=0.02). The z-score of the left ventricular lateral E/e' ratio, a diastolic measure that reflects left ventricular filling pressure, negatively correlated with the maximal exercise capacity VO2 max (r=-0.57, p=0.02) and positively with worse ventilation efficiency measured by VE/VCO2 max (r=0.61, p=0.01), indicating an association between diastolic dysfunction and worse exercise performance. We did not find an association between ECV and exercise capacity. Hemoglobin concentration was moderately associated with VO2 max (r=0.37) but this association was not statistically significance (p=0.09).Conclusion:Diastolic dysfunction is associated with poor exercise capacity assessed by CPET in patients with SCD. Myocardial diastolic dysfunction may be one of the causes of impaired exercise capacity in SCD. Strategies to prevent or delay the acquisition of diastolic dysfunction to improve exercise capacity and long-term outcomes in SCD should be explored. DisclosuresQuinn:Global Blood Therapeutics: Research Funding.

Характеристика одышки у больных прогрессирующим фибротическим фенотипом интерстициальных заболеваний легких, ассоциированных с ишемической болезнью сердца

Study Objective: To compare the quantitative aspects of shortness of breath in patients with fibrous interstitial lung disease (ILD) associated with cardio ischemia; to compare analysis results of the data obtained during functional and instrumental examinations. Study Design: Open comparative study in parallel groups. Materials and Methods. The study included 47 patients with fibrous ILD: 8 patients had idiopathic pulmonary fibrosis; 25 patients had chronic hypersensitive pneumonitis, and 14 patients had fibrous non-specific interstitial pneumonia. The patients were divided into two groups: study group of 24 patients with fibrous ILD associated with cardio ischemia, and 23 controls with fibrous ILD without cardio ischemia. We analysed clinical symptoms, instrumental examination results, changes in patients’ functional status with and without cardiac pathology. Study Results. In patients with fibrous ILD and cardio ischemia, respiratory symptoms were more intensive than in patients without cardio ischemia. Patients with fibrous ILD and cardio ischemia experienced worsening of their shortness of breath statistically earlier (in 3.15 days) vs patients with isolated fibrous ILD, who had shortness of breath in 7.29 days (p &lt; 0.05). Patients with fibrous ILD and cardio ischemia demonstrated mixed functional changes: restrictive (reduced lung capacity and FVRC) and obstructive disorders (reduced FEV1 and instantaneous exhalation rate, МСВ25); statistically significant reduction in diffusing lung capacity, p &lt; 0.05. A shorter 6-minute walking distance, more marked desaturation (SрO2 reduction by 8.31% in the study group and by 2.12% in controls, p &lt; 0.05), higher scores of Borg Dyspnoea Scale and CRP scale (Clinical, Radiographic, and Physiologic scoring system) demonstrated statistically reduced tolerance to physical exercises in patients with cardio ischemia. CT scans did not reveal any differences in the intensity of interstitial changes in patients of both groups; “ground glass” areas were significantly more intense in patients with cardio ischemia, p &lt; 0.05. Pulmonary hypertension and structural changes in right compartments of heart were recorded in patients in both groups; however, left ventricular hypertrophy and dysfunction were noted only in patients with cardio ischemia. Conclusion. In patients with fibrous ILD associated with cardio ischemia, intensification of shortness of breath can be a sign of a progressive respiratory disease or a new event: coronary event, atrial fibrillation attack, cardiac failure, chronic cor pulmonale. Assessment of the functional status using Borg Dyspnoea Scale, CRP, Medical Research Council Scale is a tool to identify the reasons of dyspnoea in primary care settings, to develop an algorithm for instrumental differential diagnosis of shortness of breath. Keywords: progressive fibrous interstitial lung diseases, quantification of shortness of breath, cardio ischemia.

Survivors of Acute Lung Injury Have Greater Impairments in Strength and Exercise Capacity Than Survivors of Other Critical Illnesses as Measured Shortly After ICU Discharge.

To compare the physical function on ICU discharge in adults who survived an ICU admission for acute lung injury (ALI) with those admitted for a critical illness other than ALI. Two groups were recruited, (i) those who survived an ICU admission for ALI and, (ii) those who survived an ICU admission for a critical illness other than ALI. Within 7 days of discharge from ICU, in all participants, measures were collected of peripheral muscle strength, balance, walking speed and functional exercise capacity. Recruitment was challenging and ceased prior to achieving the desired sample size. Participants with ALI (n = 22) and critical illness (n = 33) were of similar median age (50 vs. 57 yr, p = 0.09), sex proportion (males %, 45 vs. 58, p = 0.59) and median APACHE II score (21.5 vs. 23.0, p = 0.74). Compared with the participants with critical illness, those with ALI had lower hand grip (mean ± SD, 18 ± 9 vs. 13 ± 8 kg, p = 0.018) and shoulder flexion strength (10 ± 4 vs. 7 ± 3 kg, p = 0.047), slower 10-meter walk speed (median [IQR], 1.03 [0.78 to 1.14] vs. 0.78 [0.67 to 0.94] m/s, p = 0.039) and shorter 6-minute walk distance (265 [71 to 328] vs. 165 [53 to 220] m, p = 0.037). The Berg balance scores were similar in both groups. Compared with survivors of a critical illness that is not ALI, those with ALI are likely to have greater physical impairment when measured shortly after discharge to the ward.

Impact of Body Mass Index Change on the Prognosis of Chronic Obstructive Pulmonary Disease

Background: Low body mass index (BMI) is an important prognostic factor in chronic obstructive pulmonary disease (COPD). However, the prognostic value of longitudinal BMI change in COPD has not been well studied. Objective: We aimed to evaluate the association between longitudinal change of BMI and prognosis of COPD in Korean COPD cohort. Methods: This study was conducted in a prospective Korean Obstructive Lung Disease (KOLD) cohort where COPD patients were recruited on an outpatient basis at 17 hospitals in South Korea. Annual BMI was measured over a period of 3 years or more. All patients were categorized into underweight (UW), normal weight (NW), and overweight (OW) groups by BMI. Clinical characteristics and outcomes including exacerbation and mortality were compared based on initial BMI grade and longitudinal change of BMI. Results: This analysis included 537 COPD patients (mean age = 67.4 ± 7.9 years, male = 97.0%, mean BMI = 23.0 ± 3.1) of KOLD cohort. The proportions of UW, NW, and OW groups were 6.9% (n = 37), 68.9% (n = 370), and 24.2% (n = 130) respectively. The UW group showed lower forced expiratory volume in 1 s (FEV₁) (p < 0.001), shorter 6-minute walk distance (p < 0.001), higher modified Medical Research Council score (p = 0.002), higher St. George Respiratory Questionnaire score (p < 0.001), higher emphysema index (p < 0.001) and air-trapping index (p < 0.001), and more frequent (p < 0.001) and severe exacerbations (p = 0.003). Multivariable analyses demonstrated that decrease of BMI (hazard ratio [HR] = 0.786, p = 0.038) and the descent of BMI group (HR = 3.167, p = 0.016) at 3-year follow-up along with age, initial BMI, post-bronchodilator FEV₁, and severe exacerbations were significantly associated with mortality. Conclusions: This study demonstrated that BMI decrease during follow-up was independently associated with exacerbation and higher mortality of COPD, suggesting BMI reduction in COPD should be carefully managed.

Disproportionally Impaired Diffusion Capacity Relative to Airflow Limitation in COPD

Forced expiratory volume in 1 s (FEV1) is a standard physiological index of chronic obstructive pulmonary disease (COPD), but reflects emphysema and vascular abnormalities less sensitively than diffusion capacity for carbon monoxide (DLCO). This study tested whether a disproportionally impaired DLCO relative to FEV1 (FEV1 z-score>-3 and DLCO z-score≤-3) is a common functional COPD phenotype associated with distinct clinical and structural features and the prognosis of two cohorts. The cross-sectional analyses of the Korea COPD Subgroup Study (KOCOSS) cohort (multicenter study in Korea) included 743 males with COPD whose DLCO was available. The cross-sectional and longitudinal analyses of the Kyoto University Cohort (single-center study in Japan) included 195 males with COPD who were prospectively followed for 10 years. A disproportionally impaired DLCO relative to FEV1 was observed in 29% and 31% of patients in the KOCOSS and Kyoto University cohorts, respectively. In the multivariable analysis, the disproportionally impaired DLCO was associated with worse symptoms, shorter 6-minute walking distance, paraseptal and centrilobular emphysema on computed tomography, and reduced arterial oxygen and carbon dioxide pressures compared to the reference (FEV1 z-score>-3 and DLCO z-score>-3). In the multivariable Cox proportional hazard model, a higher long-term mortality was observed in the disproportionally impaired DLCO group than in the reference group (hazard ratio [95% confidence interval] = 3.09 [1.52–6.29]) and similar to the DLCO z-score≤-3 and FEV1 z-score≤-3 group. The disproportionally impaired DLCO relative to FEV1 is common and associated with increased symptoms, emphysema, arterial blood gas abnormalities, and increased long-term mortality in patients with COPD.

Fibroblast Growth Factor 23 and Exercise Capacity in Heart Failure with Preserved Ejection Fraction

BackgroundHeart failure with preserved ejection fraction (HFpEF) is characterized by left ventricular hypertrophy and decreased exercise capacity. Fibroblast growth factor 23 (FGF23), a hormone involved in phosphate, vitamin D, and iron homeostasis, is linked to left ventricular hypertrophy and HF. We measured c-terminal FGF23 (cFGF23) and intact FGF23 (iFGF23) levels and examined their associations with exercise capacity in patients with HFpEF. Methods and ResultsUsing multivariable linear regression and linear mixed models, we studied the associations of cFGF23 and iFGF23 with baseline and mean weekly change over 24 weeks in peak oxygen consumption and 6-minute walk distance in individuals enrolled in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in HFpEF trial. Our study population included 172 individuals with available plasma for cFGF23 and iFGF23 measurements. Median (25th–75th percentile) baseline cFGF23 and iFGF23 levels were 208.7 RU/mL (132.1–379.5 RU/mL) and 90.3 pg/mL (68.6–128.5 pg/mL), respectively. After adjustment for cardiovascular disease and hematologic and kidney parameters, higher cFGF23 was independently associated with a lower peak oxygen consumption at baseline. Higher iFGF23 was independently associated with shorter 6-minute walk distance at baseline. No significant associations were appreciated with the longitudinal outcomes. ConclusionsIn patients with HFpEF, higher FGF23 levels are independently associated with decreased exercise capacity at baseline.

Clinical characteristics and response to supervised exercise therapy of people with lower extremity peripheral artery disease

BackgroundAmong people with lower extremity peripheral artery disease (PAD), little is known about variation in response to supervised exercise therapy (SET). Clinical characteristics associated with greater responsiveness to SET have not been identified. MethodsData from participants with PAD in two randomized clinical trials comparing SET vs nonexercising control were combined. The exercise intervention consisted of three times weekly supervised treadmill exercise. The control groups received lectures on health-related topics. ResultsOf 309 unique participants randomized (mean age, 67.9 years [standard deviation, 9.3 years]; 132 [42.7%] women; 185 [59.9%] black), 285 (92%) completed 6-month follow-up. Compared with control, those randomized to SET improved 6-minute walk distance by 35.6 meters (95% confidence interval, 21.4-49.8; P < .001). In the 95 (62.1%) participants who attended at least 70% of SET sessions, change in 6-minute walk distance varied from −149.4 to +356.0 meters. Thirty-four (35.8%) had no 6-minute walk distance improvement. Among all participants, age, sex, race, body mass index, prior lower extremity revascularization, and other clinical characteristics did not affect the degree of improvement in 6-minute walk distance after SET relative to the control group. Participants with 6-minute walk distance less than the median of 334 meters at baseline had greater percentage improvement in 6-minute walk distance compared with those with baseline 6-minute walk distance above the median (+20.5% vs +5.3%; P for interaction = .0107). ConclusionsAmong people with PAD, substantial variability exists in walking improvement after SET. Shorter 6-minute walk distance at baseline was associated with greater improvement after SET, but other clinical characteristics, including age, sex, prior lower extremity revascularization, and disease severity, did not affect responsiveness to exercise therapy.

Age-related differences in hemodynamics and functional status in pulmonary arterial hypertension: Baseline results from the Pulmonary Hypertension Association Registry

The age of patients with pulmonary arterial hypertension (PAH) has increased, with registries now reporting mean ages of 50 to 65 years old. Limited data exist on age-related differences in hemodynamic and functional assessments in PAH. Adults with PAH in the Pulmonary Hypertension Association Registry were divided into 3 groups (18-50, 51-65, and >65 years old). Analysis of variance and chi-square testing were used to assess for baseline differences. Linear regression was used to examine the association of age with continuous hemodynamic and functional variables. A total of 769 patients with mean age of 56 ± 16 years were included. Older patients had more connective tissue disease-associated PAH and less drug-associated PAH. In linear regression models, each year of increased age was associated with shorter 6-minute walk distance (-3.37 meters; 95% CI, -3.97 to -2.76), lower mean pulmonary arterial pressure (-0.21 mmHg; 95% CI, -0.27 to -0.15), and lower pulmonary vascular resistance (-0.06 Wood units; 95% CI, -0.09 to -0.04). Pulmonary arterial compliance, cardiac index, right ventricular stroke work index, and percent predicted 6-minute walk distance were unrelated to age; resistance-compliance time was negatively related to age (-3 milliseconds per year; 95% CI, -4 to -2). Relative to their pulmonary vascular resistance, older patients have lower pulmonary artery compliance and worse right ventricular performance. Based on these findings, we suspect that age influences right ventricular loading conditions and the response of the right ventricle to increased afterload.

Clinical and imaging manifestations of Takayasu's arteritis with pulmonary hypertension: A retrospective cohort study in China

BackgroundTakayasu's arteritis with pulmonary artery involvement (PTA) is uncommon and part of which may be accompanied by pulmonary hypertension (PH). This study herein investigated the clinical presentation, imaging features, and outcomes in PTA patients with and without PH. MethodsA total of 57 PTA patients were selected at the Beijing Chao-Yang Hospital from January 2011 to July 2017. Patients were placed into two groups, PTA-with-PH or PTA-without-PH. The clinical characteristics, imaging features, and outcomes of patients in these two groups were investigated. ResultsAmong the 57 PTA patients, 24 were in the PTA-without-PH group and 33 were in the PTA-with-PH group. The disease duration in PTA-with-PH patients was longer than that of PTA-without-PH patients. The mean follow-up duration of 43 patients was 33.5 ± 20.3 months, while three patients in the PTA-with-PH were deceased. The PTA-with-PH group had significantly higher prevalence of chest tightness and dyspnea, shorter 6-minute walk distance (6MWD) and higher Borg scores after walk than that the PTA-without-PH group. Imaging analyses revealed that patients had five different arterial lesions (stenosis, occlusion, vascular wall thickening, in situ thrombosis, and aneurysm), but aneurysms were only detected in patients in PTA-with-PH patients at 42%. Compared with PTA-without-PH patients, PTA-with-PH patients tended to have occlusion lesions, but less likely to have vascular wall thickening. ConclusionsCompared with PTA-without-PH patients, PTA-with-PH patients had longer disease duration, more severe symptoms and tended to be deceased during the follow-up time. In addition, PTA-with-PH patients tended to have aneurysm and occlusion vessel lesions.

Interstitial Features at Chest CT Enhance the Deleterious Effects of Emphysema in the COPDGene Cohort.

Purpose To determine if interstitial features at chest CT enhance the effect of emphysema on clinical disease severity in smokers without clinical pulmonary fibrosis. Materials and Methods In this retrospective cohort study, an objective CT analysis tool was used to measure interstitial features (reticular changes, honeycombing, centrilobular nodules, linear scar, nodular changes, subpleural lines, and ground-glass opacities) and emphysema in 8266 participants in a study of chronic obstructive pulmonary disease (COPD) called COPDGene (recruited between October 2006 and January 2011). Additive differences in patients with emphysema with interstitial features and in those without interstitial features were analyzed by using t tests, multivariable linear regression, and Kaplan-Meier analysis. Multivariable linear and Cox regression were used to determine if interstitial features modified the effect of continuously measured emphysema on clinical measures of disease severity and mortality. Results Compared with individuals with emphysema alone, those with emphysema and interstitial features had a higher percentage predicted forced expiratory volume in 1 second (absolute difference, 6.4%; P < .001), a lower percentage predicted diffusing capacity of lung for carbon monoxide (DLCO) (absolute difference, 7.4%; P = .034), a 0.019 higher right ventricular-to-left ventricular (RVLV) volume ratio (P = .029), a 43.2-m shorter 6-minute walk distance (6MWD) (P < .001), a 5.9-point higher St George's Respiratory Questionnaire (SGRQ) score (P < .001), and 82% higher mortality (P < .001). In addition, interstitial features modified the effect of emphysema on percentage predicted DLCO, RVLV volume ratio, 6WMD, SGRQ score, and mortality (P for interaction < .05 for all). Conclusion In smokers, the combined presence of interstitial features and emphysema was associated with worse clinical disease severity and higher mortality than was emphysema alone. In addition, interstitial features enhanced the deleterious effects of emphysema on clinical disease severity and mortality.

Anemia as a clinical marker of stable chronic obstructive pulmonary disease in the Korean obstructive lung disease cohort.

Anemia is a major co-morbidity in chronic obstructive pulmonary disease (COPD). However, the mechanism of development for anemia and the impact of anemia on the prognosis of COPD remain poorly understood. Therefore, this study attempted to evaluate the prognostic role of anemia on the clinical course of COPD and investigate the factors linked with the serum hemoglobin level in COPD. We analyzed 407 COPD patients enrolled in the Korean obstructive lung disease (KOLD) cohort at 16 hospitals in Korea recruited over 9 years. Multivariate Cox regression analysis was performed to find independent predictors of survival and multivariate logistic regression analyses were done to find independent factors. Anemic COPD were older with lower body mass index (BMI) (P<0.001), lower serum cholesterol level (P=0.001), lower serum albumin level (P<0.001), and shorter 6-minute walking distance (P=0.046) compared to non-anemic COPD. A multivariate Cox regression analysis revealed that age (P=0.002), BMI (P=0.001), post-bronchodilator forced expiratory volume in 1 second (FEV1) (P=0.007), 6-minute walk distance (P=0.008), anemia (P=0.025) were significant predictors for all-cause mortality. In multivariate regression analysis, older age (P<0.001), female gender (P=0.001), lower BMI (P=0.016), and lower serum albumin level (P<0.001) were independent factors associated with lower serum hemoglobin level. Our data showed that anemia was an independent risk factor for mortality in COPD, and aging, lower serum albumin level, and lower BMI were independent factors associated with lower serum hemoglobin level.

Sarcopenia in Peripheral Arterial Disease: Prevalence and Effect on Functional Status

Objectives(1) To determine the prevalence of sarcopenia in older men with peripheral arterial disease (PAD); (2) to compare a subgroup of the group with age-, race-, sex-, and body mass index (BMI)–matched non-PAD control counterparts, and (3) to compare the functional status of those with PAD with and without sarcopenia. DesignCohort study. SettingMedical center. ParticipantsSedentary community-dwelling men (N=108; age, >50y) with a confirmed diagnosis of PAD (44% blacks; BMI, 27.8±0.4kg/m2; ankle-brachial index, .62±.01). InterventionsNot applicable. Main Outcome MeasuresDual-energy x-ray absorptiometry scans were used to assess appendicular lean mass and determine the prevalence of sarcopenia by/height2. Treadmill tests were used to determine claudication onset time, peak walking time, and claudication recovery time. 6-Minute walk distance was also measured. ResultsSarcopenia prevalence in our PAD cohort was 25%. The PAD subgroup (n=42) matched with control counterparts in terms of race, sex, age, and BMI had higher prevalence rates than did their non-PAD counterparts (23.8% vs 2.4%; P<.05). Individuals with sarcopenia (n=28) had a shorter 6-minute walk distance (326±18.8m vs 380±9.7m; P<.05) and higher claudication recovery time (592±98s vs 395±29s; P<.05) than did individuals with PAD but without sarcopenia (n=80). There was no difference in claudication onset time or peak walking time between the PAD groups. ConclusionsMen with PAD demonstrate a high prevalence of sarcopenia. Those with sarcopenia and PAD demonstrate decreased mobility function.

Clinical characteristics of Japanese candidates for lung transplant for interstitial lung disease and risk factors for early death while on the waiting list.

Lung transplants have produced very favorable outcomes for patients with interstitial lung disease (ILD) in Japan. However, because of the severe donor lung shortage, patients must wait approximately 2.5 years before they can undergo transplantation and many candidates die before allocation. We reveal the clinical characteristics of Japanese patients with ILD who are candidates for lung transplants and the risk factors for early death while on the waiting list. We retrospectively reviewed the clinical data of patients registered in the Japan Organ Transplant Network from Okayama University Hospital who are candidates for cadaveric lung transplants for ILD between 1999 and 2015. Fifty-three patients with ILD were included (24 patients with idiopathic pulmonary fibrosis and 29 others). They had severe pulmonary dysfunction and low exercise tolerability. The median waiting time for transplantation was 462 days, and 22 patients died before allocation. Patients who died before 462 days without undergoing transplantation had more severe dyspnea, shorter 6-minute walk distance (6MWD), and lower performance status than those who waited ≥462 days. Japanese candidates for cadaveric lung transplants for ILD have severe pulmonary dysfunction. Severe dyspnea, short 6MWD, and low performance status are risk factors for early death while on the waiting list.