The impact of panic disorder on interoception and dyspnea reports in chronic obstructive pulmonary disease

The prevalence of panic disorder (PD) in patients with chronic obstructive pulmonary disease (COPD) is significantly higher than that in the general population. Comorbid anxiety disorders in COPD are associated with a number of worse outcomes, however little is known about the mechanisms by which PD affects patients with COPD. We hypothesized that patients with COPD and PD would have greater dyspnea severity, but not greater somatosensory sensitivity, to dyspneic stimuli.We studied 10 patients with COPD and PD, 9 patients with COPD without PD, and 9 healthy, matched controls. Participants were administered the Anxiety Sensitivity Index-3. We tested interoceptive sensitivity using a respiratory load detection protocol and dyspnea ratings in response to inspiratory resistive loads.Participants with COPD and PD had higher anxiety sensitivity scores and reported greater dyspnea in response to resistive loads. However no group differences were found in resistive load detection threshold. Anxiety sensitivity scores accounted for a significant amount of the variance in the group difference in dyspnea ratings.Patients with COPD and PD do not show heightened interoceptive sensitivity, but report greater dyspnea to inspiratory resistive loads. Emotional responses to dyspneic sensations may account for higher dyspnea ratings in patients with PD and COPD.     

Aerobic exercise improves the inflammatory profile correlated with cardiac remodeling and function in chronic heart failure rats

OBJECTIVE:

The aim of the present study was to evaluate the effect of 8 weeks of aerobic exercise training on cardiac functioning and remodeling and on the plasma levels of inflammatory cytokines in chronic heart failure rats.

METHODS:

Wistar rats were subjected to myocardial infarction or sham surgery and assigned to 4 groups: chronic heart failure trained (n = 7), chronic heart failure sedentary (n = 6), sham trained (n = 8) and sham sedentary (n = 8). Four weeks after the surgical procedures, the rats were subjected to aerobic training in the form of treadmill running (50 min/day, 5 times per week, 16 m/min). At the end of 8 weeks, the rats were placed under anesthesia, the hemodynamic variables were recorded and blood samples were collected. Cardiac hypertrophy was evaluated using the left ventricular weight/body weight ratio, and the collagen volume fraction was assessed using histology.

RESULTS:

The chronic heart failure trained group showed a reduction in left ventricular end-diastolic pressure, a lower left ventricular weight/body weight ratio and a lower collagen volume fraction compared with the chronic heart failure sedentary group. In addition, exercise training reduced the plasma levels of TNF-α and IL-6 and increased the plasma level of IL-10.

CONCLUSION:

An 8-week aerobic exercise training program improved the inflammatory profile and cardiac function and attenuated cardiac remodeling in chronic heart failure rats.     

The impact of affective states on the perception of dyspnea in patients with chronic obstructive pulmonary disease

Dyspnea is the cardinal symptom of chronic obstructive pulmonary disease (COPD). Affective states can profoundly impact upon the perception of dyspnea, but little is known about this relationship in patients with COPD. We, therefore, examined the impact of viewing positive versus negative affective picture series on perceived dyspnea during two cycle ergometer exercise tests (CEET) in 30 patients with COPD. Whereas cardiopulmonary measures indicated comparable exercise intensity during both CEETs, parallel viewing of negative affective pictures resulted in increased dyspnea ratings compared to positive affective pictures. Regression analyses showed that only during positive picture viewing increases in the affective unpleasantness of dyspnea, but not in the sensory intensity of dyspnea, during CEETs were predictive of greater dyspnea during everyday activities and reduced health-related quality of life. The results suggest that negative affective states increase perceived dyspnea in patients with COPD and underline the importance of targeting the affect-dyspnea-relationship in this patient group.     

新生儿肺炎期间肺动脉压力、心腔内径及心脏功能变化的研究

目的探讨新生儿肺炎期间及肺炎合并心衰时肺动脉压力、心腔内径及心功能变化规律。方法用彩色多谱勒超声TR压差法检测肺炎期间及肺炎合并心衰时肺动脉压力、心腔内径及心脏功能,同时做血气及心肌酶谱检查,并与正常新生儿比较,找出变化规律。结论新生儿肺炎期间肺动脉压力增高、肺动脉内径增宽、血气及心肌酶谱均有不同程度改变。肺炎合并心衰时左心室内径及右心室内径均有不同程度的增大。同时也证明肺炎合并心衰时是肺动脉压力增高及毒素等作用的结果。     

Impact of chronic obstructive pulmonary disease on linear and nonlinear dynamics of heart rate variability in patients with heart failure

The objective of this study was to investigate the impact of chronic obstructive pulmonary disease (COPD)-heart failure (HF) coexistence on linear and nonlinear dynamics of heart rate variability (HRV). Forty-one patients (14 with COPD-HF and 27 HF) were enrolled and underwent pulmonary function and echocardiography evaluation to confirm the clinical diagnosis. Heart rate (HR) and R-R intervals (iRR) were collected during active postural maneuver (APM) [supine (10 min) to orthostasis (10 min)], respiratory sinus arrhythmia maneuver (RSA-M) (4 min), and analysis of frequency domain, time domain, and nonlinear HRV. We found expected autonomic response during orthostatic changes with reduction of mean iRR, root mean square of successive differences between heart beats (RMSSD), RR tri index, and high-frequency [HF (nu)] and an increased mean HR, low-frequency [LF (nu)], and LF/HF (nu) compared with supine only in HF patients (P<0.05). Patients with COPD-HF coexistence did not respond to postural change. In addition, in the orthostatic position, higher HF nu and lower LF nu and LF/HF (nu) were observed in COPD-HF compared with HF patients. HF patients showed an opposite response during RSA-M, with increased sympathetic modulation (LF nu) and reduced parasympathetic modulation (HF nu) (P<0.05) compared with COPD-HF patients. COPD-HF directly influenced cardiac autonomic modulation during active postural change and controlled breathing, demonstrating an autonomic imbalance during sympathetic and parasympathetic maneuvers compared with isolated HF.     

Improved relationship between left and right ventricular electrical activation after cardiac resynchronization therapy in heart failure patients can be quantified by body surface potential mapping

OBJECTIVES:

Few studies have evaluated cardiac electrical activation dynamics after cardiac resynchronization therapy. Although this procedure reduces morbidity and mortality in heart failure patients, many approaches attempting to identify the responders have shown that 30% of patients do not attain clinical or functional improvement. This study sought to quantify and characterize the effect of resynchronization therapy on the ventricular electrical activation of patients using body surface potential mapping, a noninvasive tool.

METHODS:

This retrospective study included 91 resynchronization patients with a mean age of 61 years, left ventricle ejection fraction of 28%, mean QRS duration of 182 ms, and functional class III/IV (78%/22%); the patients underwent 87-lead body surface mapping with the resynchronization device on and off. Thirty-six patients were excluded. Body surface isochronal maps produced 87 maximal/mean global ventricular activation times with three regions identified. The regional activation times for right and left ventricles and their inter-regional right-to-left ventricle gradients were calculated from these results and analyzed. The Mann-Whitney U-test and Kruskall-Wallis test were used for comparisons, with the level of significance set at p≤0.05.

RESULTS:

During intrinsic rhythms, regional ventricular activation times were significantly different (54.5 ms vs. 95.9 ms in the right and left ventricle regions, respectively). Regarding cardiac resynchronization, the maximal global value was significantly reduced (138 ms to 131 ms), and a downward variation of 19.4% in regional-left and an upward variation of 44.8% in regional-right ventricular activation times resulted in a significantly reduced inter-regional gradient (43.8 ms to 17 ms).

CONCLUSIONS:

Body surface potential mapping in resynchronization patients yielded electrical ventricular activation times for two cardiac regions with significantly decreased global and regional-left values but significantly increased regional-right values, thus showing an attenuated inter-regional gradient after the cardiac resynchronization therapy.     

Diastolic function and functional capacity after a single session of continuous positive airway pressure in patients with compensated heart failure

OBJECTIVE:

The effects of acute continuous positive airway pressure therapy on left ventricular diastolic function and functional capacity in patients with compensated systolic heart failure remain unclear.

METHODS:

This randomized, double-blind, placebo-controlled clinical trial included 43 patients with heart failure and a left ventricular ejection fraction <0.50 who were in functional classes I-III according to the New York Heart Association criteria. Twenty-three patients were assigned to continuous positive airway pressure therapy (10 cmH₂O), while 20 patients received placebo with null pressure for 30 minutes. All patients underwent a 6-minute walk test (6MWT) and Doppler echocardiography before and immediately after intervention. Clinicaltrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01088854","term_id":"NCT01088854"}}NCT01088854.

RESULTS:

The groups had similar clinical and echocardiographic baseline variables. Variation in the diastolic function index (e′) after intervention was associated with differences in the distance walked in both groups. However, in the continuous positive airway pressure group, this difference was greater (continuous positive airway pressure group: Δ6MWT = 9.44+16.05×Δe′, p = 0.002; sham group: Δ6MWT = 7.49+5.38×Δe′; p = 0.015). There was a statistically significant interaction between e′ index variation and continuous positive airway pressure for the improvement of functional capacity (p = 0.020).

CONCLUSIONS:

Continuous positive airway pressure does not acurately change the echocardiographic indexes of left ventricle systolic or diastolic function in patients with compensated systolic heart failure. However, 30-minute continuous positive airway pressure therapy appears to have an effect on left ventricular diastolic function by increasing functional capacity.     

免疫调节在心力衰竭发生发展中的研究进展

心力衰竭是由于多种复杂因素导致心肌细胞收缩及舒张运动受限、无力,致心室正常射血受阻的一种疾病,心力衰竭也是心脏疾病发展的终末阶段和主要死亡原因。近些年来,随着有关心力衰竭的研究发展的不断深入,越来越多的证据表明细胞因子、淋巴细胞亚群、自身抗体、免疫球蛋白、抗原及补体参与了心力衰竭的发生发展,也为心力衰竭的治疗带来启示。...     

The role of hepatic venous congestion and endotoxaemia in the production of fulminant hepatic failure secondary to congestive heart failure

The present study was undertaken to clarify the role of congestion of the liver and endotoxemia in the production of fulminant hepatic failure secondary to congestive heart failure. Induction of congestion of the liver, i.e. an elevation of hepatic venous pressure, in rats was accomplished by partial obstruction of the inferior vena cava. A close relationship was demonstrated between venous pressure and serum levels of transaminases as a measure of hepatic dysfunction. Hepatic dysfunction was mild in rats with venous hypertension alone, and only centrilobular congestion was seen on microscopy. In contrast, severe abnormalities of hepatic function were induced by venous hypertension and endotoxaemia. Histologically, the liver revealed bridging centrilobular necrosis as seen in patients with congestive heart failure who develop fulminant hepatic failure. These data suggest that coexistence of endotoxaemia and congestion of the liver may induce fulminant hepatic failure, and that the latter alone is associated only with slight hepatic dysfunction and liver damage.     

Statin therapy blunts inflammatory activation and improves prognosis and left ventricular performance assessed by Tissue Doppler Imaging in subjects with chronic ischemic heart failure: results from the Daunia Heart Failure Registry

BACKGROUND:

A limited number of studies have used Tissue Doppler Imaging (TDI) to evaluate the effect of statin therapy on left ventricular dysfunction in patients with chronic heart failure. In this work, we aimed to determine whether statin administration influenced prognosis, inflammatory activation and myocardial performance evaluated by Tissue Doppler Imaging in subjects enrolled in the Daunia Heart Failure Registry, a local registry of patients with chronic heart failure.

METHODS:

This study retrospectively analyzed 353 consecutive outpatients with chronic heart failure (mean follow-up 384 days), based on whether statin therapy was used. In all patients, several Tissue Doppler Imaging parameters were measured; circulating levels of interleukin (IL)-6, IL-10 and C-reactive protein were also assayed.

RESULTS:

Statin administration in 128 subjects with ischemic heart disease was associated with a lower incidence of adverse events (rehospitalization for HF 15% vs. 46%, p<0.001; ventricular arrhythmias 5% vs. 21%, p<0.01; cardiac death 1% vs. 8%, p<0.05), lower circulating levels of IL-6 (p<0.05) and IL-10 (p<0.01), lower rates of chronic heart failure (p<0.001) and better Tissue Doppler Imaging performance (E/E'' ratio 12.82±5.42 vs. 19.85±9.14, p<0.001; ET: 260.62±44.16 vs. 227.11±37.58 ms, p<0.05; TP: 176.79±49.93 vs. 136.7±37.78 ms, p<0.05 and St: 352.35±43.17 vs. 310.67±66.46±37.78 ms, p<0.05).

CONCLUSIONS:

Chronic ischemic heart failure outpatients undergoing statin treatment had fewer readmissions for adverse events, blunted inflammatory activation and improved left ventricular performance assessed by Tissue Doppler Imaging.     

Relationship between improvements in heart failure patient disease specific knowledge and clinical events as part of a randomized controlled trial

Objective

To examine the changes in performance on heart failure knowledge assessments administered before and after discharge education.

Methods

We conducted a randomized controlled trial comparing the effects of a 1-h, one-on-one teaching session with a nurse educator to the standard discharge process in patients with systolic heart failure. Patients completed a 30 point heart failure knowledge questionnaire (HFKQ) prior to and 3 months after the education intervention.

Results

Patients randomized to the nurse education intervention (n = 113) demonstrated significantly higher total HFKQ score increases compared to patients receiving the standard discharge process (n = 114) (median, IQR 1, 0 to 4 vs 0, −2 to 2, p = 0.007). Patients experiencing death or rehospitalization in the subsequent 6 months were found to have significantly lower HFKQ scores (10, 7 to 12 vs 11, 8 to 13, p = 0.002) compared to patients without a clinical event.

Conclusion

Heart failure nurse education at the time of hospital discharge results in improved patient knowledge and reduced risk of readmission.

Practice implications

Health care personnel should encourage education sessions for heart failure patients. Resources possibly need to be allocated for nurse led education sessions in heart failure patients as it improves outcomes and knowledge.     

血浆microRNA-21水平与左室射血分数保留的心力衰竭相关性肺高压的关系

目的:探讨血浆微小RNA-21(miR-21)水平与左室射血分数保留的心力衰竭(HFpEF)相关性肺高压(PH-HFpEF)的关系。方法:选择2014年1月～2017年2月在江西省人民医院心内科就诊的HFpEF患者102例,通过三尖瓣反流压差法估测肺动脉收缩压(pulmonary artery systolic pressure,PASP),并按PASP分为PH-HFpEF组(n=36,PASP≥50 mmHg)和HFpEF组(n=40,PASP 50 mmHg),另选年龄和性别相应的同期健康体检者作为对照组(n=36),比较各组患者的临床资料,血浆miR-21水平与临床资料的相关性用Spearman相关分析,血浆miR-21水平预测PH-HFpEF准确性用受试者工作特征(ROC)曲线分析。多因素logistic回归分析与PH-HFpEF相关的危险因素。结果:PH-HFpEF组患者年龄、血浆内皮素1(ET-1)、血浆白细胞介素6(IL-6)、脑钠尿肽(BNP)和左房直径(LAD)均高于HFpEF组(P 0. 05)。PH-HFpEF组血浆miR-21表达明显高于HFpEF组及健康对照组(P 0. 05)。Spearman相关分析显示,血浆miR-21与PASP (r=0. 267,P=0. 000)、血浆IL-6 (r=0. 302,P=0. 013)和左心室重量指数(LVMI)(r=0. 515,P=0. 036)相关;血浆IL-6与ET-1正相关(r=0. 622,P=0. 002);PASP分别与血浆IL-6 (r=0. 36,P=0. 023)、ET-1 (r=0. 76,P=0. 004)、BNP (r=0. 43,P=0. 031)及LAD (r=0. 39,P=0. 044)正相关。血浆miR-21诊断PH-HFpEF的ROC曲线分析显示,曲线下面积为0. 8。多因素logistic回归分析显示,血浆miR-21相对表达水平、LAD、BNP与HFpEF患者肺高压相关。结论:血浆miR-21水平与PHHFpEF呈正相关,是HFpEF患者出现肺高压的独立预测因素。血浆miR-21可能是PH-HFpEF的标志物。     

肺炎伴心衰患儿血清中内皮素及内源性洋地黄样因子水平变化分析

目的探讨肺炎和肺炎并发心力衰竭(肺炎心衰),患儿血清内皮素和内源性洋地黄样因子水平变化。方法采用放射免疫分析法测定患儿内皮素和内源性洋地黄样因子。结果肺炎及肺炎心衰患儿内皮素和内源性洋地黄样因子有明显改变。结论内皮素及内源性洋地黄样因子与肺循环、缺氧有关。     

The effect of graded immersion on heart volume,central venous pressure,pulmonary blood distribution,and heart rate in man

The present experiments have been conducted to study the immediate effects of graded immersion on the central circulation. When taking heart volume as an indicator, it was found that immersion to the diaphragm of a standing subject produces the same changes as assumption of the supine posture. Heart volume increases by approximately 130ml. When the water level is raised to the neck, an extra pressure corresponding to a water column extending from the diaphragm to the surface of the water of approximately 25 cm H₂O forces blood into the thorax. The heart becomes distended by an additional 120ml. Correspondingly the central venous pressure at the height of the right atrium increases from 2.5 to 12.8 mm Hg when the water level rises from the diaphragm to the neck. The greater filling of the pulmonary circulation is accompanied by a decrease in vital capacity and visualized by scintigrams. The preferential increase in blood volume of the apical regions is striking. When raising the water level from the symphysis to the xiphoid heart rate falls by about 15%.     

充血性心力衰竭犬肾组织内皮素系统表达的变化

目的：观察充血性心力衰竭犬肾脏内皮素系统表达的变化。方法：快速右心室起搏致心力衰竭犬模型,21只犬随机分为对照组、起搏2周组和起搏4周组。测定血液动力学评价心力衰竭严重程度,放射免疫测定法测定血浆内皮素浓度,RT-PCR法检测肾脏皮质和髓质内皮素系统的表达水平。结果：起搏2周组和起搏4周组血浆内皮素浓度均明显升高,起搏2周组肾髓质内皮素B受体表达水平上升,起搏4周组肾皮质和髓质内皮素前体原、内皮素A受体和内皮素B受体的表达均上升,在肾皮质,以内皮素A受体上升幅度较明显,而在肾髓质,则以内皮素B受体上升为显著。结论：在心力衰竭的不同阶段,肾脏内皮素系统表达的改变参与机体水电解质平衡的调节。     

Physical exercise improves the functional capacity and quality of life in patients with heart failure

OBJECTIVE: The purpose of this study was to investigate the effects of physical exercise on the functional capacity and quality of life in heart failure patients. METHODS: Forty-two patients of both sexes with heart failure of NYHA class II and III with different etiologies were randomly divided into untrained or trained groups. The six-month exercise program consisted of aerobic training, muscle strength training, agility and joint flexibility activities. Physical fitness was evaluated by testing the performance on these trained components. Quality of life was evaluated by scored answers to a standardized questionnaire involving multiple domains. RESULTS: Baseline values did not differ between groups. Improvement in the trained group was identified in all components of functional capacity when compared to the untrained group (p<0.001). Quality of life improved in the trained patients concerning physical, psychological, social and environmental domains (p<0.001), whereas no significant change was found in the untrained patients. CONCLUSIONS: Guided and monitored physical exercise is safe and has the potential to improve functional capacity and quality of life in heart failure patients with multiple etiologies.     

Domestic and foreign trends in the prevalence of heart failure and the necessity of next-generation artificial hearts: a survey by the Working Group on Establishment of Assessment Guidelines for Next-Generation Artificial Heart Systems

A series of guidelines for development and assessment of next-generation medical devices has been drafted under an interagency collaborative project by the Ministry of Health, Labor and Welfare and the Ministry of Economy, Trade and Industry. The working group for assessment guidelines of next-generation artificial hearts reviewed the trend in the prevalence of heart failure and examined the potential usefulness of such devices in Japan and in other countries as a fundamental part of the process of establishing appropriate guidelines. At present, more than 23 million people suffer from heart failure in developed countries, including Japan. Although Japan currently has the lowest mortality from heart failure among those countries, the number of patients is gradually increasing as our lifestyle becomes more Westernized; the associated medical expenses are rapidly growing. The number of heart transplantations, however, is limited due to the overwhelming shortage of donor hearts, not only in Japan but worldwide. Meanwhile, clinical studies and surveys have revealed that the major causes of death in patients undergoing long-term use of ventricular assist devices (VADs) were infection, thrombosis, and mechanical failure, all of which are typical of VADs. It is therefore of urgent and universal necessity to develop next-generation artificial hearts that have excellent durability to provide at least 2 years of event-free operation with a superior quality of life and that can be used for destination therapy to save patients with irreversible heart failure. It is also very important to ensure that an environment that facilitates the development, testing, and approval evaluation processes of next-generation artificial hearts be established as soon as possible. Working Group on Establishment of Assessment Guidelines for Active Implantable Medical Devices: Next-Generation Artificial Heart System, Inter-agency Committee for the Guideline Program, the Ministry of Health, Labour and Welfare of Japan and the Ministry of Economy, Trade and Industry of Japan, Tokyo, Japan     

Force-frequency relationship and inotropic stimulation in the nonfailing and failing human myocardium: implications for the medical treatment of heart failure

Summary In isolated papillary muscle strips from nonfailing donor hearts (NF) and from the hearts of patients with dilated cardiomyopathy with severe heart failure (NYHA IV), the force-frequency relationship was studied. Experiments were performed under basal conditions and in the presence of 0.01 M or 0.1 M isoprenaline and 0.02 M ouabain. In NF, there was a positive inotropic effect following an increase of the stimulating frequency, whereas in NYHA IV, the force gradually declined under these conditions. Low concentrations (0.01) M of isoprenaline prevented the negative inotropic effect in NYHA IV, whereas at 0.1 M the mechanical function deteriorated in NF and NYHA IV. Ouabain had no effect on the force-frequency relationship compared to basal conditions. It is concluded that a reduction of high frequencies does improve the contractility in the failing myocardium. It is not unreasonable to speculate that this mechanism might be involved in the beneficial effects of drugs which reduce the heart rate, such as -adrenoceptor antagonists and cardiac glycosides, in the condition of congestive heart failure in which the sympathetic tone is high.Abbreviations NF nonfailing myocardium - DCM dilated cardiomyopathy - SEM standard error of the mean - Hz hertz - NYHA IV functional class IV heart failure according to the New York Heart Association - CAMP cyclic 3,5-adenosine monophosphate Supported by the Deutsche Forschungsgemeinschaft (Bo 896/1-2)     

The predictive value of low heart rate and heart rate variability during stress for reoffending in delinquent male adolescents

Low autonomic (re)activity is a consistent correlate of antisocial behavior in juveniles. However, longitudinal research relating autonomic measures to persistent antisocial behavior has remained scarce. Therefore, in the present study we examined the predictive value of heart rate (HR) and heart rate variability (HRV, often studied as respiratory sinus arrhythmia) for reoffending in delinquent male adolescents. At initial assessment, HR and HRV were measured at rest and in response to a public speaking task. Registered reoffending was assessed after 5-year follow-up. Attenuated HR response and stronger HRV response to stress predicted higher reoffending rates. Results provide evidence that HR/HRV reactivity are neurobiological markers for persistent juvenile antisocial behavior. Although effect sizes were small to moderate, our findings underscore the consistency of the relationship between autonomic markers and antisocial behavior.