Prognostic value of exercise capacity among patients with treated depression: The Henry Ford Exercise Testing (FIT) Project

Background

Exercise capacity is associated with survival in the general population. Whether this applies to patients with treated depression is not clear.

Hypothesis

High exercise capacity remains associated with lower risk of all‐cause mortality (ACM) and nonfatal myocardial infraction (MI) among patients with treated depression.

Methods

We included 5128 patients on antidepressant medications who completed a clinically indicated exercise stress test between 1991 and 2009. Patients were followed for a median duration of 9.4 years for ACM and 4.5 years for MI. Exercise capacity was estimated in metabolic equivalents of tasks (METs). Cox proportional hazards regression models were used.

Results

Patients with treated depression who achieved ≥12 METs (vs those achieving <6 METs) were younger (age 46 ± 9 vs 61 ± 12 years), more often male (60% vs 23%), less often black (10% vs 27%), and less likely to be hypertensive (51% vs 86%), have DM (9% vs 38%), or be obese (11% vs 36%) or dyslipidemic (45% vs 54%). In the fully adjusted Cox proportional hazard regression model, exercise capacity was associated with a lower ACM (HR per 1‐MET increase in exercise capacity: 0.82, 95% CI: 0.79–0.85, P < 0.001) and nonfatal MI (HR: 0.92, 95% CI: 0.87–0.97, P = 0.004).

Conclusions

Exercise capacity had an inverse association with both ACM and nonfatal MI in patients with treated depression, independent of cardiovascular risk factors. These results highlight the potential impact of assessing exercise capacity to identify risk, as well as promoting an active lifestyle among treated depression patients.     

Sildenafil: study of a novel oral treatment for erectile dysfunction in diabetic men

The efficacy and safety of oral sildenafil, a potent inhibitor of phosphodiesterase type 5, were evaluated in men with diabetes mellitus and erectile dysfunction (ED). Twenty-one men (aged 42–65 years) were enrolled in a double-blind, placebo-controlled, three-way crossover study conducted in two parts. In part I, the effect of a single dose (25 mg or 50 mg) of sildenafil or placebo on penile rigidity was assessed by penile plethysmography during visual sexual stimulation. In part II, daily diary records of erectile activity and a global efficacy question were used to evaluate once-daily dosing with 25 mg or 50 mg of sildenafil or placebo for 10 days. After a single 50 mg dose of sildenafil, the adjusted geometric mean duration (min) of penile rigidity >60 % at the base of the penis during visual sexual stimulation was significantly increased (10.1 min) compared with placebo (2.8 min; p = 0.0053). In part II, sildenafil significantly increased the number of erections considered sufficiently hard for vaginal penetration compared with placebo (p = 0.0005). Improved erections were reported by 50 % and 52 % of patients treated with 25 mg and 50 mg of sildenafil, respectively, compared with 10 % of those receiving placebo (p values < 0.05). Adverse events were mostly mild or moderate in nature and included muscular pains, headache, and dyspepsia. Sildenafil is a well-tolerated and potentially efficacious oral treatment for ED in men with diabetes mellitus. © 1998 John Wiley & Sons, Ltd.     

Prognostic value of mitral regurgitation assessment during exercise echocardiography in patients with left ventricular dysfunction: a follow-up study of 1.7 +/- 1.5 years.

AIMS: The value of exercise echocardiography (EE) over resting echocardiography when this last incorporates information on mitral regurgitation (MR) is only partially known. Furthermore, limited data exist regarding the value of MR worsening during exercise in patients with left ventricular (LV) dysfunction. We investigate whether EE has incremental value over a resting echo-Doppler study; and whether post-exercise MR increments the value of EE for predicting outcome in patients with LV dysfunction. METHODS AND RESULTS: Three hundred and twenty-three consecutive patients with LV dysfunction (LV ejection fraction < or =45%) referred for EE were followed for 1.7 +/- 1.5 years. There were 43 hard events (myocardial infarction in 9 and cardiac death in 34). Resting MR, peak heart rate x blood pressure, and number of involved territories at exercise were independently associated to hard events (incremental P-value of EE =0.02). Independent variables associated to cardiac death were resting MR, peak heart rate x blood pressure, peak wall motion score index, and MR worsening (incremental P-value of MR worsening = 0.04). CONCLUSIONS: EE maintains its prognostic value over resting echocardiography even when this last incorporates information on MR. Exercise-induced MR worsening has independent prognostic value for cardiac death in patients with LV dysfunction.     

Oral OPC-8212 for the treatment of congestive heart failure: Hemodynamic improvement and increased exercise capacity

Summary The chronic effects of the oral administration of OPC-8212 (3,4-DIHYDRO-6-[4-(3,4-dimethoxybenzoyl)-1-piperazinyl]-2(1H)-quinolinone) on resting hemodynamics and exercise capacity were assessed in 15 patients with congestive heart failure (NYHA II–IV). Doses of 30 or 60 mg per day were given per os over 3.0 weeks on average (range 2–6 weeks). Multigated radionuclide ventriculography and multistage exercise testing were performed before and during OPC-8212 therapy to assess the changes in left ventricular volume and exercise capacity respectively. Systolic blood pressure showed a slight increase (from 123±3 to 129±4 mmHg) during OPC-8212 therapy, while heart rate was unchanged (69±3 vs 67±3 beats/min). The left ventricular end-diastolic volume index decreased from 127±9 to 107±7 ml/m², and ejection fraction and the P/V index (the ratio of peak systolic pressure to left ventricular end-systolic volume index) increased during OPC-8212 therapy (from 27%±3% to 30%±4% and from 1.5±0.2 to 2.0±0.3 mmHg/ml/m² respectively). NYHA functional class was improved in 9 of 15 patients, and the average peak work load achieved during exercise testing increased from 27±6 to 47±7 W. No significant adverse effect was observed in any patient. These results indicate that OPC-8212 enhances the inotropic state and, hence, reduces heart size with no change in heart rate. Moreover, it increases exercise capacity. Thus, OPC-8212 is an inotropic agent with promise for application in the long-term treatment of congestive heart failure.     

运动平板负荷试验中T波峰末间期对冠心病的诊断价值

目的 探讨运动平板负荷试验前后T波峰末间期（Tpe）、Tpec、Tpe/QT在冠心病心肌缺血诊断中的价值。方法 收集昆山市第一人民医院2014年1月至2018年3月期间,运动平板负荷试验阳性及冠状动脉造影确诊为冠心病的患者52例为缺血组,并按病变血管支数分为三组（单支病变组、双支病变组、多支病变组）,选取同期运动平板负荷试验阴性,排除冠心病,无心血管病史者52例为对照组。记录运动前、运动峰值、运动结束后2 min、运动结束后4 min、运动结束后6 min 的Tpe、Tpec、Tpe/QT数值。计算缺血组Gensini积分与运动前Tpe间期作相关性分析。结果 运动前缺血组Tpe（110.58±20.81）、Tpec（120.37±21.93）、Tpe/QT（0.27 ±0.04）均高于对照组Tpe（90.19 ±12.91）、Tpec（99.87 ±13.18）、Tpe/QT（0.24 ±0.03）,差异均有统计学意义（t值为6.003、5.781、4.939,P均为0.000）,运动峰值缺血组Tpe（86.52 ±13.13）、Tpec（131.45±18.75）、Tpe/QT（0.29 ±0.03）均高于对照组Tpe（58.46 ±6.68）、Tpec（94.51 ±10.86）、Tpe/QT（0.23 ±0.02）,差异均有统计学意义（t值为13.734、12.294、10.587,P均为0.000）,运动结束后2min、4min、6min缺血组Tpe、Tpec、Tpe/QT数值均高于对照组,差异有统计学意义（P均为0.000）。缺血组Tpe、Tpec值随病变支数增加而增加,差异有统计学意义（P=0.000）,运动峰值时Tpe缩短,Tpec延长,提示 Tpec反映心肌缺血心室复极离散度增加较Tpe更为敏感（P=0.000）。冠心病缺血组Gensini积分与运动前Tpe间期相关性系数为0.399,P=0.003,线性回归分析显示,两者显著相关（F=9.461,P=0.003）。结论 Tpe间期可作为反映冠状动脉狭窄和心肌缺血程度的新指标,Tpec反映冠状动脉狭窄程度较 Tpe更为敏感。在运动平板试验阳性基础上,结合运动前后Tpe、Tpec、Tpe/QT等数值变化可提高运动平板试验结果阳性预测值,为冠心病病情评估提供更多客观证据。     

The efficacy and safety of acupuncture in the treatment of erectile dysfunction: A protocol for systematic review and meta-analysis

Background:Erectile dysfunction (ED) can negatively affect men''s mental health, interpersonal relationships, and overall well-being. ED has affected >150 million men worldwide, and this number will reach approximately 322 million by 2025. Although PDE5-Is is a landmark in the treatment of erectile dysfunction, it may have side effects such as penile pain, cardiovascular dysfunction, and deafness. Some studies have shown that acupuncture may have a positive effect on the pathophysiology of ED. Therefore, we will select all randomized controlled trials related to evaluate the efficacy and safety of acupuncture treatment of ED.Methods:This study will systematically search 7 digital databases including China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine, Cochrane Library, PubMed, and Embase for randomized controlled trials without language restrictions. Two researchers will independently read the title, abstract, and full text to screen for studies that can be included in the meta-analysis. If there is any dispute, the third party will be required to reach a consensus.Results:The purpose of this study is to evaluate the efficacy and safety of acupuncture in the treatment of ED and the difference in the impact of different types of acupuncture on ED.Conclusion:Judge whether acupuncture and moxibustion can help improve the symptoms of ED by evaluating relevant literatures, and make up for the lack of relevant research.INPLASY registration number:INPLASY 202140040     

The effect of fasting status on lipids,lipoproteins, and inflammatory biomarkers assessed after hospitalization for an acute coronary syndrome: Insights from PROVE IT–TIMI 22

Background

For decades, fasting for 8 to 12 hours has been recommended for measurement of lipid profiles. The effect of fasting on low‐density lipoprotein cholesterol (LDL‐C) and triglycerides (TG) has been described in healthy cohorts and those with stable disease states. Recently, guidelines suggested that fasting may not be necessary due to its small effect on lipid measures. Little is known, however, regarding whether the impact of fasting is altered in the setting of an acute coronary syndrome (ACS).

Hypothesis

We hypothesized that the post‐ACS period would minimally effect the impact of fasting status on lipid measurements.

Methods

We evaluated the association of fasting on lipid and other biomarkers at the randomization visit, which occurred at a median of 7 days after the onset of an ACS, as well as during follow‐up, in a cohort of 4177 subjects from the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction 22 (PROVE IT–TIMI 22) trial.

Results

Fasting samples were independently associated with a higher LDL‐C of 4.1 mg/dL and apolipoprotein‐B 100 of 2.6 mg/dL as well as a lower TG of 21.0 mg/dL and high‐sensitivity C‐reactive protein of 0.48 mg/dL. The relative difference was 3.8% for LDL‐C and ?11.3% for TG. Fasting did not change total cholesterol, high‐density lipoprotein cholesterol, apolipoprotein A‐I, lipoprotein(a), or apolipoprotein C‐III.

Conclusions

Although fasting does impact lipid measurements, the effect on LDL‐C is small (about 4 mg/dL), both early after ACS and during follow‐up. These data provide support for recent guidelines that no longer advocate for fasting lipid samples, including in the setting of ACS.