Diagnosis and prognostic value of restrictive ventilatory disorders in the elderly: a systematic review of the literature

Although less extensively studied compared to pulmonary obstructive diseases, restrictive lung disease (RLD) is highly prevalent and frequently disabling in the adult and, more, the elderly population. The underlying conditions may be either primarily pulmonary diseases, such as idiopathic pulmonary fibrosis, or non respiratory conditions secondarily affecting the lung, e. g. congestive heart failure, or else conditions affecting the lung expansion, e. g. obesity or rib cage deformity. The diagnosis is frequently based on the measurement of surrogate indexes such as the forced vital capacity (FVC) used as a proxy for total lung capacity (TLC). As a consequence, diagnosis of RLD is often characterized by poor specificity. In the elderly, worsening in the quality of life and poor prognosis are variably, but significantly, associated to RLD, being the underlying condition an important source of variability. Several causes of RLD are preventable and treatable conditions. A prompt identification of these conditions may allow to slow the decline of respiratory reserve and, thus, to preserve both personal independence and resistance to acute respiratory infections. This review gives an update on the latest evidence available on the prevalence and the prognosis of RLD in the elderly. Studies were identified through systematic searches of the electronic database MEDLINE. Reference list of eligible papers were also manually searched.     

Antegrade percutaneous valve implantation for mitral ring dysfunction,a challenging case

The operative risk for reoperation of degenerated bioprosthetic valves or failing mitral‐valve annuloplasty is higher compared with the risks for first isolated native valve repair or replacement (Astor et al., Eur Heart J 2008;29:2382–2387). In the presence of comorbidities, these risks increase exponentially. The recent introduction of transcatheter valve implantation opened new perspectives for the treatment of patients at very high surgical risk. We report a percutaneous mitral valve (MV) implantation using a transatrial approach within a MV ring using the Edwars Sapien XT valve. © 2012 Wiley Periodicals, Inc.     

附子与山茱萸配伍对慢性心力衰竭大鼠的影响

目的探讨附子与山茱萸配伍对慢性心力衰竭大鼠增效减毒作用。方法 ip盐酸阿霉素构建大鼠慢性心力衰竭模型,分别给予附子提取物、山茱萸提取物和附子-山茱萸提取物3周后,检测动物血清脑钠素(BNP)含量,心肌细胞Ca2+-ATP酶和Na~+,K~+-ATP酶活性,镜下观察左心室组织病理学形态变化。结果造模3周后,模型组大鼠普遍出现腹水、消瘦、稀便、弓背等症状体征;左心室射血分数(EF)和左心室短轴缩短率(FS)明显下降;血清BNP水平显著升高;左心室组织出现心肌纤维断裂及心肌细胞变性、坏死等病理改变。连续ig给予附子-山茱萸提取物3周后,大鼠症状及体征明显改善,血清BNP水平下降,心肌细胞Na~+,K~+-ATP酶活性升高,左心室组织病理学形态有明显改善。附子提取物和山茱萸提取物分别连续给药3周,上述指标未见明显改善。结论附子与山茱萸配伍可能通过提高心肌细胞Na~+,K~+-ATP酶活性,改善慢性心力衰竭的心肌能量代谢障碍,提高心力衰竭的心肌活性,起到增效减毒作用。     

别嘌呤醇对伴高尿酸血症慢性心力衰竭急性发作患者血清NO、MDA、SOD及肱动脉内皮依赖性舒张功能的影响

目的通过观察试验组和对照组用药前后慢性心力衰竭急性发作患者血浆一氧化氮（NO）丙二醛（MDA）超氧化物歧化酶（SOD）及肱动脉内皮依赖性舒张功能（EDD）的变化来探讨别嘌呤醇对伴高尿酸血症慢性心力衰竭急性发作患者内皮功能及氧自由基的影响。方法78例慢性心力衰竭急性发作患者被随机分为别嘌呤醇组（常规治疗＋别嘌呤醇，38例）和对照组（常规治疗，40例），分析NO、MDA、SOD在1周治疗前后浓度的变化及EDD的变化。结果别嘌呤醇治疗7d后，与对照组相比，试验组血SOD浓度明显升高（P〈0．05），血MDA显著下降（P〈0．05），而试验组NO及肱动脉EDD有上升趋势；但差异无统计学意义。结论别嘌呤醇能显著增加慢性心力衰竭急性发作患者血SOD，降低血MDA，因而减轻此类患者氧化应激的程度，进而可能对该类患者内皮舒张功能产生积极影响。     

氯沙坦对5/6肾切除慢性心衰大鼠的影响

目的：主要探讨氯沙坦对5/6肾切除慢性心衰模型大鼠心血管的影响。方法：雄性SD大鼠30只随机分为假手术组（Sham）、病理组（Nx）和氯沙坦治疗组（Lst）。Nx组和Lst组行5/6肾切除术,Lst组于术后第7周初于饮水中连续两周给予氯沙坦（10 mg·kg-1·d-1）治疗。8周末处理所有大鼠,测定血流动力学参数、心指数、血管舒张度、血清肌酐、尿素氮以及心肌和血管组织中丙二醛（MDA）含量和超氧化物歧化酶（SOD）活性。结果：与Nx组比较,Lst组大鼠LVEDP降低,LVSP、LVDP绝对值升高,心指数降低,血管舒张度增大,血清中肌酐、尿素氮降低,各组织中MDA含量降低,SOD活性升高,结果有显著性差异或极显著性差异（P〈0.05或P〈0.01）。结论：氯沙坦能够改善慢性心衰大鼠左心肥厚、左心和血管内皮功能;降低心肌和血管组织中MDA含量并提高SOD活性,减轻组织氧化应激,对心血管产生有益作用。     

Are inotropic agents contraindicated in congestive heart failure?

Summary The myocardium in the patient with congestive heart failure is abnormal and probably unable to generate sufficient chemical energy to meet the heart's mechanical needs. Such a condition of energy starvation would have several important implications; among these is that inotropic stimulation, by increasing energy utilization, could accelerate the progressive death of myocardial cells that characterizes end-stage heart failure. An important goal of therapy in these patients, therefore, is to reduce cardiac energy expenditure. This can be accomplished by unloading the failing heart, which has already been shown to prolong survival in patients with severe congestive heart failure. Slowing the progressive death of myocardial cells may also be accomplished by the administration of negative, rather than positive, inotropic drugs.Supported in part by NHLBI Program Project HL-33026.     

Effect of Renin–Angiotensin System Inhibition on Cardiovascular Events in Older Hypertensive Patients with Metabolic Syndrome

Objective

Metabolic syndrome (MetS) is associated with cardiovascular disease (CVD). Insulin resistance has been hypothesized as the underlying feature of MetS. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are widely used antihypertensives that may improve insulin sensitivity. The aim of the study is to evaluate the effect of ACEI/ARB on incident CVD events in older hypertensive patients with MetS.

Materials/Methods

We used the Cardiovascular Health Study, a prospective cohort study of individuals > 65 years of age to evaluate ACEI/ARB use and time to CVD events (including coronary and cerebrovascular events). The study included 777 subjects who had hypertension and ATP III-defined MetS, but free of CVD and diabetes at baseline. Cox regression models were used to evaluate the effect of ACEI/ARB as compared to other antihypertensives on the time to the first CVD events.

Results

ACEI/ARB use was associated with a decreased risk of CVD events (adjusted HR = 0.658, 95 % C.I. [0.436–0.993]) compared to other antihypertensives. When CVD endpoints were evaluated separately, use of ACEI/ARB was associated with lower rates of angioplasty and coronary events (HR of 0.129 and 0.530 respectively, with 95 % CI [0.017–0.952] and [0.321–0.875]).

Conclusions

ACEI/ARB use was associated with a lower risk of CVD events in older hypertensive patients with MetS, primarily due to a reduction in coronary events. The potential protective effect of ACEI/ARB on CVD events in older individuals with MetS will need further confirmation from prospective studies.     

An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: A confirmatory factor analysis and a resulting continuous severity score

Objective

The metabolic syndrome (MetS) is typically diagnosed based on abnormalities in specific clustered clinical measures that are associated with increased risk for coronary heart disease (CHD) and Type 2 diabetes mellitus (T2DM). However, current MetS criteria result in racial/ethnic discrepancies. Our goals were to use confirmatory factor analysis (CFA) to delineate differential contributions to MetS by sub-group, and if contributions were discovered, develop sex and racial/ethnic-specific equations to calculate MetS severity.

Research Design and Methods

Using data on adults from the National Health and Nutrition Examination Survey 1999–2010, we performed a CFA of a single MetS factor that allowed differential loadings across groups, resulting in a sex and race/ethnicity-specific continuous MetS severity score.

Results

Loadings to the single MetS factor differed by sub-group for each MetS component (p < 0.001), with lower factor loadings among non-Hispanic-blacks for triglycerides and among Hispanics for waist circumference. Systolic blood pressure exhibited low factor loadings among all groups. MetS severity scores were correlated with biomarkers of future disease (high-sensitivity C-reactive-protein, uric acid, insulin resistance). Non-Hispanic-black-males with diabetics had a low prevalence of MetS but high MetS severity scores that were not significantly different from other racial/ethnic groups.

Conclusions

This analysis among adults uniquely demonstrated differences between sexes and racial/ethnic groups regarding contributions of traditional MetS components to an assumed single factor. The resulting equations provide a clinically-accessible and interpretable continuous measure of MetS for potential use in identifying adults at higher risk for MetS-related diseases and following changes within individuals over time. These equations hold potential to be a powerful new outcome for use in MetS-focused research and interventions.