Experimental Induction of Emotional and Sexual Intimacy: Exploring the Validity of the German Fast Friends Procedure in Individuals with and without Childhood Maltreatment

The Fast Friends Procedure (FFP) is a widely used experimental paradigm to induce emotional intimacy. Besides exploring the validity of a German translation of the paradigm (n?=?46), we developed an extension of the FFP that induces sexual intimacy and assessed heart rate, high-frequency heart rate variability, and electrodermal activity responses to the FFP and its extension. Furthermore, we examined its applicability to individuals with childhood maltreatment (n?=?56), who frequently suffer from intimacy-related difficulties. Intimacy, positive affect, liking, and attraction increased during the FFP and partly during the sexual intimacy extension in both study groups. Moreover, both groups showed physiological responses consistent with positive social interactions. The use of the German FFP and its sexual intimacy extension can thus be recommended for research in the general population and in individuals with childhood maltreatment, although more studies are needed to further validate the paradigms.

     

Dissociation between contraction and relaxation: The possible role of phospholamban phosphorylation

Summary The relationship between myocardial relaxation and phosphorylation of phospholamban, an intrinsic protein of sarcoplasmic reticulum (SR), was studied in perfused rat hearts beating at constant rate and perfused at constant coronary flow. The positive inotropic effect (increase in developed tension, T, and maximal rate of rise of tension, + ) of 3×10^–9 and 3×10^–8M isoproterenol (ISO) occurred together, with a proportionately greater increase in maximal velocity of relaxation, – . Thus, the + /– ratio decreased 0.23±0.04 and 0.41±0.05 respectively. Time to half-relaxation (t_1/2) and the time constant of relaxation (Tau) were also significantly decreased by ISO. Phospholamban phosphorylation (in pmol³²Pi/mg SR protein) increased from 23±3.3 (control) to 42±2.3 (3×10^–9M ISO) and to 186±19.3 (3×10^–8M ISO). When the negative inotropic action of nifedipine was just offset by either Ca²⁺ (N–Ca²⁺) or ISO (N–I), relaxation was faster when ISO was present. Perfusion with N–I significantly decreased + /– 0.18±0.05, t_1/2 14±3 ms and Tau 1.4±0.2 ms. Phospholamban phosphorylation significantly increased from 23±3.3 to 40±4.9 pmol 32 Pi/mg SR protein. N–Ca²⁺ did not elicit any significant change in these parameters nor in phospholamban phosphorylation. Thus, phospholamban phosphorylation appears closely related to myocardial relaxation and may be one of the important mechanisms by which contractility and relaxation are dissociated in vivo.This work was supported by grants # 3-106600/85 from CONICET and # 2109-1239/85 from CIC.     

Clinical characteristics, sex hormones, and long-term follow-up in Swiss postmenopausal women presenting with Takotsubo cardiomyopathy

Background:

The overwhelming majority of patients with stress cardiomyopathy (SC) are postmenopausal women, suggesting an important pathophysiologic role of the female sex hormones. Preliminary data suggest that myocardial stunning might be provoked by estrogen deficiency.

Hypothesis:

We hypothesized that, compared with age‐ and gender‐matched patients with myocardial infarction (MI) or patients with normal coronary arteries, patients with SC would exhibit altered levels of sex hormones. Furthermore, we aimed to describe the clinical course and the pattern of sex hormones of the SC patients during long‐term follow‐up.

Methods:

Blood samples obtained on hospital admission were analyzed for estradiol (E2), progesterone (P), luteinizing hormone (LH), and follicle‐stimulating hormone (FSH) in women with SC (n = 17), age‐matched women with acute MI (n = 16), and women with normal coronary arteries (n = 15). Six years after the initial event, SC patients underwent a clinical and echocardiographic follow‐up and reassessment of sex hormones.

Results:

Estrogen concentrations at hospital admission were significantly higher in the SC group compared with the MI and the control groups, with no difference in P, FSH, and LH concentrations. Follow‐up E2 after 6 years in SC patients was lower than during the acute SC episode. Follow‐up P in these patients was lower than P in the MI and control groups during the acute event, with a similar trend for E2. After a median follow‐up of 6.4 years, 1 sudden cardiac death occurred and 2 patients suffered from SC recurrence.

Conclusions:

During the acute event, E2 concentrations are elevated in postmenopausal SC patients compared with women with acute MI or with normal coronary arteries. The higher E2 concentrations might have exerted atheroprotective effects and thus diverted the stress response to SC rather than MI. Recurrence and/or sudden cardiac death remains a potential risk of SC. Clin. Cardiol. 2012 DOI: 10.1002/clc.21986 Roman Brenner, MD, and Daniel Weilenmann, MD, contributed equally to this work and should be considered first authors. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

Combining low-intensity and maximal exercise test results improves prognostic prediction in chronic heart failure

OBJECTIVES: This study investigated the combination of maximal and low-intensity exercise testing in predicting prognosis in chronic heart failure (CHF), using one single exercise test (two-step protocol). BACKGROUND: Risk assessment based on any single factor has limited accuracy and reproducibility. METHODS: Treadmill exercise testing was performed in 202 consecutive CHF patients (174 male; mean age 52 +/- 11 years) using "breath-by-breath" gas exchange monitoring. Oxygen uptake (VO(2)) kinetics were defined as oxygen deficit (DeltaVO(2) x time [rest to steady state] - Sigma VO(2) [rest to steady state]) and mean response time (MRT = oxygen-deficit/DeltaVO(2)). Peak VO(2) (VO(2)max) was defined as the highest VO(2). Mean follow-up was 873 +/- 628 days. The primary end point was cardiac mortality and the need for urgent heart transplantation. RESULTS: Forty-four patients (22%) died and 15 (7%) were urgently transplanted. In both univariate and multivariate analyses, MRT >50 s was the most powerful predictor of the primary end point (hazard ratio [HR] 4.44), followed by predicted VO(2)max <50% (HR 3.50) and resting systolic blood pressure <105 mm Hg (HR 2.49, all p < 0.001). A majority (n = 130 [64%]) had one or none of these risk factors, with a one-year event rate of only 3%. Patients with two risk factors (n = 45 [22%]) were at medium risk (one-year event rate of 33%). Twenty-seven patients (13%) had all three risk factors, with a one-year event rate of 59%. The area under the curve, using the number of risk factors, was 0.86 +/- 0.04 for the primary end point at one year. These results were independent of medication, in particular, beta-blockade. CONCLUSIONS: A combination of low-intensity and maximal exercise test results improves assessment of prognosis in patients with CHF.     

Prolonged oxygen uptake kinetics during low-intensity exercise are related to poor prognosis in patients with mild-to-moderate congestive heart failure

STUDY OBJECTIVE: To investigate the prognostic value of oxygen uptake (O(2)) kinetics during low-intensity exercise in patients with congestive heart failure. DESIGN: Prospective cohort study. SETTING: Tertiary care center. PATIENTS: One hundred forty-six consecutive patients (128 men) with chronic heart failure, followed up for a mean (+/- SD) duration of 25 +/- 15 months. MEASUREMENTS: A treadmill exercise test was performed with "breath by breath" gas-exchange monitoring. VO(2) kinetics were defined as the VO(2) deficit (ie, Delta VO(2) x time[rest to steady state] - Sigma VO(2)[rest to steady state]) and mean response time (MRT) [ie, VO(2) deficit/Delta VO(2)]. Cardiac death, urgent cardiac transplantation, and hospitalization due to worsening heart failure were considered as the end points. RESULTS: Thirty patients (21%) died, 11 patients (8%) underwent urgent transplantation, and 32 patients (22%) were hospitalized. In univariate analysis, MRT was the most powerful predictor of survival, survival free of urgent transplantation, and survival free of hospitalization (hazard ratios [HRs] per 10 s, 1.65, 1.72, and 1.61, respectively; all p < 0.0001). The predictive value of MRT exceeded that of peak VO(2) (HR per mL/kg/min, 0.90; p = 0.02, 0.91; p = 0.007, and 0.95; p = 0.08, respectively). In multivariate analysis, MRT (HR per 10 s, 1.73; p = 0.0002), resting systolic BP (HR per 10 mm Hg, 0.65; p = 0.003), and the slope of the ventilatory response to exercise (HR per 10 U, 1.68; p = 0.02) were independent predictors of survival. CONCLUSIONS: Our results suggest that VO(2) kinetics are strongly related to outcome in heart failure patients. Since it has several additional advantages over peak exercise testing (eg, less time-consuming, less demanding for the patients, less dependent on motivation, and applicable in patients with limitations other than cardiopulmonary disease), it has the potential to become a prognostic test for the assessment of heart failure patients.     

Noninvasive evaluation of pulmonary capillary wedge pressure by BP response to the Valsalva maneuver

STUDY OBJECTIVES: To determine the BP response to the Valsalva maneuver (VM) at baseline and after changes in therapy and to compare this response to the invasively measured pulmonary capillary wedge pressure (PCWP). DESIGN: Comparison of the BP response to the VM with invasively measured PCWP. In a subset of patients, direct PCWP and pulse amplitude ratio (PAR) measurements were repeated (mean +/- SD) 3.2 +/- 4.5 months later after adjusting the therapy. SETTING: Tertiary-care center. PATIENTS: Forty-two stable patients (8 women; mean age, 58 +/- 13 years) undergoing right heart catheterization who were in sinus rhythm. MEASUREMENTS: PAR calculated between the end and the beginning of the VM using the last two beats and the first three beats of the straining phase and simultaneous measurement of PCWP. RESULTS: There was a highly significant correlation between the invasively measured PCWP (range, 2 to 32 mm Hg) and the PAR (range, 0.28 to 1.15; R(2) = 0.75; p < 0.001). In addition, changes of PCWP during follow-up (-16 to 13 mm Hg) were well-correlated (R(2) = 0.93; p < 0.001; n = 11) with changes in PAR (-0.44 to 0.47). The administration of medication (eg, beta-blockers, amiodarone, angiotensin-converting enzyme inhibitor, and digoxin) did not influence the results. CONCLUSIONS: PCWP and changes during therapy can be estimated noninvasively by measuring the PAR during the VM with acceptable accuracy in stable patients with cardiac conditions. Thus, this method may be a useful tool in detecting an elevated PCWP and hemodynamic response to therapy.