BACKGROUND: Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. OBJECTIVES: This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. METHODS: Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. RESULTS: Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. CONCLUSIONS: Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621).

• MeSH
• akutní koronární syndrom diagnóza   mortalita   patofyziologie   MeSH
• časové faktory MeSH
• elektroencefalografie mortalita   trendy   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita trendy   MeSH
• následné studie MeSH
• nemoci nervového systému diagnóza   patofyziologie   MeSH
• prognóza MeSH
• psychický stres diagnóza   mortalita   patofyziologie   MeSH
• registrace * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• takotsubo kardiomyopatie diagnóza   mortalita   patofyziologie   psychologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

BACKGROUND: Ventilatory efficiency (V˙e/V˙co2 slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙e/V˙co2 during exercise also exhibit an increased V˙e/V˙co2 ratio and a decreased end-tidal CO2 at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures. METHODS: Inclusion criteria for this retrospective, multicenter study were thoracotomy and cardiopulmonary exercise testing as part of routine preoperative assessment. Respiratory complications were assessed from the medical records (from the hospital stay or from the first 30 postoperative days). For comparisons, Student's t test or the Mann-Whitney U test was used. Logistic regression and receiver operating characteristic analyses were performed for evaluation of measurements associated with respiratory complications. Data are summarized as mean ± SD; p <0.05 is considered significant. RESULTS: Seventy-six subjects were studied. Postoperatively, respiratory complications developed in 56 (74%) patients. Patients with postoperative respiratory complications had significantly lower resting tidal volume (0.8 ± 0.3 vs 0.9 ± 0.3L; p = 0.03), lower rest end-tidal CO2 (28.1 ± 4.3vs 31.5 ± 4.2 mm Hg; p < 0.01), higher resting V˙e/V˙co2 ratio (45.1 ± 7.1 vs 41.0 ± 6.4; p = 0.02), and higher V˙e/V˙co2 slope (34.9 ± 6.4 vs 31.2 ± 4.3; p = 0.01). Logistic regression (age and sex adjusted) showed resting end-tidal CO2 to be the best predictor of respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06 to 1.39; area under the curve: 0.77; p = 0.01). CONCLUSIONS: Resting end-tidal CO2 may identify patients at increased risk for postoperative respiratory complications of thoracic surgical procedures.

• MeSH
• časové faktory MeSH
• dechový objem fyziologie   MeSH
• hrudní chirurgické výkony škodlivé účinky   MeSH
• incidence MeSH
• lidé MeSH
• míra přežití trendy   MeSH
• následné studie MeSH
• odpočinek fyziologie   MeSH
• oxid uhličitý metabolismus   MeSH
• plicní nemoci mortalita   patofyziologie   chirurgie   MeSH
• pooperační komplikace diagnóza   epidemiologie   MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• senioři MeSH
• zátěžový test MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

Epicardial adipose tissue (EAT) has been recognized as a sensitive marker of cardiometabolic risk. Recent evidence suggests efficacy of long-term statin therapy in reducing EAT in patients with coronary artery disease. Whether short-term statin therapy is associated with changes in the volume of EAT is currently unknown. A cohort of patients with atrial fibrillation who underwent pulmonary vein isolation were randomized to receive either 80 mg/day of atorvastatin (n = 38, 32 men, age 56 ± 11 years) or placebo (n = 41, 33 men, age 56 ± 10 years) for a 3-month period. EAT volume was assessed by cardiac computed tomography at baseline and at follow-up. Patients randomized to statin treatment exhibited a modest but significant decrease in median EAT volume (baseline vs follow-up: 92.3 cm(3) [62.0 to 133.3] vs 86.9 cm(3) [64.1 to 124.8], p <0.05), whereas median EAT remained unchanged in the placebo group (81.9 cm(3) [55.5 to 110.9] vs 81.3 cm(3) [57.1 to 110.5], p = NS). Changes in median systemic inflammatory markers and lipid profile were also seen with statin treatment: C-reactive protein (2.4 mg/L [0.7 to 3.7] vs 1.1 mg/L [0.5 to 2.7], p <0.05), total cholesterol (186 mg/dL [162.5 to 201] vs 123 mg/dL [99 to 162.5], p <0.001), and low-density lipoprotein cholesterol (116 mg/dL [96.5 to 132.5] vs 56 [40.5 to 81] mg/dL, p <0.001) diminished, whereas median body mass index did not change (27.8 kg/m(2) [25 to 30] versus 27.6 kg/m(2) [25.7 to 30.5], p = NS). No variations occurred in the placebo group. In conclusion, short-term intensive statin therapy significantly reduced the volume of EAT in patients with atrial fibrillation.

• MeSH
• anticholesteremika terapeutické užití   MeSH
• atorvastatin terapeutické užití   MeSH
• biologické markery krev   MeSH
• C-reaktivní protein účinky léků   metabolismus   MeSH
• dvojitá slepá metoda MeSH
• fibrilace síní krev   diagnóza   farmakoterapie   MeSH
• index tělesné hmotnosti MeSH
• LDL-cholesterol krev   účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• perikard * metabolismus   radiografie   MeSH
• počítačová rentgenová tomografie MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• senzitivita a specificita MeSH
• tuková tkáň účinky léků   MeSH
• venae pulmonales * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Heart failure (HF) is characterized by heightened sensitivities of the CO2 chemoreflex and the ergoreflex which promote increased ventilatory drive manifested as increased minute ventilation per volume of expired CO2 (VE/VCO2). The aims of this study were to evaluate the effects of cardiac resynchronization therapy (CRT) on carbon dioxide (CO2) chemosensitivity and the arterial CO2 setpoint. METHODS AND RESULTS: Consecutive HF patients (n = 35) who underwent clinically indicated CRT were investigated by means of cardiopulmonary exercise testing and CO2 chemosensitivity evaluation with the use of a rebreathe method before and 4-6 months after CRT. Pre- and post-CRT measures were compared with the use of either paired t test or Wilcoxon test. Decreased peak VE/VCO2 (44 ± 10 vs 40 ± 8; P < .01), CO2 chemosensitivity (2.2 ± 1.1 vs 1.7 ± 0.8 L min(-1) mm Hg(-1); P = .04), and increased peak end-tidal CO2 (29 ± 5 vs 31 ± 5 mm Hg; P < .01) were also observed after CRT. Multivariate analysis adjusted for age and sex showed the decrease of peak VE/VCO2 from before to after CRT to be most strongly associated with the increase of peak end-tidal CO2 (β = -0.84; F = 21.5; P < .0001). CONCLUSIONS: Decrease of VE/VCO2 after CRT is associated with decreased CO2 chemosensitivity and increase of the arterial CO2 setpoint, which is consistent with decreased activation of both the CO2 chemoreflex and the ergoreflex.

• MeSH
• analýza krevních plynů metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• oxid uhličitý metabolismus   MeSH
• plicní ventilace fyziologie   MeSH
• senioři MeSH
• spotřeba kyslíku fyziologie   MeSH
• srdeční resynchronizační terapie metody   MeSH
• srdeční selhání diagnóza   metabolismus   terapie   MeSH
• zátěžový test metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: To assess the diagnostic performance of the skinfold (SKF) method to detect obesity in patients enrolled in an outpatient cardiac rehabilitation (CR) program. METHODS: This study involves outpatients attending a phase II CR program who underwent air displacement plethysmography (ADP) to assess body composition. We measured body fat percentage (BF%), using a 3-site SKF method calculated through the Jackson-Pollock equation utilizing a Harpenden caliper. Air displacement plethysmography calculated BF% using a bicompartmental model, deriving the body composition after the direct calculation of body density (BD), using the Siri equation [(BF% = 495/BD) - 450]. We calculated the diagnostic performance of SKF to detect obesity, utilizing a BF% cutoff of ≥35% for women and ≥25% for men determined by SKF and ADP to define obesity. RESULTS: Our sample (n = 310) was 80% men, 60.2 ± 11 years of age, had a mean weight of 89.88 ± 17.96 kg, height 173.38 ± 8.68 cm, body mass index (BMI) 29.78 ± 5.01 kg/m, waist circumference 100.55 ± 14.38 cm, and waist-to-hip ratio of 0.96 ± 0.09. The evaluation of the diagnostic performance of SKF to detect obesity showed a sensitivity of 57%, specificity of 93%, a positive predictive value of 97%, and a negative predictive value of 33%. These values were not different from the diagnostic performance of BMI to detect obesity as defined by BF%. SKF and BMI misclassified 43% and 49% of obese patients as nonobese, respectively. CONCLUSION: Our findings underscore the limitation of using SKF to assess body fatness in the CR setting.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci srdce komplikace   rehabilitace   MeSH
• obezita komplikace   diagnóza   MeSH
• odchylka pozorovatele MeSH
• pletysmografie metody   MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• tloušťka kožní řasy * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Increased serum leptin concentration has been linked to increased ventilation in patients with mild heart failure (HF). However, in animal models the absence of leptin has also been associated with increased ventilation. This study evaluated the relationship of circulating leptin concentration with exercise ventilation in HF patients. METHODS AND RESULTS: Fifty-eight consecutive ambulatory HF patients were stratified by quintiles of leptin concentration, with a lowest quintile of mean leptin concentration of 1.8 ± 8.9 ng/mL and a highest of 33.3 ± 30.3 ng/mL. Peak exercise ventilatory efficiency (VE/VCO2) was significantly elevated in the lowest (46 ± 6 vs 34 ± 4; P < .01) as well as in the highest (38 ± 8 vs 34 ± 4; P < .05) leptin concentration quintiles compared with the reference middle quintile. Multiple regression analysis adjusted for confounders such as age, sex, and body mass index showed leptin concentration to be independently inversely correlated to VE/VCO2 in the low-to-normal quintiles (β = -0.64; P < .01), positively in the normal-to-high quintiles (β = 0.52; P = .02), and positively correlated to PETCO2 in the low-to-normal quintiles (β = 0.59; P = .01) and inversely in the normal-to-high quintiles (β = -0.53; P = .02). CONCLUSIONS: In HF patients, both high and low leptin concentrations are associated with increased VE/VCO2 and decreased PETCO2 with a nonlinear U-shaped relationship, suggesting that either leptin deficiency or leptin resistance may modulate ventilatory control in HF patients.

• MeSH
• biologické markery krev   MeSH
• leptin krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní ventilace fyziologie   MeSH
• senioři MeSH
• srdeční selhání krev   diagnóza   patofyziologie   MeSH
• tepový objem fyziologie   MeSH
• zátěžový test metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

PURPOSE: To assess the effect of a lifestyle therapy program using cardiac rehabilitation (CR) resources for patients at risk for metabolic syndrome (MetS). METHODS: We designed a cardiometabolic program (CMP) using CR facilities and resources. We compared MetS components of 240 patients classified as either obese (body mass index, ≥30 kg/m) or hyperglycemic (fasting glucose, >100 mg/dL): 58 enrolled and completed the CMP, 59 signed up for the CMP but never attended or dropped out early (control 1) but had followup data, and 123 did not sign up for the CMP (control 2). RESULTS: The CMP group showed a significant improvement at 6 weeks in waist circumference, body weight, diastolic blood pressure, and total cholesterol. At 6 months, fasting glucose also improved. In contrast, improvements in control 1 and control 2 were modest at best. Comparing the 6-month changes in the CMP group versus control 1 group, those in the CMP had pronounced weight loss (-4.5 ± 5 kg vs. -0.14 ± 6 kg; P < .001), decreased systolic blood pressure (-1.1 ± 17 mm Hg vs. +9.6 ± 20 mm Hg; P = .004), and decreased diastolic blood pressure (-4.6 ± 11 mm Hg vs. +3.4 ± 15 mm Hg; P = .002). Similarly, comparing CMP group versus control 2 group, body weight (-4.5 ± 5 kg vs. -0.9 ± 3 kg; P < .001) and diastolic blood pressure (-4.6 ± 11 mm Hg vs. -0.7 ± 9 mm Hg; P = .02) declined in the CMP group. CONCLUSION: A lifestyle therapy program using resources of a CR program is effective for individuals who have or are at risk for MetS, although enrollment and completion rates are low.

• MeSH
• časové faktory MeSH
• index tělesné hmotnosti MeSH
• kognitivně behaviorální terapie metody   MeSH
• krevní glukóza metabolismus   MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• metabolický syndrom krev   patofyziologie   rehabilitace   MeSH
• následné studie MeSH
• retrospektivní studie MeSH
• tělesná hmotnost MeSH
• terapie cvičením metody   MeSH
• výsledek terapie MeSH
• životní styl * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH