BACKGROUND: Chronic heart failure is characterized by high mortality, frequent hospitalization, and reduced quality of life. Patients with severe heart failure are often in very poor physical condition, they are unable to take part in the usual exercise programs, and therefore need an individual approach. HYPOTHESIS: To assess the systemic and pulmonary hemodynamic responses to maximum voluntary contraction of the lower extremity muscles (MVC-LEM) with persistent physiologic breathing, the Valsalva maneuver, and the combination of Valsalva with MVC-LEM. METHODS: Seventeen patients with severe heart failure (ejection fraction 20%) were exposed to 3 types of load for a period of 10 seconds: 1) MVC-LEM with persistent physiologic breathing, 2) the Valsalva maneuver, and 3) a combination of MVC-LEM with the Valsalva maneuver. During each measurement, a continuous, time-synchronized record was taken of the electrocardiogram, and the pulmonary and systemic blood pressures. RESULTS: There were slight changes in the heart rate and systemic blood pressure when comparing resting versus MVC-LEM values. There were much greater and significant changes (P < .01) in the systemic and pulmonary blood pressures when comparing resting versus the Valsalva maneuver or the combination of the MVC-LEM plus the Valsalva maneuver values. CONCLUSIONS: A short maximum voluntary contraction of the muscles of the lower extremities with persistent physiologic breathing did not have an abnormal effect on the systemic and pulmonary hemodynamics in patients with severe chronic heart failure. The Valsalva maneuver caused significantly higher hemodynamic changes in the systemic and pulmonary system with possible negative effects. 2009 Wiley Periodicals, Inc.
- MeSH
- časové faktory MeSH
- chronická nemoc MeSH
- dolní končetina MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- funkce levé komory srdeční MeSH
- hemodynamika MeSH
- isometrická kontrakce MeSH
- kosterní svaly krevní zásobení patofyziologie MeSH
- krevní tlak MeSH
- lidé středního věku MeSH
- lidé MeSH
- plicní oběh MeSH
- regionální krevní průtok MeSH
- srdeční frekvence MeSH
- srdeční selhání patofyziologie MeSH
- stupeň závažnosti nemoci MeSH
- tepový objem MeSH
- Valsalvův manévr MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
Improved survival has been observed in poor-risk diffuse large B-cell lymphoma (DLBCL) patients treated with high-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) in first complete remission. Retrospective studies have suggested that HDT with ASCT can improve survival also in partial responders but some doubts about the advantage of intensive therapy in such patients still remain. We evaluated retrospectively the results of HDT and ASCT in 55 patients with confirmed DLBCL treated between May 1999 and July 2006. Thirty-six patients (65%) showed partial remission (PR) and 19 patients (35%) reached complete remission (CR) after induction treatment with (44%) or without (56%) concomitant rituximab (R) immunotherapy. After HDT and ASCT, 69% of patients fulfilled the criteria of CR, 22% had unconfirmed CR (CRu), 7% remained in PR and 1 patient (2%) relapsed. Twenty patients in PR after the induction treatment reached CR after ASCT, 12 other PR patients achieved CRu. The 5-year event-free survival (EFS) of the 55 transplanted patients was 76% (95% confidence interval /CI/, 63% to 89%) and the 5-year overall survival (OS) was 85% (95% CI, 73% to 97%). The EFS and OS rates differed significantly only between patients younger than 40 years and older groups (p=0.022 and p=0.046, respectively). On univariate analysis of prognostic factors, EFS and OS were not affected by any of the following: age, sex, stage, subtype of DLBCL, initial lactate dehydrogenase, beta-2-microglobulin and serum thymidine kinase levels, International Prognostic Index (IPI) and age-adjusted IPI scores, induction treatment with or without rituximab and type of primary therapeutic response (CR vs PR). These results show that first-line HDT and ASCT for adults up to the age of 65 years with poor-risk DLBCL is a feasible and effective treatment option even in the era of R-chemotherapy in CR as well as for patients in PR.
- MeSH
- autologní transplantace MeSH
- difúzní velkobuněčný B-lymfom terapie MeSH
- dospělí MeSH
- financování organizované MeSH
- indukce remise MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- přežití po terapii bez příznaků nemoci MeSH
- prognóza MeSH
- protokoly antitumorózní kombinované chemoterapie terapeutické užití MeSH
- retrospektivní studie MeSH
- transplantace hematopoetických kmenových buněk MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
BACKGROUND AND PURPOSE: Levels of natriuretic peptides and their changes in the course of therapy may serve as a prognostic marker of long-term survival in patients with heart failure. The authors compared natriuretic peptide levels in patients with heart failure at admission and at hospital discharge and examined the relationship between their natriuretic peptide levels and clinical status at hospital discharge. PATIENTS AND METHODS: 108 patients with acute heart failure underwent, at admission to hospital and discharge after clinical improvement, an examination consisting of a physical checkup, B-type natriuretic peptide (BNP) measurements, and echocardiography. In addition, each patient was asked to use a 1-100 graphic grading scale to indicate a level of satisfaction with his/her overall health status, as well as quality of breathing at admission and discharge. RESULTS: All patients had elevated BNP levels at admission (1,066 +/- 887.8 pg/ml). In the course of treatment, all patients demonstrated a statistically significant downward trend in BNP levels (p < 0.002). However, BNP levels at discharge still remained in the pathologic range. Both at admission and discharge, patients with left ventricular systolic dysfunction had BNP values statistically significantly higher than those with diastolic dysfunction (1,880 +/- 1,160 vs. 454 +/- 323 pg/ml, and 993 +/- 828 vs. 338 +/- 226 pg/ml, respectively). Patients with repeated attacks of heart failure prior to admission had higher BNP levels compared to those with a first attack (p < 0.001). Both groups showed a statistically significant difference in subjective perception of difficulties which, both at admission and discharge, was reported by patients with a first decompensation attack as being more marked (p < 0.002 and p < 0.009, respectively). CONCLUSION: The question arises, whether one's "objective" assessment of the final degree of compensation at discharge may or may not be premature, and whether a follow-up "prognostic" BNP determination should or should not be performed until the moment of a "subjective optimum" as reported by the patient.
- MeSH
- dysfunkce levé srdeční komory diagnóza epidemiologie krev MeSH
- hodnocení rizik metody MeSH
- incidence MeSH
- lidé MeSH
- natriuretický peptid typu B krev MeSH
- nízký srdeční výdej krev diagnóza epidemiologie MeSH
- příjem pacientů statistika a číselné údaje MeSH
- prognóza MeSH
- propuštění pacienta statistika a číselné údaje MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- anomálie koronárních cév radiografie MeSH
- balónková koronární angioplastika MeSH
- infarkt myokardu diagnóza etiologie terapie MeSH
- lidé MeSH
- stenty využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- beta blokátory aplikace a dávkování farmakokinetika terapeutické užití MeSH
- blokátory kalciových kanálů aplikace a dávkování farmakokinetika terapeutické užití MeSH
- blokátory receptoru 1 pro angiotenzin II aplikace a dávkování farmakokinetika terapeutické užití MeSH
- diabetes mellitus farmakoterapie klasifikace terapie MeSH
- diuretika aplikace a dávkování farmakokinetika terapeutické užití MeSH
- hypertenze epidemiologie etiologie komplikace MeSH
- inhibitory ACE aplikace a dávkování farmakokinetika terapeutické užití MeSH
- koordinovaný terapeutický postup klasifikace normy statistika a číselné údaje MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- MeSH
- bakteriální endokarditida diagnóza etiologie MeSH
- lidé MeSH
- nemoci srdečních chlopní chirurgie MeSH
- srdeční chlopně umělé škodlivé účinky využití MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- kongresy MeSH
