Evolving changes in lung interstitial fluid content after acute myocardial infarction: mechanisms and pathophysiological correlates.

In acute myocardial infarction (AMI), alveolar interstitium edema is generally attributed to a hydrostatic imbalance. However, inflammatory burden and/or neural/hormonal/hemodynamic stimulation might injure the microvascular endothelium, eliciting interstitial overflow and altering alveolar-capillary gas diffusion. In 118 patients with AMI (ejection fraction >or=50% and wedge pulmonary pressure <16 mmHg), admission alveolar-capillary gas diffusing membrane conductance (DM) averaged 35.

Prognostic value of flow-mediated dilatation following myocardial infarction.

Background: Risk stratification for subsequent cardiovascular events following a myocardial infarction (MI) is an important area of research. Previous findings indicate flow-mediated dilatation (FMD) may be a valuable prognostic indicator. This study investigates the prognostic value of FMD in patients suffering an uncomplicated MI.

Impact of the implementation of telemanagement on a disease management program in an elderly heart failure cohort.

The purpose of the present investigation is to examine the impact of a telemanagement component on an outpatient disease management program in patients with heart failure (HF). A total of 282 patients in whom HF was diagnosed and who were enrolled in an outpatient HF program were included in this analysis. One hundred fifty-eight patients additionally participated in a self-directed telemanagement component.

Long-term use of sildenafil in the therapeutic management of heart failure.

Objectives: This study sought to test the functional exercise capacity and endothelial function in a cohort of chronic heart failure (CHF) patients treated with chronic type 5 phosphodiesterase (PDE5) inhibitor.

Background: In CHF, endothelial dysfunction is involved in muscle underperfusion, ergoreflex oversignaling, and exercise ventilation inefficiency. Inhibition of PDE5 by improving endothelial dysfunction might be beneficial.

The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review.

A hallmark symptom of heart failure (HF) is exercise intolerance, typically evidenced by excessive shortness of breath, and/or fatigue with exertion. In recent years, the physiologic response to progressive exercise using direct measures of ventilation and gas exchange, commonly termed the cardiopulmonary exercise test (CPX), has evolved into an important clinical tool in the management of patients with HF. There is currently debate regarding the optimal CPX response to apply when stratifying risk for mortality, hospitalization, or other outcomes in patients with HF.

High aerobic capacity does not attenuate aortic stiffness in hypertensive subjects.

Background: It is unknown whether increased physical fitness reduces aortic stiffness in hypertensive individuals. The purpose of this cross-sectional study was to examine, in a cohort of community-dwelling subjects with no history of cardiac events, differences in the impact of aerobic capacity on aortic stiffness between normotensive and hypertensive subjects.

Methods: The study sample included 275 subjects representing a large age range (21-85 years).

A discordance in rosiglitazone mediated insulin sensitization and skeletal muscle mitochondrial content/activity in Type 2 diabetes mellitus.

Skeletal muscle mitochondrial dysfunction is hypothesized to contribute to the pathophysiology of insulin resistance and Type 2 diabetes. Whether thiazolidinedione therapy enhances skeletal muscle mitochondrial function as a component of its insulin-sensitizing effect is unknown. To test this, we evaluated skeletal muscle mitochondria and exercise capacity in Type 2 diabetic subjects with otherwise normal cardiopulmonary function in response to rosiglitazone therapy.

Regulation of the extracellular matrix remodeling by lutein in dermal fibroblasts, melanoma cells, and ultraviolet radiation exposed fibroblasts.

With aging and cancer there is increased expression or activity of matrix metalloproteinases (MMPs) that degrade and remodel the structural extracellular matrix (ECM). In addition, exposure of skin to ultraviolet (UV) radiation (photoaging) leads to loss of cell viability, membrane damage, and deposition of excessive elastotic material. Lutein has antioxidant, anti-inflammatory, photoprotective, and anti-carcinogenic properties.

The added prognostic value of ventilatory efficiency to the Weber classification system in patients with heart failure.

Background: The Weber classification system is a well established method for categorizing patients according to peak oxygen consumption (VO(2)), but it is unknown whether ventilatory efficiency adds prognostic value. The purpose of the current study was to assess the added prognostic value of the minute ventilation/carbon dioxide production (VE/VCO(2)) slope to the Weber classification system in patients diagnosed with heart failure (HF).

Methods: Five hundred and forty-eight subjects with HF participated in this analysis.

The minute ventilation/carbon dioxide production slope is prognostically superior to the oxygen uptake efficiency slope.

Background: Ventilatory efficiency, commonly assessed by the minute ventilation (VE)-carbon dioxide production (VCO2) slope, has proven to be a strong prognostic marker in the heart failure (HF) population. Recently, the oxygen uptake efficiency slope (OUES) has demonstrated prognostic value, but additional comparisons to established cardiopulmonary exercise test (CPET) variables are required.

Methods And Results: A total of 341 subjects were diagnosed with HF participated in this analysis.

Exercise oscillatory ventilation may predict sudden cardiac death in heart failure patients.

Objectives: The purpose of this study was to test the ability of cardiopulmonary exercise testing (CPET)-derived variables as sudden cardiac death (SCD) predictors.

Background: The CPET variables, such as peak oxygen uptake (VO2), ventilatory requirement to carbon dioxide (CO2) production (VE/VCO2) slope, and exercise oscillatory breathing (EOB), are strong predictors of overall mortality in chronic heart failure (CHF) patients. Even though up to 50% of CHF patients die from SCD, it is unknown whether any of these variables predicts SCD.

Heart rate recovery is lower following supine exercise in asymptomatic hereditary hemochromatosis subjects compared with healthy controls.

Introduction: Heart rate recovery (HRR) has become an important diagnostic and prognostic marker in recent years. Subjects with hereditary hemochromatosis (HH) demonstrate arterial wall changes that reduce compliance. Arterial compliance may influence HRR by altering baroreceptor discharge.

Evaluation of toxic chemical parameters and ecotoxicity levels in bottled mineral waters.

Heavy metals, phthalates, characterizing elements, CO2 concentrations and pH and hardness levels were measured in forty samples of bottled mineral waters. In some samples arsenic, manganese, mercury and selenium were present in higher concentrations than permitted by Italian law. No significant release of phthalates from containers in PET was observed.

Development of a ventilatory classification system in patients with heart failure.

Background: Ventilatory efficiency, commonly assessed by the minute ventilation (VE)-carbon dioxide production (VCO2) slope, is a powerful prognostic marker in the heart failure population. The purpose of the present study is to refine the prognostic power of the VE/VCO2 slope by developing a ventilatory class system that correlates VE/VCO2 cut points to cardiac-related events.

Methods And Results: Four hundred forty-eight subjects diagnosed with heart failure were included in this analysis.

Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: an unfavorable combination with high prognostic value.

Background: Increased slope of exercise ventilation to carbon dioxide production (VE/VCO2) is an established prognosticator in patients with heart failure. Recently, the occurrence of exercise oscillatory breathing (EOB) has emerged as an additional strong indicator of survival.

Objective: The aim of this study is to define the respective prognostic significance of these variables and whether excess risk may be identified when either respiratory disorder is present.

Relationship between arterial stiffness and heart rate recovery in apparently healthy adults.

Introduction: Arterial stiffness and heart rate recovery (HRR) following exercise testing have emerged as variables holding significant prognostic value in a number of populations. The purpose of the present study is to examine the relationship between arterial stiffness and HRR in a group of apparently healthy subjects.

Methods: Two hundred and nine apparently healthy subjects underwent maximal exercise testing.

The prognostic value of ventilatory efficiency with beta-blocker therapy in heart failure.

Purpose: Beta-blockade (BB) has been shown to improve outcomes among patients with heart failure (HF). The impact this pharmacological approach has on the prognostic information gained from cardiopulmonary exercise testing (CPX) is, however, unclear.

Methods: Four hundred seventeen subjects diagnosed with HF underwent CPX.

Influence on aerobic fitness on aortic stiffness in apparently healthy Caucasian and African-American subjects.

Background: Previous research suggests that arterial stiffness may be significantly higher in African-Americans compared to Caucasians. However, the influence of aerobic fitness on the putative difference in arterial stiffness between these groups has not been previously investigated.

Methods: Two hundred forty-eight subjects (215 Caucasian, 33 African-American) participated in this study.

Exercise capacity of cardiac asymptomatic hereditary hemochromatosis subjects.

Purpose: The exercise capacity of cardiac asymptomatic subjects with hereditary hemochromatosis (HH) has not been well described. In this study, we tested whether the iron overload associated with HH affected exercise capacity with a case control study design.

Methods: Forty-three HH and 21 normal control subjects who were New York Heart Association functional class I underwent metabolic stress testing using the Bruce protocol at the clinical center of the National Institutes of Health.

The relationship between C-reactive protein and other cardiovascular risk factors in men and women.

Introduction: C-reactive protein (CRP) has emerged as an important indicator of risk for cardiovascular disease. The impact of gender on the relationship between CRP and other cardiovascular risk factors, however, has not been thoroughly investigated.

Methods: Ninety men and 75 women participated in this study.

Short-term reliability of oxygen uptake on-kinetics in apparently healthy subjects.

Purpose: The analysis of oxygen (O2) uptake on-kinetics at the onset of aerobic exercise has been shown to be reflective of cardiovascular and skeletal muscle health in a number of previous investigations. The purpose of the present investigation is to assess the short-term reliability of O2 uptake on-kinetics in a group of apparently healthy individuals.

Methods: Forty apparently healthy subjects participated in 3 consecutive treadmill exercise sessions on 3 consecutive days.

Improved aortic stiffness assessment in the elderly using a one-dimensional fluid displacement MR method.

Purpose: To assess the in vitro accuracy of two rapid projective MR wave velocity measurement sequences, and their relative performance for assessing aortic stiffness in adults of all ages.

Materials And Methods: In vitro testing was performed using latex tube phantoms with precisely-known flow wave velocities, both in the presence and absence of simulated static tissue. A total of 104 adults representing a large age range (21-83 years) underwent aortic wave velocity (AWV) measurements using multiple trials of each method in a single MR session.

Prognostic value of end-tidal carbon dioxide during exercise testing in heart failure.

Background: The partial pressure of end-tidal carbon dioxide production (P(ET)CO2) at ventilatory threshold (VT) has been shown to be strongly correlated with cardiac output during exercise in patients with heart failure (HF), but few data are available regarding its prognostic utility.

Aims: The purpose of this study was to assess the ability of P(ET)CO2 to predict cardiac-related events in a group of subjects with HF.

Methods: One hundred and thirty subjects diagnosed with compensated HF underwent cardiopulmonary exercise testing (CPX).