Soluble CD146 in the detection and grading of intravascular and tissue congestion in patients with acute dyspnoea: analysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort.

OBJECTIVES: To evaluate the potential of soluble cluster of differentiation 146 (sCD146) in the detection and grading of congestion in patients with acute dyspnoea. DESIGN: Subanalysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort. SETTING: Two Lithuanian university centres. PARTICIPANTS: Adult patients with acute dyspnoea admitted to the emergency department. METHODS: Congestion was assessed using clinical and sonographic parameters. All patients underwent sCD146 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. RESULTS: The median value of sCD146 concentration in the study cohort (n=437) was 405 (IQR 315-509) ng/mL. sCD146 was higher in patients with peripheral oedema than in those without (median (IQR) 472 (373-535) vs 400 (304-501) ng/mL, p=0.009) and with pulmonary rales than in those without (439 (335-528) vs 394 (296-484) ng/mL, p=0.001). We found a parallel increase of estimated right atrial pressure (eRAP) and sCD146 concentration: sCD146 was 337 (300-425), 404 (290-489) and 477 (363-572) ng/mL in patients with normal, moderately elevated and high eRAP, respectively (p=0.001). In patients with low NT-proBNP, high sCD146 distinguished a subgroup with a higher prevalence of oedema as compared with patients with low levels of both biomarkers (76.0% vs 41.0%, p=0.010). Moreover, high sCD146 indicated a higher prevalence of elevated eRAP, irrespective of NT-proBNP concentration (p<0.05). CONCLUSION: sCD146 concentration reflects the degree of intravascular and tissue congestion assessed by clinical and echocardiographic indices, with this association maintained in patients with low NT-proBNP. Our data support the notion that NT-proBNP might represent heart stretch while sCD146 rather represents peripheral venous congestion.

Biologically Active Adrenomedullin (bio-ADM) is of Potential Value in Identifying Congestion and Selecting Patients for Neurohormonal Blockade in Acute Dyspnea.

PURPOSE: This study was designed to evaluate the role of biologically active adrenomedullin (bio-ADM) in congestion assessment and risk stratification in acute dyspnea. METHODS: This is a sub-analysis of the Lithuanian Echocardiography Study of Dyspnea in Acute Settings. Congestion was assessed by means of clinical (peripheral edema, rales) and sonographic (estimated right atrial pressure) parameters. Ninety-day mortality was chosen for outcome analysis. RESULTS: There were 1188 patients included. Bio-ADM concentration was higher in patients with peripheral edema at admission (48.2 [28.2-92.6] vs 35.4 [20.9-59.2] ng/L, P < .001). There was a stepwise increase in bio-ADM concentration with increasing prevalence of rales: 29.8 [18.8-51.1], 38.5 [27.5-67.1], and 51.1 [33.1-103.2] ng/L in patients with no rales, rales covering less than one-half, and greater than or equal to one-half of the pulmonary area, respectively (P < 0.001). Bio-ADM concentration demonstrated gradual elevation in patients with normal, moderately, and severely increased estimated right atrial pressure: 25.1 [17.6-42.4] ng/L, 36.1 [23.1-50.2], and 47.1 [30.7-86.7] ng/L, respectively (P < .05). Patients with bio-ADM concentration >35.5 ng/L were at more than twofold increased risk of dying (P < .001). Survival in those with high bio-ADM was significantly modified by neurohormonal blockade at admission (P < .05), especially if NT-proBNP levels were lower than the median (P = .002 for interaction). CONCLUSION: Bio-ADM reflects the presence and the degree of pulmonary, peripheral, and intravascular volume overload and is strongly related to 90-day mortality in acute dyspnea. Patients with high bio-ADM levels demonstrated survival benefit from neurohormonal blockade.

Perioperative Management of Pulmonary Hypertension. a Review.

Pulmonary hypertension is a rare and progressive pathology defined by abnormally high pulmonary artery pressure mediated by a diverse range of aetiologies. It affects up to twenty-six individuals per one million patients currently living in the United Kingdom (UK), with a median life expectancy of 2.8 years in idiopathic pulmonary hypertension. The diagnosis of pulmonary hypertension is often delayed due to the presentation of non-specific symptoms, leading to a delay in referral to specialists services. The complexity of treatment necessitates a multidisciplinary approach, underpinned by a diverse disease aetiology from managing the underlying disease process to novel specialist treatments. This has led to the formation of dedicated specialist treatment centres within centralised UK cities. The article aimed to provide a concise overview of pulmonary hypertension's clinical perioperative management, including key definitions, epidemiology, pathophysiology, and risk stratification.

Readmission following both cardiac and non-cardiac acute dyspnoea is associated with a striking risk of death.

AIMS: Readmission and mortality are the most common and often combined endpoints in acute heart failure (AHF) trials, but an association between these two outcomes is poorly investigated. The aim of this study was to determine whether unplanned readmission is associated with a greater subsequent risk of death in patients with acute dyspnoea due to cardiac and non-cardiac causes. METHODS AND RESULTS: Derivation cohort (1371 patients from the LEDA study) and validation cohort (1986 patients from the BASEL V study) included acute dyspnoea patients admitted to the emergency department. Cox regression analysis was used to determine the association of 6 month readmission and the risk of 1 year all-cause mortality in AHF and non-AHF patients and those readmitted due to cardiovascular and non-cardiovascular causes. In the derivation cohort, 666 (49%) of patients were readmitted at 6 months and 282 (21%) died within 1 year. Six month readmission was associated with an increased 1 year mortality risk in both the derivation cohort [adjusted hazard ratio (aHR) 3.0 (95% confidence interval, CI 2.2-4.0), P < 0.001] and the validation cohort (aHR 1.8, 95% CI 1.4-2.2, P < 0.001). The significant association was similarly observed in AHF (aHR 3.2, 95% CI 2.1-4.9, P < 0.001) and other causes of acute dyspnoea (aHR 2.9, 95% CI 1.9-4.5, P < 0.001), and it did not depend on the aetiology [aHR 2.2, 95% CI 1.6-3.1 for cardiovascular readmissions; aHR 4.1, 95% CI 2.9-5.7 for non-cardiovascular readmissions (P < 0.001 for both)] or timing of readmission. CONCLUSION​S: Our study demonstrated a long-lasting detrimental association between readmission and death in AHF and non-AHF patients with acute dyspnoea. These patients should be considered 'vulnerable patients' that require personalized follow-up for an extended period.

Low-Dose Omega-3 Fatty Acid and Vitamin D for Anthropometric, Biochemical Blood Indices and Respiratory Function. Does it work?

Omega-3 fatty acids and vitamin D3 have beneficial effects on different blood, cardiovascular parameters and physical performance. However, the effect of low-dose omega-3 fatty acid supplementation remains unclear. 84 office workers aged 40-60 years, participated in a 16-week open, randomized, placebo-controlled, parallel-group study. The experimental group received 330 mg of omega-3 fatty acid and 0.005 mg (200 IU) of vitamin D3 per day and the control group received placebo. Anthropometric, biochemical blood and respiratory indices were measured at 12 and 16 weeks. Body mass (BM) and body mass index (BMI) significantly reduced in both the experimental (BM from 74.4 ± 13.04 to 73.2 ± 13.02 kg, p < 0.001; BMI from 25.8 ± 4.1 to 25.4 ± 4.3 kg/m2, p < 0.001) and the placebo groups (BM from 69.5 ± 11. to 68.7 ± 11.4 kg, p < 0.05; BMI from 24.1 ± 4.0 to 23.8 ± 4.2 kg/m2, p < 0.05). Omega-3 fatty acid supplementation significantly improved glucose (from 5.12 ± 0.55 to 4.97 ± 0.62 mmol/l; p = 0.05), total cholesterol (from 5.86 ± 1.0 to 5.32 ± 1.55 mmol/l; p = 0.003), and vitamin D levels (from 35.07 ± 21.65 to 68.63 ± 25.94 nmol/l; p = 0.000). Maximal oxygen consumption (from 33.7 ± 2.4 to 36.6 ± 3.2 ml/kg/min, p = 0.035), forced vital capacity (from 3.5 ± 0.6 to 3.9 ± 0.9 l, p = 0.044), forced expiratory volume (from 3.2 ± 0.6 to 3.5 ± 0.7 l, p = 0.014), and peak expiratory flow (from 6.7 ± 1.4 to 7.5 ± 1.6 l/s, p = 0.019) also slightly improved in the omega-3 fatty acid group. Daily supplementation of 330 mg of omega-3 fatty acids had a slight positive impact on total cholesterol and glucose level, while there was no effect on low and high density lipoproteins, and triglycerides levels. Therefore, dose of 330 mg per day seems as insufficient.

Challenges of Treating Acute Heart Failure in Patients with Chronic Obstructive Pulmonary Disease.

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) comorbidity poses substantial diagnostic and therapeutic challenges in acute care settings. The specific role of pulmonary comorbidity in the treatment and outcomes of cardiovascular disease patients was not addressed in any short- or long-term prospective study. Both HF and COPD can be interpreted as systemic disorders associated with low-grade inflammation, endothelial dysfunction, vascular remodelling and skeletal muscle atrophy. HF is regularly treated as a broader cardiopulmonary syndrome utilising acute respiratory therapy. Based on observational data and clinical expertise, a management strategy of concurrent HF and COPD in acute settings is suggested. Concomitant use of beta2-agonists and beta-blockers in a comorbid cardiopulmonary condition seems to be safe and effective.

Exploring Game Performance in the National Basketball Association Using Player Tracking Data.

Recent player tracking technology provides new information about basketball game performance. The aim of this study was to (i) compare the game performances of all-star and non all-star basketball players from the National Basketball Association (NBA), and (ii) describe the different basketball game performance profiles based on the different game roles. Archival data were obtained from all 2013-2014 regular season games (n = 1230). The variables analyzed included the points per game, minutes played and the game actions recorded by the player tracking system. To accomplish the first aim, the performance per minute of play was analyzed using a descriptive discriminant analysis to identify which variables best predict the all-star and non all-star playing categories. The all-star players showed slower velocities in defense and performed better in elbow touches, defensive rebounds, close touches, close points and pull-up points, possibly due to optimized attention processes that are key for perceiving the required appropriate environmental information. The second aim was addressed using a k-means cluster analysis, with the aim of creating maximal different performance profile groupings. Afterwards, a descriptive discriminant analysis identified which variables best predict the different playing clusters. The results identified different playing profile of performers, particularly related to the game roles of scoring, passing, defensive and all-round game behavior. Coaching staffs may apply this information to different players, while accounting for individual differences and functional variability, to optimize practice planning and, consequently, the game performances of individuals and teams.

Relationship between general and specific coordination in 8- to 17-year-old male basketball players.

The purpose of the present study was to investigate the relationships between general coordination, sport-specific coordination, and sport-specific fitness of 8- to 17-year-old male basketball players. 312 males with training experience ranging from one year in the 8-year-old cohort up to 10 years for the 17-year-olds performed basketball-specific fitness (20 m sprint, Illinois, countermovement jump), general coordination (20 m run with three obstacles), semi-basketball-specific coordination (20 m sprint dribbling two balls, countermovement jump with arm swing) and basketball-specific coordination (Illinois ball dribbling) tests. There were moderate to large correlations between the results of both general and basketball-specific coordination with the results of most basketball-specific coordination tests in all age groups. Correlations between general and basketball-specific coordination were large in four age groups (11-14 yr., r = .52 to r = .76), moderate in five groups (8-10, 15 & 16 yr., r = .37 to r = .46), while not significant in the 17-year-olds. These results suggest that the importance of general coordination for sport-specific skills improvements during a sports-specific skill acquisition phase, remains high at the skill refinement phase, and decreases when sport-specific skills have been mastered to near-perfection.

Pre-operative high sensitive C-reactive protein predicts cardiovascular events after coronary artery bypass grafting surgery: a prospective observational study.

C-reactive protein is a powerful independent predictor of cardiovascular events in patients with coronary artery disease. The relation between C-reactive protein (CRP) concentration and in-hospital outcome, after coronary artery bypass grafting (CABG), has not yet been established. The study aims to evaluate the predictive value of pre-operative CRP for in-hospital cardiovascular events after CABG surgery. High-sensitivity CRP (hs-CRP) levels were measured pre-operatively on the day of surgery in 66 patients scheduled for elective on pump CABG surgery. Post-operative cardiovascular events such as death from cardiovascular causes, ischemic stroke, myocardial damage, myocardial infarction and low output heart failure were recorded. During the first 30 days after surgery, 54 patients were free from observed events and 14 developed the following cardiovascular events: 10 (15%) had myocardial damage, four (6%) had low output heart failure and two (3%) suffered stroke. No patients died during the follow-up period. Serum concentration of hs-CRP > or = 3.3 mg/l (cut-off point obtained by ROC analysis) was related to higher risk of post-operative cardiovascular events (36% vs 6%, P = 0.01), myocardial damage (24% vs 6%, P = 0.04) and low output heart failure (12% vs 0%, P = 0.04). Multivariate logistic regression analysis showed that hs-CRP > or = 3.3 mg/l ( P = 0.002, O.R.: 19.3 (95% confidence interval (CI) 2.9-128.0)), intra-operative transfusion of red blood cells ( P = 0.04, O.R.: 9.9 (95% C.I. 1.1-85.5)) and absence of diuretics in daily antihypertensive treatment ( P = 0.02, O.R.: 15.1 (95% C.I. 1.4-160.6) were independent predictors of combined cardiovascular event. Patients having hs-CRP value greater or equal to 3.3 mg/l pre-operatively have an increased risk of post-operative cardiovascular events after on pump coronary artery bypass grafting surgery.

Markers of endothelial dysfunction after cardiac surgery: soluble forms of vascular-1 and intercellular-1 adhesion molecules.

Endothelium forms an inner layer of vascular wall. It plays an important role in inflammatory process, regulation of vascular tone, and synthesis of thromboregulatory substances. Leukocyte and endothelium interactions during inflammation are regulated by different families of adhesion molecules. Increased levels of soluble forms of adhesion molecules have been detected in the circulating blood in conditions such as autoimmune diseases, transplant rejection, ischemia-reperfusion injury in addition to neutrophil- and endothelial membrane-bound forms reflecting the level of endothelial dysfunction. It is known that endothelial dysfunction is a risk factor for ischemic events such as stroke, myocardial infarction, unstable angina pectoris, ventricle fibrillation, necessity of revascularisation procedures, and death from cardiovascular reasons. Clinical studies showed that cardiac surgery has an impact on vascular endothelial function as well. The amount of endothelium-derived soluble forms of vascular-1 and intercellular-1 adhesion molecules increases after cardiopulmonary bypass suggesting endothelial dysfunction. However, further investigations are needed to be done to support the evidence that endothelial dysfunction proceeding heart surgery is one of the reasons of tissue ischemia-reperfusion injury.

Long term effects of different training modalities on power, speed, skill and anaerobic capacity in young male basketball players.

The purpose of this study was to identify the effect of 4 months of different training modalities on power, speed, skill and anaerobic capacity in 15-16 year old male basketball players. Thirty five Lithuanian basketball players were randomly assigned into three groups: power endurance group (intermittent exercise, PE, n = 12), general endurance group (continuous exercise, GE, n = 11) and control group (regular basketball training, CG, n = 12). The power endurance model was based in basketball game external structure whereas the general endurance model was based in continuous actions that frequently occur during the basketball game. The training models were used for 16 weeks in sessions conducted 3 times a week during 90 minutes each in the competition period. The following tests were performed: 20 m speed run, Squat jump, Countermovement jump, Running-based Anaerobic Sprint Test (RAST), 2 min. shooting test and the Shuttle ball-dribbling test. A 3×2 repeated measures ANOVA revealed no statistically significant differences in the 20 m speed run, Squat jump and Countermovement jump (p > 0.05). On the other hand, RAST showed significant increases in PE, with greater increases during the 5(th) and 6(th) runs. The PE training model also produced a significant improvement in the shuttle ball-dribbling test (48.7 ± 1.5 in the pretest, 45.5 ± 1.3 in the posttest, p < 0.05). Globally, our results suggest that both training modalities were able to maintain initial values of speed and power, however, the anaerobic capacity and skill increased only in the players from the power endurance group. Therefore, the power endurance training (intermittent high intensity exercise) may be more beneficial to prepare junior players according to the game cardiovascular and metabolic specific determinants. Key PointsPower endurance training produced significant increases in anaerobic capacity during the competition period.Power endurance training did not have a detrimental effect on power or speed performance during the competition period.The greatest differences between general endurance and power endurance training were noticed during the 5(th) and 6(th) runs of the RAST test.