Resting pulmonary function and artery pressure and cardiopulmonary exercise testing in chronic heart failure patients in Taiwan - a prospective observational cross-sectional study comparing healthy subjects and interstitial lung disease patients.

BACKGROUND: Restrictive ventilatory defects and elevated pulmonary artery pressure (PAP) are common in patients with chronic heart failure (CHF) and those with interstitial lung disease (ILD). However, as oxyhemoglobin desaturation seldom occurs in stable CHF patients at peak exercise, we hypothesized that the pathophysiology may be different between them. This study aimed to investigate: (1) PAP and lung function at rest, (2) pulmonary gas exchange (PGX) and breathing patterns at peak exercise, (3) mechanisms of dyspnea at peak exercise in patients with CHF compared to healthy subjects and ILD patients. METHODS: We consecutively enrolled 83 participants (27 with CHF, 23 with ILD, and 33 healthy controls). The CHF and ILD groups had similar functional status. Lung function and cardiopulmonary exercise tests with Borg Dyspnea Score were performed. PAP was estimated using echocardiography. Resting lung function, PAP and peak exercise data in the CHF group were compared to the healthy and ILD groups. Correlation analysis was performed to elucidate the mechanisms of dyspnea in the CHF and ILD groups. RESULTS: Compared to the healthy group, the CHF group had normal lung function, PAP at rest, and normal dyspnea score and PGX at peak exercise, whereas the ILD group had abnormal values compared to the CHF group. Dyspnea score was positively correlated with pressure gradient, lung expansion capabilities, and expiratory tidal flow in the CHF group (all p < 0.05), but inversely correlated with inspiratory time-related variables in the ILD group (all p < 0.05). CONCLUSION: Normal lung function and PAP at rest, and dyspnea scores and PGX at peak exercise indicated that pulmonary hypertension and fibrosis were insignificant in the patients with CHF. The factors affecting dyspnea at peak exercise were different between the CHF and ILD groups. As the sample size in this study was small, large-scale studies are warranted to confirm our findings.

Normal lung function and pulmonary arterial pressure at rest, and dyspnea scores and pulmonary gas exchange at peak exercise indicated that pulmonary hypertension and fibrosis in the patients with chronic heart failure were not significant.Dyspnea score was correlated with different physiological variables between the groups with chronic heart failure and interstitial lung disease.

The Impact of Oxygen Pulse and Its Curve Patterns on Male Patients with Heart Failure, Chronic Obstructive Pulmonary Disease, and Healthy Controls-Ejection Fractions, Related Factors and Outcomes.

Oxygen pulse (O2P) is a function of stroke volume and cellular oxygen extraction and O2P curve pattern (O2PCP) can provide continuous measurements of O2P. However, measurements of these two components are difficult during incremental maximum exercise. As cardiac function is evaluated using ejection fraction (EF) according to the guidelines and EF can be obtained using first-pass radionuclide ventriculography, the aim of this study was to investigate associations of O2P%predicted and O2PCP with EF in patients with heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) and chronic obstructive pulmonary disease (COPD), and also in normal controls. This was a prospective observational cross-sectional study. Correlations of resting left ventricular EF, dynamic right and left ventricular EFs and outcomes with O2P% and O2PCP across the three participant groups were analyzed. A total of 237 male subjects were screened and 90 were enrolled (27 with HFrEF/HFmrEF, 30 with COPD and 33 normal controls). O2P% and the proportions of the three types of O2PCP were similar across the three groups. O2P% reflected dynamic right and left ventricular EFs in the control and HFrEF/HFmrEF groups, but did not reflect resting left ventricular EF in all participants. O2PCP did not reflect resting or dynamic ventricular EFs in any of the subjects. A decrease in O2PCP was significantly related to nonfatal cardiac events in the HFrEF/HFmrEF group (log rank test, p = 0.01), whereas O2P% and O2PCP did not predict severe acute exacerbations of COPD. The findings of this study may clarify the utility of O2P and O2PCP, and may contribute to the currently used interpretation algorithm and the strategy for managing patients, especially those with HFrEF/HFmrEF. (Trial registration number NCT05189301.).

Periodontitis is associated with incidental valvular heart disease: A nationwide population-based cohort study.

AIM: Periodontitis and valvular heart disease (VHD) are common diseases. Both diseases are related to chronic inflammation and share many common risk factors. Previous periodontal studies had focused mainly on atherosclerotic cardiovascular disease. This study aimed to determine whether periodontitis is associated with the development of VHD. MATERIALS AND METHODS: This was a retrospective nationwide cohort study using Taiwan's Longitudinal Health Insurance Database. Using ICD-9-CM coding, both the periodontitis and non-periodontitis groups were matched. RESULTS: There were 8483 cases and 4919 cases of VHD diagnosed in the periodontitis group and non-periodontitis group, respectively. The cumulative incidence of VHD was significantly higher in the periodontitis group (log-rank test, p < .001), with the incidence density of 6.44 (95% CI, 6.31-6.58) per 1000 person-years in the periodontitis group compared to 4.65 (95% CI, 4.52-4.78) in the non-periodontitis group. The relative risk for VHD was 1.39 (95% CI, 1.34-1.44). After multivariate analysis, periodontitis was independently associated with a risk for VHD (HR, 1.38; 95% CI, 1.33-1.42, p < .001). Intensive treatment of periodontitis significantly lowered the risk for VHD (HR, 0.68; 95% CI, 0.60-0.77, p < .001). CONCLUSIONS: Periodontitis was significantly associated with the development of VHD. Treatment of periodontitis reduced the risk for VHD.

Long-Term Hydroxychloroquine Therapy and Risk of Coronary Artery Disease in Patients with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic systemic inflammatory disease associated with a high prevalence of cardiovascular disease (CVD). Hydroxychloroquine (HCQ) is commonly used to control disease activity in patients with SLE. We evaluated its potential additional therapeutic effect for reducing CVD in SLE patients. We conducted a retrospective cohort study, in which one million participants were sampled from 23 million beneficiaries and data were collected from 2000 to 2013. In total, 826 SLE patients receiving HCQ medication were included after exclusion for previous CVD. The total number of SLE patients was 795 after follow-up for more than one year. After adjusting for chronic comorbidity, a significantly decreased hazard ratio (HR) for coronary artery disease (CAD) was found among SLE patients with a high usage of HCQ for at least 318 days (HR = 0.31, 95% confidence interval, CI: 0.12-0.76). A low HR for CAD was observed in SLE patients with a high cumulative dose of at least 100,267 mg HCQ (HR = 0.25, 95% CI: 0.09-0.66). However, there was no significant lowering of the HR for stroke. Long-term HCQ therapy decreases the HR of CVD in SLE patients. The cardiovascular protective effect of HCQ therapy was associated with decrease in CAD, but not stroke.

Oxygenation dynamics of sepsis patients undergoing far-infrared intervention based on near-infrared spectroscopy.

Near-infrared spectroscopy (NIRS; continuous wave type) is a noninvasive tool for detecting the relative change of oxyhemoglobin and deoxyhemoglobin. To make this change, intervention methods must be applied. This study determined the hemodynamics of 44 healthy participants and 35 patients with sepsis during exposure to FIR as a novel physical intervention approach. Local microcirculation of their brachioradialis was monitored during exposure and recovery through NIRS. The variations in blood flow and microvascular reaction were determined by conducting paired and unpaired t tests. The oxyhemoglobin levels of the healthy participants increased continuously, even during recovery. In contrast to expextations, the oxyhemoglobin levels of the patients plateaued after only 5 min of FIR illumination. The proposed method has potential applications for ensuring efficient treatment and facilitating doctors in diagnosing the functions of vessels in intensive care units. Mapping diagrams of HbO2 in healthy males and males with sepsis illustrated unique scenarios during the process.

Distribution and phenotypic expression of mineralocorticoid receptor and CYP11B2 T-344C polymorphisms in a Taiwanese hypertensive population.

Numerous genetic loci are involved in the pathogenesis of hypertension, including genes related to aldosterone synthesis and mineralocorticoid receptor. The aim of this study was to evaluate the genotypic distribution of mineralocorticoid receptor and cytochrome P450 11B2 (CYP11B2) T-344C polymorphisms and their relationship with hypertension and cardiac remodeling in a Taiwanese population. Genomic DNA extracted from peripheral blood samples was subjected to polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis for the mineralocorticoid receptor loci, G3514C and A4582C, and CYP11B2 T-344C. The genetic distribution and the association with echocardiographic measurements were analyzed. A total of 192 normotensive and 514 hypertensive Taiwanese patients were recruited. Statistical analysis revealed no significant differences in the genetic distribution of mineralocorticoid receptor and CYP11B2 polymorphisms between normotensive and hypertensive patients, nor were there differences in the echocardiographic measurements. Female patients with the T/T genotype of CYP11B2 were more likely to have hypertension (p = 0.045), compared with the T/C or C/C genotypes. In addition, female hypertensive patients carrying C-allele had significantly greater left ventricular mass (p = 0.0215) and left atrial dimension (p = 0.0081). Such differences were not observed in the male patients. Our data suggest that CYP11B2 T-344C polymorphism affects left ventricular structures only in the female hypertensive population. This gender-difference needs to be further elucidated.

Subaortic-Right Atrial Fistula after Endocarditis in Hypertrophic Cardiomyopathy.

UNLABELLED: Infective endocarditis in hypertrophic obstructive cardiomyopathy is rare. Management of this disease is challenging due to the unique features of dynamic pressure gradient over the left ventricular outflow tract and its unpredictable interaction with the management of sepsis. The added complexity of infective endocarditis further complicates an already difficult situation. A 72-year-old man with hypertrophic obstructive cardiomyopathy presented with acute stroke, fever, and Staphylococcus aureus bacteremia. Infective endocarditis of the aortic valve was confirmed. Despite treatment with antibiotics and aortic valve replacement, the patient had recurrent bacteremia and developed a periannular abscess and a subaortic-right atrial fistula, with a resulting fatal outcome. KEY WORDS: Aortic valve replacement; Endocarditis; Hypertrophic obstructive cardiomyopathy; Subaortic-right atrial fistula.

Double vessel acute myocardial infarction showing simultaneous total occlusion of left anterior descending artery and right coronary artery.

Simultaneous double vessel acute myocardial infarction (AMI) is extremely rare and usually has poor clinical outcomes. Management of this complicated condition is challenging and time-limited. The case of a 46-year-old Taiwanese man with simultaneous anterior and inferior wall AMI is reported. Rapid deterioration of clinical condition with ventricular fibrillations (VF), cardiogenic shock and asystole developed before catheterization. Coronary angiogram revealed simultaneous total occlusion of left anterior descending (LAD) and right coronary arteries (RCA). Frequent VF attack was still noted after diagnostic catheterization. After cardiopulmonary resuscitation, immediate percutaneous coronary intervention of the LAD and RCA, and intra-aortic balloon counterpulsation was inserted. Due to intractable heart failure and cardiogenic shock, extracorporeal membrane oxygenation was performed. Rabdomyolysis with acute renal failure was also noted with hemodialysis treatment. Thirty-one days after hospitalization, he was discharged with a New York Heart Association functional class III heart failure, without hemodialysis.

Acquired hypophosphatemia osteomalacia associated with Fanconi's syndrome in Sjögren's syndrome.

Sjögren's syndrome is an autoimmune disorder involving exocrine glands that occurs alone or in association with various autoimmune and connective tissue diseases. The severity of Sjögren's syndrome ranges from isolated sicca syndrome to severe complications such as vasculitis, lung and renal involvement. Overt or latent renal tubular acidosis caused by autoimmune tubulointerstitial nephritis, is a common extraglandular manifestation in Sjögren's syndrome. Osteomalacia is a rare complication of renal tubular acidosis, and it was reported to be associated with distal renal tubular acidosis in Sjögren's syndrome. We report a 60-year-old woman who presented with multiple bone deformity and general muscle weakness. Osteomalacia was secondary to Fanconi's syndrome, and the Fanconi's syndrome was a result of renal involvement in Sjögren's syndrome. Fanconi's syndrome is a rare kidney manifestation in Sjögren's syndrome. It may be latent and may precede the subjective sicca symptoms. These findings suggest that evidence for Sjögren's syndrome should be sought in adult patients with unexplained osteomalacia and renal tubular acidosis, even in the absence of subjective sicca syndrome. Conversely, in patients with Sjögren's syndrome, early investigation and treatment of renal tubular dysfunction may prevent future complications, such as osteomalacia.