Efficacy of Adaptive Servo-Ventilation in Worsening Heart Failure.

Despite advancements in heart failure (HF) therapies, managing symptoms and congestion remains challenging for some patients. Adaptive servo-ventilation (ASV) has been used in Japan to treat residual congestion in chronic HF, but its efficacy remains debated.This study is a subanalysis of the SAVIOR-L study, a multicenter prospective observational study in Japan evaluating ASV in worsening HF.

Relationship Between Health-Related Quality of Life and Exercise Tolerance Improvement in Remote Cardiac Rehabilitation: Sub-Analysis of RecRCR Study.

Remote cardiac rehabilitation (RCR) is emerging alternative to outpatient rehabilitation. However, evidence related to its effect on health-related quality of life (HRQOL) is limited. This is a sub-analysis of the RecRCR study, a multi-center, nonrandomized trial evaluating the efficacy and safety of RCR with real-time telemonitoring in patients with CVD, after discharge.

Clinical advantages of reduced expiratory positive airway pressure setting in adaptive servo-ventilation therapy.

The clinical ramifications of adaptive servo-ventilation (ASV) therapy have stirred debate within the medical community. Given the potential detrimental effect of elevated expiratory positive airway pressure (EPAP) on cardiac output, we hypothesized that relatively lower EPAP may be recommended for successful ASV therapy. In-hospital patients with congestive heart failure refractory to medical therapy were included in the prospective cohort study of ASV therapy on prognosis in repeatedly hospitalized patients with chronic heart failure: longitudinal observational study of effects on readmission and mortality (SAVIOR-L) study.

Improved Peak Oxygen Uptake Reduces Cardiac Events After 3 Weeks of Inpatient Cardiac Rehabilitation for Chronic Heart Failure Patients.

The incidence of heart failure (HF) is increasing, and the mortality from HF remains high in an aging society. Cardiac rehabilitation (CR) programs (CRP) increase oxygen uptake (V̇O) and reduce HF rehospitalization and mortality. Therefore, CR is recommended for every HF patient.

Age- and sex-stratified normal values for circulatory and ventilatory power during ramp exercise derived from a healthy Japanese population.

Circulatory power (CP) and ventilatory power (VP), obtained by cardiopulmonary exercise testing (CPX), have been suggested to be excellent prognostic markers for heart failure. However, the normal values of these parameters in healthy Japanese populations remain unknown; thus, we aimed to investigate these values in such a population. A total of 391 healthy Japanese participants, 20-78 years of age, underwent CPX with a cycle ergometer with ramp protocols.

Examination of the Relationship and Dissociation Between Minimum Minute Ventilation/Carbon Dioxide Production and Minute Ventilation vs. Carbon Dioxide Production Slope.

Background: Minute ventilation/carbon dioxide production (V̇E/V̇CO) is a variable of cardiopulmonary exercise testing (CPET), which is evaluated by arterial COpressure and ventilation-perfusion mismatch via invasive methods. This study evaluated substitute non-invasively obtained variables for minimum V̇E/V̇CO(Min) and V̇E vs. V̇COslope (Slope) and the relationship between Min and Slope.

Sodium Restriction Counseling Reduces Cardiac Events in Patients With Heart Failure.

Background: Many heart failure (HF) guidelines recommend sodium restriction for patients with HF, but the outcome of sodium restriction counseling (SRC) for HF patients is still unknown. We wanted to clarify whether SRC reduces cardiac events in patients with HF.

Methods and results: Overall, 800 patients (77±12 years) who were hospitalized for HF were enrolled.

Efficacy of Add-on Therapy with Carvedilol and the Direct Renin Inhibitor Aliskiren for Improving Cardiac Sympathetic Nerve Activity, Cardiac Function, Symptoms, Exercise Capacity and Brain Natriuretic Peptide in Patients with Dilated Cardiomyopathy.

: Aliskiren is a direct renin inhibitor that has been reported to be effective for CHF, but the usefulness of combined therapy with carvedilol and aliskiren has not been reported. Forty-four patients with dilated cardiomyopathy (DCM) were randomized into a group receiving add-on therapy with carvedilol plus aliskiren and another group receiving carvedilol alone for 6 months. Nuclear imagings with I-Metaiodobenzylguanidine (MIBG) and Tc-Sestamibi were performed.

Poor Increase in Pulse Pressure During Cardiopulmonary Exercise Testing Predicts Cardiovascular Death of Patients With Heart Failure With Reduced Ejection Fraction.

Background: The increase in stroke volume during inotropic stimulation in patients with heart failure with reduced ejection fraction (HFrEF) is called the "pump function reserve." Few studies have reported on the relationship between pump function reserve and HF prognosis. In HFrEF patients who have pump function reserve, stroke volume increases during exercise.

Relationship between ventilatory pattern and peak VO and area M regulates the respiratory system during exercise.

Background: Exertional dyspnea is a major symptom of heart failure. We investigated the tidal volume (TV)-the respiratory rate (RR) regulation according to the peak O uptake (VO) during cardiopulmonary exercise testing (CPET) for clarifying exercise ventilatory pattern.

Methods: We enrolled 1111 patients (66±13 years old, 68% men) who had undergone CPET at our hospital.

Active Participation in Outpatient Cardiac Rehabilitation Is Associated With Better Prognosis After Coronary Artery Bypass Graft Surgery - J-REHAB CABG Study.

Background: There is little evidence regarding the effect of outpatient cardiac rehabilitation (CR) on exercise capacity or the long-term prognosis in patients after coronary artery bypass graft surgery (CABG). This study aimed to determine whether participation in outpatient CR improves exercise capacity and long-term prognosis in post-CABG Japanese patients in a multicenter cohort.

Methods and results: We enrolled 346 post-CABG patients who underwent cardiopulmonary exercise testing during early (2-3 weeks) and late (3-6 months) time points after surgery.

Ventilatory Efficacy After Transcatheter Aortic Valve Replacement Predicts Mortality and Heart Failure Events in Elderly Patients.

Background: We aimed to clarify the predictors of death or heart failure (HF) in elderly patients who undergo transcatheter aortic valve replacement (TAVR).

Methods and results: We prospectively enrolled 83 patients (age, 83±5 years) who underwent transthoracic echocardiography (TTE) and cardiopulmonary exercise testing (CPET) with impedance cardiography post-TAVR. We investigated the association of TTE and CPET parameters with death and the combined outcome of death and HF hospitalization.

Relationship Between Exercise Oscillatory Ventilation Loop and Prognosis of Heart Failure.

Background: The cardiopulmonary exercise test (CPX) is a tool for evaluating disease severity and limitations in activities of daily living in patients with cardiac disorders. However, few studies have evaluated the association between exercise oscillatory ventilation (EOV) severity and prognosis in heart failure (HF) patients with EOV. EOV severity can be evaluated by detecting endtidal COpressure (PETCO, an indicator of the arterial partial pressure of CO(PaCO)) and minute ventilation, which is a reflection of the respiratory response to elevated CO.

Glucagon secretion determined by the RIA method is lower in patients with low left ventricular ejection fraction: The new glass study.

Aims: We investigated the glucagon levels in patients with heart failure (HF), using long oral glucose tolerance test (OGTT).

Methods: In this prospective observational study, we enrolled 30 undiagnosed diabetes patients (age 69 ± 10 years, 70% males, HbA1c 43 mmol/mol). A 4-h OGTT was performed.

Asymptomatic Reactive Hypoglycemia and Inflammatory Reaction in Patients with Coronary Artery Disease.

Hyperglycemia is an established risk factor of coronary artery disease (CAD). However, hyperglycemia with preserved pancreatic β cell function induces hyperinsulinemia to correct the glucose profile and may even result in reactive hypoglycemia (RH), which induces an inflammatory response. In this study, the incidence of RH and its effect on arteriosclerosis were examined in CAD patients with a lengthy oral glucose tolerance test (OGTT).

Characteristics of patients with a relatively greater minimum VE/VCO against peak VO% and impaired exercise tolerance.

Purpose: Cardiopulmonary exercise testing (CPX) is used to evaluate functional capacity and assess prognosis in cardiac patients. Ventilatory efficiency (VE/VCO) reflects ventilation-perfusion mismatch; the minimum VE/VCO value (minVE/VCO) is representative of pulmonary arterial blood flow in individuals without pulmonary disease. Usually, minVE/VCO has a strong relationship with the peak oxygen uptake (VO), but dissociation can occur.

Subarachnoid Block-Induced Deafferentation Pain Successfully Treated with Pentazocine.

Deafferentation pain induced by subarachnoid block (SAB) is rare, but it can appear in the form of recurrent phantom lower limb pain, new acute-onset stump pain in amputees, lower limb pain in patients with tabes dorsalis, and neuropathic pain. We have previously reported that thiopental is an effective treatment for deafferentation pain induced by therapeutic SAB applied to treat neuropathic pain of central origin. Here, we report the case of an amputee who developed new stump pain in his lower limb immediately after subarachnoid tetracaine was administered prior to appendectomy.