[Show abstract][Hide abstract] ABSTRACT: Aim: Studies investigating the effects of type II diabetes mellitus on exercise capacity, peripheral muscle strength, and physical activity level in patients with heart failure are limited. This study aimed to compare maximal exercise capacity, peripheral muscle strength, and physical activity level in patients with heart failure with and without diabetes mellitus.
Methods: Thirty-four patients with heart failure—16 diabetic and 18 nondiabetic (New York Heart Association Class II and III, left ventricular ejection fraction below 40%)—were included. Pulmonary function was evaluated using spirometry, peripheral muscle strength using a handheld dynamometer, maximal exercise capacity using Modified Incremental Shuttle Walk Test (MISWT), energy expenditure in daily activities, and physical activity level using the International Physical Activity Questionnaire.
Results: The MISWT distance was significantly shorter in diabetic patients with heart failure than in nondiabetic ones (P < .05). Hand grip, biceps brachii, and quadriceps femoris muscle strength were significantly lower in diabetic patients than in nondiabetic ones (P < .05). Thirteen percent of the patients with heart failure with diabetes were minimally active, 88% were inactive. In the nondiabetic group, 11% were minimally active and 88.89% patients were inactive. There was no significant difference in energy expenditure in daily activities between diabetic and nondiabetic patients (P > .05).
Conclusions: Presence of diabetes mellitus further decreases maximal exercise capacity, and peripheral muscle strength in patients with heart failure. Energy expenditure in daily activities is severely impaired in both in diabetic and nondiabetic patients with heart failure. Physical inactivity is present in heart failure independent of the diabetes. Diabetes mellitus should be taken in consideration while evaluating maximal exercise capacity and peripheral muscle strength in patients with heart failure.
Topics in Geriatric Rehabilitation 12/2011; 28(1):54–59. · 0.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although predictive value of heart rate recovery (HRR) has been tested in large populations, the reproducibility of HRR in treadmill exercise test has not been assessed prospectively. This prospective study examined whether HRR index has test-retest stability in the short term.
A total of 52 healthy volunteers without cardiovascular risk factors (mean age, 30 ± 10 years, 30 females) underwent standardized graded treadmill exercise test, and the test was repeated on the 7th and the 30th days. The subjects' maximal heart rates and the decrease of heart rate from the peak exercise level to the level of 1, 2, 3, 4, and 5 minutes after the termination of the exercise were examined on each test, and heart rates for each minute from the first, second, and third tests were compared for each individual.
The maximal heart rates on the 1st, 7th, and the 30th days were 179 ± 11, 177 ± 10, 178 ± 10 beats/min, respectively [P = 0.07, intraclass correlation coefficient (ICC) = 0.92], and the 1st minute HRR indices after peak exercise were 33 ± 10, 33 ± 10, 33 ± 11, respectively (P = 0.66, ICC = 0.88). There was no statistical difference in the 2nd, 3rd, 4th, and 5th minute heart rates of the recovery phase among the 1st, 7th, and 30th day treadmill exercise tests, either.
Maximal heart rates and the decline of heart rate to the 5th minute on recovery phase after treadmill exercise test have short-term reproducibility.
Annals of Noninvasive Electrocardiology 10/2011; 16(4):365-72. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the effects of inspiratory muscle training (IMT) on functional capacity and balance, respiratory and peripheral muscle strength, pulmonary function, dyspnea, fatigue, depression, and quality of life in heart failure patients.
A prospective, randomized controlled, double-blinded study. Thirty patients with heart failure (NYHA II-III, LVEF<40%) were included. Sixteen patients received IMT at 40% of maximal inspiratory pressure (MIP), and 14 patients received sham therapy (15% of MIP) for 6 weeks. Functional capacity and balance, respiratory muscle strength, quadriceps femoris muscle strength, pulmonary function, dyspnea, fatigue, quality of life, and depression were evaluated.
Functional capacity and balance, respiratory and peripheral muscle strength, dyspnea, depression were significantly improved in the treatment group compared with controls; quality of life and fatigue were similarly improved within groups (p < 0.05). Functional capacity (418.59 ± 123.32 to 478.56 ± 131.58 m, p < 0.001), respiratory (MIP = 62.00 ± 33.57 to 97.13 ± 32.63 cmH(2)O, p < 0.001) and quadriceps femoris muscle strength (240.91 ± 106.08 to 301.82 ± 111.86 N, p < 0.001), FEV(1)%, FVC% and PEF%, functional balance (52.73 ± 3.15 to 54.25 ± 2.34, p < 0.001), functional dyspnea (2.27 ± 0.88 to 1.07 ± 0.79, p < 0.001), depression (11.47 ± 7.50 to 3.20 ± 4.09, p < 0.001), quality of life, fatigue (42.73 ± 11.75 to 29.07 ± 13.96, p < 0.001) were significantly improved in the treatment group. Respiratory muscle strength (MIP = 78.64 ± 35.95 to 90.86 ± 30.23 cmH(2)O, p = 0.001), FVC%, depression (14.36 ± 9.04 to 9.50 ± 10.42, p = 0.011), quality of life and fatigue (42.86 ± 12.67 to 32.93 ± 15.87, p = 0.008) were significantly improved in the control group.
The IMT improves functional capacity and balance, respiratory and peripheral muscle strength; decreases depression and dyspnea perception in patients with heart failure. IMT should be included effectively in pulmonary rehabilitation programs.
Respiratory medicine 05/2011; 105(11):1671-81. · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate heart rate variability (HRV) and heart rate recovery (HRR) in otherwise healthy ankylosing spondylitis (AS) patients and control subjects.
A total of 28 patients with AS and 30 volunteers matched for age and sex were enrolled. All subjects underwent HRV analysis, exercise testing (ET), and transthoracic echocardiography. HRR indices were calculated by subtracting first, second, and third minute heart rates (HR) from the maximal HR.
The AS and control groups were similar with respect to age (28.7 ± 5.7 vs. 29.3 ± 5.8 years), gender distribution [(male/female) 24/4 vs. 26/4], and left ventricular ejection fraction (LVEF) (63.8 ± 2.8% vs. 65.7 ± 3.6%). Mean HRR1 (24.8 ± 4.2 vs. 28.8 ± 5.5, P = 0.001) and HRR2 (42.0 ± 4.4 vs. 48.0 ± 6.3, P = 0.001) values were significantly higher in control group. SDNN, SDANN, RMSDD, and PNN50 significantly decreased; LF and LF/HF increased in AS patients compared with control subjects.
Patients with AS has lower HRR and HRV indices with respect to normal subjects. Cardiac autonomic functions might be involved in AS patients even in patients without cardiac symptoms.
Clinical Research in Cardiology 12/2010; 99(12):803-8. · 3.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims: The aims of this study were to investigate the relationship between functional capacity and pulmonary function, respiratory and peripheral muscle strength, and find out the best predictor of functional capacity in patients with heart failure. Design: A prospective, cross sectional study.
Subjects and Methods: Thirty-four clinically stable patients with heart failure (68.59 ± 9.85 years, left ventricular ejection fraction = 34.24% ± 7.59%, New York Heart Association class II/III) were included. Patients' characteristics were recorded. Functional capacity was evaluated using 6-minute walk test (6MWT). Pulmonary function was measured using spirometry, respiratory muscle strength (maximum inspiratory pressure and maximum expiratory pressure) was measured using a mouth pressure device, and quadriceps femoris and biceps brachii muscle strengths were assessed using a hand-held dynamometer.
Results: There were statistically significant positive correlations between 6MWT distance and pulmonary function, maximum inspiratory pressure, maximum expiratory pressure, quadriceps femoris and biceps brachii muscle strengths (P < .05). In the multiple regression analysis conducted in the 34 heart failure patients, 79% of the variance in the 6MWT distance was explained by qaudriceps femoris (R2 = 0.70, P < .001) and the biceps brachii (R2 = .09, P = .007) muscle strengths. When the 6MWT distance was expressed as the percentage of predicted values, 58% of the variance in the 6MWT distance was explained by qaudriceps femoris (R2 = 0.40, P = .001) and the percent biceps brachii muscle strength (R2 = 0.18, P = .007).
Conclusions: Upper and lower extremity muscle strength is a factor significantly contributing to impaired functional capacity in patients with heart failure. These findings suggest that routine screening of upper and lower extremity muscle strengths is advisable in patients with heart failure.
Topics in Geriatric Rehabilitation 09/2010; 26(4):368–375. · 0.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the era of early and invasive therapeutic approaches, myocardial rupture has become an uncommon complication of myocardial infarction. We report an uncommon complication following inferior myocardial infarction with both left ventricular and right ventricular rupture and subsequent communication via a shared pseudoaneurysm.
[Show abstract][Hide abstract] ABSTRACT: Cardiac resynchronization therapy (CRT) improves left ventricular (LV) systolic function in heart failure (HF). However, the effects of CRT on right ventricular (RV) systolic function are not fully understood.
We aimed to determine echocardiographic correlates of improvement in RV systolic function after CRT.
Fifty-four patients (61.9 ± 10.5 years; 43 men; LV ejection fraction 24.6 ± 4.0%; QRS duration > 120 ms) with HF were enrolled. Standard echocardiography, strain rate (SR), and tissue Doppler imaging were performed in all patients before and 6 months after CRT. Pulsed-wave TDI-derived systolic indices of RV included systolic (RV(S) ) and isovolumic velocity (RV(IVV)) and isovolumic acceleration (RV(IVA)). Response to CRT was defined as decline in LV end-systolic volume (LVESV) ≥ 10%.
When indices of RV systolic function were assessed between responders and nonresponders, in responders (38 patients, 70.4%) RV end-diastolic diameters (RVD1-3), mid-RV strain, and mid-RV SR improved significantly (P < 0.01, for all). RV(S) (10.77 ± 4.29 vs 12.62 ± 4.10 cm/sec, P = 0.005), RV(IVV) (14.71 ± 5.88 vs 18.52 ± 6.62 cm/sec, P < 0.001), and RV(IVA) (1.69 ± 0.70 vs 2.39 ± 0.77 m/sec(2) , P < 0.001) significantly increased among responders. There was no significant change in these parameters among nonresponders. Pearson's analyses revealed moderate positive correlations between reduction of LVESV and ΔRV(IVV) (r = 0.467, P = 0.001) and ΔRV(IVA) (r = 0.473, P = 0.001), respectively.
RV diameters and systolic indices after CRT improved only in the responder group. Improvement in RV systolic performance after CRT is correlated with the reduction of LVESV.
Pacing and Clinical Electrophysiology 09/2010; 34(2):200-7. · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was designed to determine the relationship between serum uric acid level and the presence and severity of coronary artery disease (CAD).
A total of 1012 patients who underwent coronary angiography were included in this study. All patients were assessed for the presence of cardiovascular risk factors and ongoing medications. Serum uric acid and creatinine level, as well as a fasting lipid profile and fasting blood glucose, were measured in all patients before the procedure. The severity of CAD was assessed by the Gensini score.
Of 1012 patients (mean age, 59.4 +/- 10.24 years), 680 were men (mean age, 58.7 +/- 10.5 years) and 332 were women (mean age, 61.0 +/- 9.51 years). Of the study patients, 703 (69%) were hypertensive, 292 (28.9%) were diabetic (DM), 304 (30%) had a smoking history, 306 (30%) had low high-density lipoprotein cholesterol levels and 350 (34%) had hypertriglyceridaemia. CAD was present in 689 (68%) patients who were assessed by coronary angiography. One-, two- and three-vessel disease was detected in 32.6%, 32.5% and 34.9% of the patients respectively; left main coronary artery lesion was detected in 15% of the patients. A statistically significant difference in the mean uric acid concentrations was found between the patients with or without CAD [380 +/- 121 micromol/l (6.39 +/- 2.04 mg/dl) vs. 323.5 +/- 83.2 micromol/l (5.44 +/- 1.40 mg/dl) p < 0.001]. Based on logistic regression analysis, the increased serum uric acid level was found to be associated with the presence of CAD in both men and women (p < 0.001). The increased serum uric acid level was also found to be associated with the severity of CAD in both men and women based on multivariate linear regression analysis (p < 0.001).
In conclusion, serum uric acid level was found to be associated with the presence and severity of CAD.
International Journal of Clinical Practice 06/2010; 64(7):900-7. · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to demonstrate that irbesartan is successful in reducing diastolic blood pressure (BP) even following a missed dose after 6-8-weeks' treatment as measured by 24-hour ambulatory BP monitoring (ABPM).
Eighty-eight patients (64 females, mean age: 53.4 +/- 10.6 years) with primary hypertension were included in this national, single-center, single-arm, open-label, prospective clinical study. Irbesartan (150 or 300 mg/day) was administered for 8 weeks. All patients were asked to cease treatment for 1 day during weeks 6-8. Changes in diastolic and mean 24-hour BP on the day of cessation and diastolic BP values during visits were efficacy parameters. Adverse events were also recorded.
Systolic, diastolic, and mean BP values measured via ABPM before and on the day of a missed dose did not differ significantly. Irbesartan effectively controlled BP of the patients. BP normalization rates were 54% for 150 mg/day irbesartan only and 77% for both doses (150 or 300 mg/day) of irbesartan. None of the patients experienced serious adverse events throughout the study period.
Irbesartan is successful and safe in the control of BP levels even following a missed dose at the end of a 6-8-week treatment period.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the relationship between microalbuminuria (MA) and the presence and extent of coronary artery disease (CAD).
Four hundred and two consecutive patients were divided into 4 groups based on the presence of diabetes mellitus (DM) and MA: DM(+)/MA(+), DM(+)/MA(-), DM(-)/MA(+), and DM(-)/MA(-). Severity of CAD was assessed by the Gensini scoring system.
The Gensini score was 57 +/- 38.2 vs 16.5 +/- 19.5 (P < .001) in the DM(+)/MA(+) and DM(+)/MA(-) groups and 45 +/- 39.8 vs 9.9 +/- 16.6 (P < .001) in the DM(-)/MA(+) and DM(-)/MA(-) groups. Spearman correlation analysis demonstrated a positive relation between urine albumin/creatinine ratio (ACR) and extent of CAD both in the diabetic and nondiabetic patients (r = .584, P = .001; r = .545, P = .001). Microalbuminuria was found to be an independent predictor for the presence (OR for MA: 3.728; 95% CI, 1.931-7.196; P < .001) and severity of CAD (P < .001, beta = .563).
A strong relationship between MA and the severity of CAD was reported.
[Show abstract][Hide abstract] ABSTRACT: Neurocardiogenic syncope is a common and challenging problem in clinical practice. Heart rate recovery after the first minute of exercise is mainly controlled by the parasympathetic nervous system. The aim of the present study was to evaluate heart rate recovery as an index of parasympathetic tonus for the diagnosis of neurocardiogenic syncope.
Ninety five patients (mean age 36.5 +/- 11.8 years), who had vasovagal syncope episodes documented by tilt table testing and 70 healthy subjects (mean age 32.9 +/- 9.1 years) were included in this study. Maximal exercise stress testing was performed in both groups and heart rate recovery values were calculated. Heart rate recovery was calculated by subtracting recovery heart rate in the first minute after exercise from peak heart rate. Heart rate recovery was significantly higher in the vasovagal syncope group than the control group during the first minute (42.1 vs. 30.9, p < 0.001). When the cutoff point for heart rate recovery was taken as 35, the sensitivity for the diagnosis of vasovagal syncope was 81% and the specificity was 78%.
Results of our study show that heart rate recovery is greater in the first minute after exercise in vasovagal syncope patients and that it has a supportive role in the diagnosis of neurocardiogenic syncope.