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Abstract:Cardiopulmonary exercise testing (CPET) allows for the analysis of gas exchange at rest, during exercise, and during recovery. These data can be readily integrated with standard variables measured during exercise testing, including heart rate, blood pressure, work rate, electrocardiography findings, and symptoms, to provide a comprehensive assessment of exercise tolerance and exercise responses. CPET can even be performed with adjunctive imaging modalities for additional diagnostic assessment. This paper focused on the progress in the application of CPET in the early diagnosis and prognostic evaluation of pulmonary hypertension.

Abstract:Role of cardiopulmonary exercise testing in evaluating the efficiency of targeted drug therapy for patients with chronic thromboembolic pulmonary hypertension

Abstract:Objective To investigate the differences in the indices of cardiopulmonary exercise testing (CPET) between the elderly and young patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods Fifty-seven CTEPH patients admitted to the Center for Pulmonary Vascular Diseases, Fuwai Hospital during January 2011 to May 2014 were enrolled in this study. They all underwent CPET, and were divided into 2 groups according to their age, that is, the elderly group (≥60 years old, n＝19), and the younger group (＜60 years old, n＝38). Results There was no difference in gender, prevalence of deep venous thrombosis (DVT), pulmonary targeted drug therapy, pulmonary vascular occlusion rate detected by ventilation-perfusion lung scanning, and WHO functional class between the 2 groups. Compared with the younger patients, the elderly CTEPH patients had lower heart rate response during exercise, decreased forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), lower peak minute ventilation (VE peak) and tidal volume (VT peak). While the percentage of oxygen uptake/heart rate (VO2/HR) peak to prediction and physiologic dead space fraction (VD/VT) were significantly increased in the elderly patients, along with decreased PetO2 peak. Conclusion The elderly CTEPH patients have their own characteristics in the parameters of CPET.

Abstract:heart failure; anaerobic threshold; cardiopulmonary exercise test; cardiac function

Abstract:Objective To measure the peak oxygen consumption (peak VO2) and oxygen uptake at anaerobic threshold (VO2AT) by cardiopulmonary exercise testing (CPET) in patients with chronic heart failure (CHF) and evaluate the prognostic values of the 2 indices. Methods Totally 129 patients suffering from CHF with left ventricular ejection fraction (LVEF)＜0.49 by echocardiography admitted in our department were recruited in this study. Coronary angiography indicated that there were 74 cases of ischemic cardiomyopathy and 55 cases of dilated cardiomyopathy. All subjects underwent CPET on the bicycle ergometer and were followed up for cardiac-related mortality in duration of median 33.7 months. Results (1) During the follow-up, 19 cardiac deaths were identified. There was no differences in the age, sex, body mass index (BMI) and peak respiratory exchange ratio (peak RER) between those dead patients and the survivors (P＞0.05). But LVEF (0.33±0.09 vs 0.38±0.09), peak VO2 [11.8±4.3 vs 14.4±3.7ml/(kg·min)] and VO2AT [9.3±3.2 vs 10.7±2.1ml/(kg·min)] were obviousty lower, while left ventricular mass index (LVMI, 158.3±53.9 vs 133.2±40.1) was significantly higher in the dead ones than in the survivors (all P＜0.05). (2) By receiver operating characteristic (ROC) curve analysis, the area under curve (AUC) of peak VO2 was 0.640 in predicting cardiac-related mortality in CHF patients (P＜0.05), the sensitivity was 0.590, the specificity was 0.667, and the optimal threshold value of peak VO2 was ≤13.4ml/(kg·min). The AUC of VO2AT was 0.600 (P＜0.05), the sensitivity was 0.886, the specificity was 0.360, and the optimal threshold value of VO2AT was ≤8.2ml/(kg·min). Conclusion Peak VO2 and VO2AT have certain predictive values for cardiac-related mortality in CHF patients, and the former is superior to the latter.

Abstract:Objective To compare the features of the parameters of cardiopulmonary exercise testing (CPET) between the elderly patients with chronic left heart failure (LHF) and those with chronic right heart failure (RHF). Methods A prospective study was carried out on 25 elderly patients with chronic LHF [20 males, aged (60.2±4.7) years] and 25 elderly patients with chronic RHF [(19 males, aged (61.3±5.7) years]. Those patients with pulmonary diseases, neuromuscular diseases and/or anemia were excluded. Valuables of CPET were compared between the 2 groups. Results There was no significant difference in the gender, age, BMI and New York Heart Association (NYHA) class between the 2 groups. Echocardiography indicated that left ventricular end-diastolic diameter was significantly larger in the LHF group than in the RHF group [(66.1±9.0) vs (40.4±5.4)mm, P＜0.001], left ventricular ejection fraction was obviously lower in the former than in the latter group [(32.5±11.9)% vs (65.8±8.1)%, P＜0.001]. LHF group had remarkably larger peak VO2 [(1056.6±340.5) vs (750.9±269.1)ml/min], higher peak VO2/kg [(15.1±2.7) vs (11.0±3.2)ml/(min·kg)] and percentage of predicted value of peak VO2 [(52±13)% vs (39±11)%] when compared with those of RHF group (P＜0.05). Peak VO2/HR was significantly lower in the RHF group than in the LHF group [(6.3±2.2) vs (8.5±3.0)ml/(min·beat), P＝0.016]. Compared with LHF group, VO2/WR slope was obviously decreased in RHF group [(5.1±1.1) vs (6.4±1.8)ml/(min·W), P＝0.014], and VE/VCO2 slope was significantly higher [(34.7±8.2) vs (49.5±12.6), P＜0.001]. Conclusion Compared with LHF, cardiopulmonary functions are worse and VE/VCO2 slope is higher in the patients with RHF, even when having similar NYHA class.

Abstract:Objective To investigate the features of cardiopulmonary exercise testing (CPET) in elderly patients with coronary arterial disease (CAD). Methods A prospective study was carried out on the elderly patients who hospitalized and underwent coronary angiography and CPET in our center from October 2010 to October 2014. Those patients with acute myocardial infarction, pulmonary disease, left ventricular ejection fraction less than 55% or anaemia were excluded. The obtained 47 patients were divided into CAD (n＝33) and non-CAD groups (n＝17) according to the results of coronary angiography. Valuables of CPET were compared between the 2 groups of patients. Results The cohort was at an age of (62.6±4.3) years, and included 33 males and 15 females. There was no significant difference in gender, age, body mass index, and histories of cigarettes, hypertension and diabetes. No obvious difference was either seen in left ventricular end diastolic diameter (LVEDD) or left ventricular ejection fraction. CPET results showed that peak VO2 and percentage of it to expected value were lower in CAD group than in non-CAD group [(1 158.4±286.4) vs (1 382.2±337.9)ml/min], (60.5±13.4)% vs (83.6±14.5)%, P＜0.05]. Peak VO2/HR was also lower in the former than in the latter group [(9.5±1.5) vs (10.7±1.6)ml/(min·beat), P＝0.038). Compared with non-CAD group, VO2/WR slope was decreased in CAD group [(7.8±0.9) vs (6.5±1.5)ml/(min·W)]. However, there was no difference in anaerobic threshold (AT) or ventilatory equivalent ratio of oxygen and carbon dioxide (VE/VCO2) between the 2 groups. Conclusion Exercise tolerance is decreased in the elderly CAD patients than those without CAD, which may be associated with lower cardiac output for left ventricular dysfunction due to myocardial ischemia.

Abstract:Cardiopulmonary exercise testing can evaluate the functions and reserve capacities of multiple organ systems, for example, the cardiovascular system, lung and skeletal muscle system, through measuring the body’s reaction to exercise. The test shows unique advantages, especially in objective and quantitative assessment for functional status and prognosis in patients with chronic heart failure. In this paper, we mainly introduced the clinical significance of major indices of CPET in chronic heart failure.

Abstract:Objective To determine the expression profile of microRNAs (miRNAs) in the patients with unstable coronary heart disease and investigate the regulation role of differential expressed miRNAs in cell proliferation. Methods (1) After the plasma samples of patients with confirmed unstable coronary heart disease and non-coronary heart disease with suspected angina (control) were collected, miRNAs array was employed to identify distinct miRNA expression profiles. (2) The potential target genes of the above miRNAs were predicted by 3 miRNA target prediction algorithms, TargetScan, miRanda and DIANAmT. (3) The genes predicted by the three algorithms were further analyzed for their regulation roles in cell proliferation and involed signaling pathways by DAVID database. (4) Real-time PCR were used to test plasma miR-19b levels in patients with unstable coronary heart disease compared with the controls. (5) Based on the results of function cluster analysis, the effect of the most differentially expressed miR-19b was detected on the regulation of cell proliferation. Results (1) Compared with the controls, there were 39 differentially expressed miRNAs, and miR-19b was the most obviously one. (2) By analyzing the target genes of the differential expressed miRNAs, there were 14 miRNAs closely related with cell proliferation, and miR-19b was the closest one. (3) Real-time PCR confirmed that the plasma miR-19b level was obviously higher in the patients with unstable coronary heart disease than in the controls. (4) The results of CCK-8 assay showed that miR-19b indeed inhibited the proliferation in EA.hy926 cells. Conclusion There is a specific expression profile of circulating miRNAs in the patients with unstable coronary artery disease. The differentially expressed miRNAs may be the biomarkers of unstable coronary heart disease. MiR-19b may play a protective role in the stability of atherosclerotic plaque by inhibiting the proliferation of endothelial cells.

Abstract:Objective The Toranomon Hospital Health Management Center Study 16 (TOPICS 16) showed that higher fasting plasma glucose (FPG) indicated increased risk of hypertension, but glycosylated hemoglobin A1c (HbA1c) did not. This study aimed to investigate whether HbA1c was associated with the risk of hypertension. Methods A prospective study was carried out on 4 586 men initially free of hypertension, diabetes, and cardiovascular disease who taking regular physical examination in our hospital to assess the relationship of baseline HbA1c with hypertension. Their baseline clinical data were collected. The quintiles and clinical cutpoints of HbA1c for the risk of hypertension were considered and analyzed. Results During a median follow-up of 11.5 years, 2 027 of the cohort (44.2%) developed hypertension. In the model adjusted for traditional cardiovascular risk factors, the hazard ratios (HR) from the lowest (＜4.75%) to the highest (≥5.18%) quintile of HbA1c were 1.0 (referent), 0.99 (0.93, 1.07), 1.06 (0.99, 1.14), 1.08 (1.02, 1.15), and 1.22 (1.17, 1.35). When using clinical cutpoints of FPG (＜4.7, 4.8?5.2, 5.3?5.7, ≥5.7mmol/L), the model adjusted for traditional cardiovascular risk factors showed that the HR from the lowest (＜4.7mmol/L) to the highest (≥5.7mmol/L) level of FPG were 1.0 (referent), 0.95 (0.92, 1.05), 0.96 (0.91, 1.06), and 1.01 (0.95, 1.10) respectively. Conclusion HbA1c in men without diabetes is associated with risk of hypertension.

Abstract:Objective To determine the clinical efficiency and safety of 120W diode laser vaporization in the treatment of benign prostatic hyperplasia (BPH). Methods A total of 57 patients [aged 50 to 89 (71.7±7.1) years] with obvious bladder outlet obstruction and diagnosed as BPH were included in the study. They were treated with the HPD Laser (120W/980nm Ceralas D120, Germany) in our department. Their operation time, the prostate volume, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and post-void residual urine (PVR) before and after operation were measured and compared. Results The surgery was successfully performed to all of the patients within a duration of (52.6±19.6) min. Their IPSS was decreased from 24.7±4.4 (15 to 32) before surgery to 3.5±1.2 (2 to 6) after surgery surgery. Their Qmax was increased from (6.7±3.4) ml/s (0 to 12ml/s) before surgery to (24.0±4.9)ml/s (17.8 to 31.2ml/s) postoperatively, and PVR was reduced from (77.2±45.7) to (5.1±7.7) ml. Significant differences were seen in above indexes. No death, blood transfusion, urinary incontinence or secondary operation was observed in the cohort. Conclusion Diode laser of 980nm with output power up to 120W is safe and effective in prostate vaporization for BPH, but quite expensive.

Abstract:Objective To determine the plasma levels of homocysteine (Hcy), high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in the elderly patients with masked hypertension. Methods A total of 60 elderly in-patients (over 65 years old) with masked hypertension confirmed by ambulatory blood pressure monitoring admitted in our department and Midong District Branch from January 2012 to October 2013 were recruited in this study as masked hypertension group. Another 60 elderly individuals without masked hypertension who took physical examination in our hospital during same period served as control group. The gender and age well matched between two groups. Plasma levels of Hcy, hs-CRP and IL-6 were detected in all the patients, and the results were compared between the 2 groups. Results The plasma level of Hcy was significantly higher in the masked hypertension group than in the control group [(17.64±7.94) vs (11.03±5.35)mmol/L, P＜0.01]. The masked hypertension group also had obviously higher plasma hs-CRP [(0.61±0.15)mg/L and IL-6 levels (0.20±0.05)mg/L] than the control group [(0.50±0.14)mg/L and (0.16±0.04)mg/L respectively, P＜0.05]. Conclusion Plasma levels of Hcy, hs-CRP and IL-6 are higher in elderly masked hypertensive patients than in those without masked hypertension. Whether Hcy, hs-CRP and IL-6 be involved in the pathogenesis of the elderly masked hypertension needs further study.

Abstract:Objective To investigate the pathogen distribution and antibiotic sensitivity of community-acquired pneumonia (CAP) from the elderly patients in order to provide references for clinical treatment and scientific use of the antibacterial drugs. Methods A retrospective analysis was carried out on the results of sputum culture of 165 elderly with CAP in the People’s Hospital of Hechuan District from 2012 to 2014. Results Among the 112 totally-isolated strains of bacteria, the leading 5 bacteria were Klebsiella pneumoniae (28 strains, 25.0%), Escherichia coli (17 strains, 15.1%), Pseudomonas aeruginosa (12 strains, 10.7%), Streptococcus pneumoniae (11 strains, 9.8%), and Haemophilus influenzae (10 strains, 8.9%). The results of drug sensitivity test showed that, K.pneumoniae, E.coli, P. aeruginosa and Str. pneumoniae had good sensitivity to beta lactam/beta lactamase inhibitor and imipenem. But most strains of Stre. pneumoniae were resistant to penicillin. Conclusion Gram-negative bacteria are the main pathogenic bacteria in CAP in the elderly. Empirical selection of antibiotics with beta lactam/beta lactamase inhibitor compound preparation is more appropriate for the treatment.

Abstract:Objective To determine the effect of the extracts of Ginkgo biloba leaf (EGB) on the endoplasmic reticulum stress-induced cardiomyocyte injury and investigate the role of Wnt signal pathway in this process. Methods Tunicamycin(Tm) was used to establish the endoplasmic reticulum stress model in rat cardiomyocytes which were isolated from neonatal rats in 1d after born and then cultured for 48h. There were 4 groups of cardiomyocytes, that is, control, Tm treated, Tm+EGB treated and EGB treated. MTT assay was used to detect cell viability. The dual-luciferase report system was used to measure Wnt activity. C-myc and CyclinD1 were detected by real-time PCR. Results Compared to control cells, Tm treatment resulted in significantly decreased cell viability, but the presence of EGB markedly attenuated the cell injury. The treatment also decreased the activity of Wnt, whereas co-treatment of Tm and EGB led to not only the increase in Wnt activity, but also recovery of the C-myc and CyclinD1 levels. However, Wnt inhibitor, secreted frizzled-related protein (sFRP) decreased Wnt activity, C-myc and CyclinD1 levels, and inversed EGB-induced protective effect. Conclusion These findings demonstrate that EGB protects cardiomyocytes against Tm-induced injury through improving Wnt activity.

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Abstract:Acute low-tone sensorineural hearing loss (ALHL) is a special type of sudden sensorineural hearing loss, which arises growing concern in clinical practice in recent years. Its clinical manifestations are sudden drop of low-frequency hearing without obvious causes, normal hearing of high-frequency area, no vertigo seizures or spontaneous eye shake, and normal auditory brainstem response (ABR). The disease seems to be related to endolymphatic hydrops, topical ischemic injury, immune factors and so on. Glucocorticoid treatment is very effective with good prognosis. Progression and recurrence of ALHL may be associated with Meniere’s disease.

Abstract:Atrial fibrillation (AF) has become a chronic disease seriously threatening the health of the elderly, and its most common complications are systemic embolism and other vascular embolic events, with higher morbidity and mortality. However, anticoagulant therapy is underused in elderly adults with AF in the clinical practice, so it is of great importance to adopt aniticoagulant therapy for them.