Agnieszka Siennicka

Could the two-minute step test be an alternative to the six-minute walk test for patients with systolic heart failure?

Background The consequence of exercise intolerance for patients with heart failure is the difficulty climbing stairs. The two-minute step test is a test that reflects the activity of climbing stairs. Design The aim of the study design is to evaluate the applicability of the two-minute step test in an assessment of exercise tolerance in patients with heart failure and the association between the six-minute walk test and the two-minute step test. Methods Participants in this study were 168 men with systolic heart failure (New York Heart Association (NYHA) class I–IV). In the study we used the two-minute step test, the six-minute walk test, the cardiopulmonary exercise test and isometric dynamometer armchair. Results Patients who performed more steps during the two-minute step test covered a longer distance during the six-minute walk test (r = 0.45). The quadriceps strength was correlated with the two-minute step test and the six-minute walk test (r = 0.61 and r = 0.48). The greater number of steps performed during the two-minute step test was associated with higher values of peak oxygen consumption (r = 0.33), ventilatory response to exercise slope (r = −0.17) and longer time of exercise during the cardiopulmonary exercise test (r = 0.34). Fatigue and leg fatigue were greater after the two-minute step test than the six-minute walk test whereas dyspnoea and blood pressure responses were similar. Conclusion The two-minute step test is well tolerated by patients with heart failure and may thus be considered as an alternative for the six-minute walk test.

Differences of psychological features in patients with heart failure with regard to gender and aetiology — Results of a CAPS-LOCK-HF (Complex Assessment of Psychological Status Located in Heart Failure) study

OBJECTIVE Objective of the study was to assess the psychological state of HF patients with reduced ejection fraction (HFrEF) with regard to gender and aetiology. METHODS 758 patients with HFrEF (mean age - 64±11years, men - 79%, NYHA class III-IV - 40%, ischemic aetiology - 61%) in a prospective Polish multicenter Caps-Lock-HF study. Scores on five different self-report inventories: CISS, MHLC, GSES, BDI and modified Mini-MAC were compared between the sexes taking into account the aetiology of HFrEF. RESULTS There were differences in the CISS and BDI score between the genders - women had higher CISS (emotion- and avoidance-oriented) and BDI (general score - 14.2±8.7 vs 12.3±8.6, P<0.05; subscale - somatic score - 7.3±3.7 vs 6.1±3.7, P<0.05). In the ischemic subpopulation, women had higher BDI (general and subscales) than men. In the non-ischemic subpopulation the differences between genders were limited to CISS scale. In a multivariable analysis with demographic and clinical data female sex, NYHA class, atrial fibrillation and diabetes mellitus determined BDI score. Similarly, in the ischemic subpopulation, the female sex, NYHA class and atrial fibrillation determined the BDI, while in the non-ischemic population NYHA class was the only factor that influenced the BDI score. Adding the psychological data made a significant additional contribution to the prediction of depression status. CONCLUSIONS There are distinct differences in psychological features with regard to gender in patients with HFrEF. Women demonstrate less favourable psychological characteristics. Gender-related differences in BDI score are especially explicit in patients with ischemic aetiology of HF. The BDI score is related to psychological predisposition.

Female perception of a partner’s mate value discrepancy and controlling behaviour in romantic relationships

Mate value discrepancy (MVD) between heterosexual partners is an important factor influencing relationship satisfaction which, in turn, has an effect on the quality and the stability of the relationship. Therefore, partners’ involvement in mate retention behaviours, such as controlling behaviours, can be related to MVD and our study aims to determine whether such an association exists. In order to do so, we analysed female perception of MVD and their opinion regarding the intensity of controlling behaviours performed by themselves as well as their romantic partners. Female perception of the intensity of controlling behaviours performed by both partners was the highest in couples where a woman assesses her own mate value (MV) as higher than her partner’s MV and significantly different than in relationships where male MV exceeded those of the female. Our study also indicates that MVD should be taken into account when analysing sex differences in intensities of mate retention behaviours. Finally, we provide evidence supporting the significance of the relationship length for controlling behaviour intensity. Findings are discussed within an evolutionary perspective.

Assessment of baroreflex sensitivity has no prognostic value in contemporary, optimally managed patients with mild‐to‐moderate heart failure with reduced ejection fraction: a retrospective analysis of 5‐year survival

We evaluated the prognostic value of cardiac baroreflex sensitivity (BRS) in contemporary, optimally treated patients with mild‐to‐moderate heart failure with reduced ejection fraction (HFrEF).

Evaluation of Skeletal Muscle Function and Effects of Early Rehabilitation during Acute Heart Failure: Rationale and Study Design

Background Acute heart failure (AHF) is associated with disturbances of the peripheral perfusion leading to the dysfunction of many organs. Consequently, an episode of AHF constitutes a “multiple organ failure” which may also affect the skeletal muscles. However, the abnormalities within skeletal muscles during AHF have not been investigated so far. The aim of this project is to comprehensively evaluate skeletal muscles (at a functional and tissue level) during AHF. Methods The study will include ≥63 consecutive AHF patients who will be randomized into 2 groups: ≥42 with cardiac rehabilitation group versus ≥21 with standard pharmacotherapy alone. The following tests will be conducted on the first and last day of hospitalization, at rest and after exercise, and 30 days following the discharge: clinical evaluation, medical interview, routine physical examination, echocardiography, and laboratory tests (including the assessment of NT-proBNP, inflammatory markers, and parameters reflecting the status of the kidneys and the liver); hemodynamic evaluation, noninvasive determination of cardiac output and systemic vascular resistance using the impedance cardiography; evaluation of biomarkers reflecting myocyte damage, immunochemical measurements of tissue-specific enzymatic isoforms; evaluation of skeletal muscle function, using surface electromyography (sEMG) (maximum tonus of the muscles will be determined along with the level of muscular fatigability); evaluation of muscle tissue perfusion, assessed on the basis of the oxygenation level, with noninvasive direct continuous recording of perfusion in peripheral tissues by local tissue oximetry, measured by near-infrared spectroscopy (NIRS). Results and Conclusions Our findings will demonstrate that the muscle tissue is another area of the body which should be taken into consideration in the course of treatment of AHF, requiring a development of targeted therapeutic strategies, such as a properly conducted rehabilitation.

Muscle Ergoreflex Activity and Autonomic Balance Assessed in the Vertical and Horizontal Body Positions in Young Healthy Men

We investigated whether indices of the reflex regulation of the cardiovascular system, i.e., muscle ergoreflex activity (ERGO) and characteristics of the autonomic balance, differ from each other while measured in the vertical vs. horizontal positions in healthy humans. Ten young healthy men (mean age 28 ± 1 years; BMI 23.6 ± 0.8 kg/m2) were examined. In each subject, the ERGO (ventilatory response to a control handgrip exercise, with repetitive isometric contractions at 50% of the maximal strength), baroreflex sensitivity (BRS, the sequence method), heart rate variability (HRV), and a few hemodynamic parameters were measured in two positions, horizontal and vertical. In the latter position, the heart rate, and diastolic and mean blood pressures (BP) were higher, while the stroke volume was smaller (all P < 0.05) with no differences in the systolic BP, cardiac output, and systemic vascular resistance (all P > 0.2). The HRV time domains, as well as BRS, decreased, whereas HRV-LF increased (all P < 0.05) in the vertical position as compared to the horizontal one. There were no differences between other HRV parameters (all P > 0.2) in the two examined positions. Minute ventilation during the exercise increased, while ERGO was reduced in the vertical position (all P < 0.05). Thus, the body position noticeably affects both reflex regulation of the cardiovascular system and autonomic balance. This observation has to be taken into account during physiological testing.

Direction of the Relationship Between Acceptance of Illness and Health-Related Quality of Life in Chronic Heart Failure Patients

Background: This study provides an in-depth insight into the relationships between illness acceptance and health-related quality of life (HRQoL) of chronic heart failure (CHF) patients. Although HRQoL is a well-established endpoint in CHF, little is known on illness acceptance in this group. Aims: The aim of this study is to critically reconsider the direction of a relationship between HRQoL and illness acceptance in CHF patients. Methods: The study included 204 patients (160 men and 44 women; mean age, 63 ± 11 years) with at least 6-month clinical evidence of CHF corresponding to New York heart Association (NYHA) classes I to IV. All the patients were examined with the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and Acceptance of Illness Scale (AIS). Results: Univariate analysis showed that the level of illness acceptance correlated inversely with patient age, and the level of HRQoL decreased with the severity of CHF (NYHA class). A relationship between illness acceptance and HRQoL was analyzed by structural equation modeling. Model 1 was based on the assumption that HRQoL is modulated by illness acceptance, and model 2 tested the opposite relationship. Both models included patient age and NYHA class as extrinsic determinants of AIS and MLHFQ scores, respectively. Model 2 proved to be well fitted (&khgr;2 [df = 2] = 3.22, P = .20, root-mean-square error of approximation = 0.055). Scores on the AIS correlated inversely with age (bage->AIS = −0.15, SE = 0.05, P = .002) and HRQoL (bQoL->AIS = −0.15, SE = 0.02, P < .001), and an increase in NYHA class was reflected by an increase in HRQoL scores (bNYHA->QoL = 5.75, SE = 1.97, P = .004). Conclusion: Patients with CHF may not accept their disease due to deteriorated HRQoL. As a result, they may be uninvolved in the therapeutic process, which leads to exacerbation of CHF, further deterioration of HRQoL, and inability to accept the illness.

Central Chemoreceptor Sensitivity Is Not Enhanced in Contemporary Patients With Chronic Systolic Heart Failure Receiving Optimal Treatment

BACKGROUND Clinical and prognostic consequences of enhanced central chemosensitivity in the contemporary optimally treated patients with chronic heart failure (CHF) are unknown. METHODS AND RESULTS We studied central chemosensitivity (defined as hypercapnic ventilatory response [HCVR; L/min/mmHg]) in 161 CHF patients (mean left ventricular ejection fraction [LVEF] 31 ± 6%, all receiving a combination of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-blocker) and 55 sex- and age-matched healthy controls. HCVR did not differ between CHF patients and controls (median 0.63 vs 0.57 L/min-1/mmHg-1, P = .76). When the CHF patients were divided into tertiles according to their HCVR values, there were no significant differences in clinical characteristics (except for ischemic etiology, which was more frequent in those with the highest HCVR), results of the cardiopulmonary exercise testing, and indices of heart rate variability. During the follow-up (median 28 months, range 1-48 months, ≥15 months in all survivors), 21 patients died. HCVR was not related to survival in the Cox proportional hazards analysis. CONCLUSIONS Central chemosensitivity is not enhanced in contemporary, optimally treated CHF patients and its assessment does not provide significant clinical or prognostic information.

Attitude towards knowledge of the disease and psychological characteristics of patients with systolic heart failure

participants and procedure This prospective study among 75 patients with stable systolic HF consisted of 2 parts: a quantitative approach, conducted during the hospitalization (based on 4 psychological questionnaires: the Multidimensional Health Locus of Control Scale; the Coping Inventory for Stressful Situations; the Acceptance of Illness Scale; and the Patient’s Request Form) and a qualitative approach (phone interviews performed later).

Non-invasive approach for the assessment of sympathetic baroreflex function: A feasibility study

BACKGROUND Evaluation of sympathetic baroreflex (sBR) function in humans requires intra-neural recording of muscle sympathetic nerve activity (MSNA) by microneurography. AIMS We proposed noninvasive approach for the evaluation of sBR function by applying the threshold-analysis (traditionally, based on MSNA) to systemic vascular resistance (SVR) measurement by photoplethysmography. METHODS & RESULTS In nine healthy subjects (5M; age: 25±5y), the threshold-analysis was calculated twice: using MSNA and SVR. Both methods yield comparable results in men (T50(burst-vs.-svr): CV=8.8%, r>0.9; Slope(burst-svr): CV=30.1%; r>0.9), but not in women. CONCLUSIONS SVR-based threshold-analysis is feasible in healthy young subjects and provides a promising alternative to the traditional MSNA-based approach.