Asmaa Mansour

Acute responses to intermittent and continuous exercise in heart failure patients.

BACKGROUND The purpose of this study was to compare cardiopulmonary responses, exercise adherence, tolerance, and safety of optimized high-intensity interval exercise (HIIE) compared with moderate-intensity continuous exercise (MICE) in patients with heart failure and reduced ejection fraction (HFREF). METHODS Twenty patients with HFREF (aged 61 ± 9.9 years) were randomly assigned to HIIE corresponding to 2 × 8 minutes of 30-second intervals at 100% of peak power output and 30-second passive recovery intervals and to a 22-minute MICE corresponding to 60% of peak power output. Gas exchange, electrocardiogram, and blood pressure were measured continuously. Cardiac troponin T (cTnT), C-reactive protein (CRP), and brain natriuretic peptide (BNP) were measured before, 20 minutes after, and 24 hours after HIIE and MICE. RESULTS Cardiopulmonary responses did not differ between MICE and HIIE. Higher exercise adherence and efficiency were observed on HIIE with a similar perceived exertion and time spent above 90% of peak oxygen consumption compared with MICE. Neither HIIE nor MICE caused any significant arrhythmias or increased CRP, BNP, or cTnT. CONCLUSIONS Compared with MICE, HIIE demonstrated a higher exercise adherence and was well tolerated in patients with HFREF, while still providing a high-level physiological stimulus and leaving indices of inflammation (CRP), myocardial dysfunction (BNP), and myocardial necrosis (cTnT) unaffected.

Long-term evolution, secular trends, and risk factors of renal dysfunction following cardiac transplantation.

Recent reports suggest that individuals who underwent heart transplantation in the last decade have improved post‐transplant kidney function. The objectives of this retrospective study were to describe the incidence and to identify fixed and time‐dependent predictors of renal dysfunction in cardiac recipients transplanted over a 25‐year period (1983–2008). To illustrate temporal trends, patients (n = 306) were divided into five groups based on year of transplantation. The primary endpoint was the estimated glomerular filtration rate (eGFR) at year 1. Secondary endpoints were time to moderate (eGFR <60 ml/min/1.73 m2) and severe renal dysfunction (eGFR <30 ml/min/1.73 m2). Risk factor analyses relied on multivariable regression models. Kidney function was mildly impaired before transplant (median eGFR=61.0 ml/min/1.73 m2), improved at discharge (eGFR=72.3 ml/min/1.73 m2; P < 0.001), decreased considerably in the first year (eGFR = 54.7 ml/min/1.73 m2; P < 0.001), and deteriorated less rapidly thereafter. At year 1, 2004–2008 recipients exhibited a higher eGFR compared with all other patients (P < 0.001). Factors independently associated with eGFR at year 1 and with moderate and severe renal dysfunction included age, gender, pretransplant eGFR, blood pressure, glycemia, and use of prednisone (P < 0.05). In summary, kidney function worsens constantly up to two decades after cardiac transplantation, with the greatest decline occurring in the first year. Corticosteroid minimization and treatment of modifiable risk factors (hypertension, diabetes) may minimize renal deterioration.

Pregnancy after heart transplantation: a well-thought-out decision? The Quebec provincial experience - a multi-centre cohort study

Despite reports of successful pregnancies in heart transplant (HTx) recipients, many centers recommend their patients against maternity. We reviewed our provincial experience of pregnancy in HTx recipients by performing charts review of all known gestations following HTx in the province of Quebec (Canada), stratified between planned and unplanned pregnancies. Long‐term survival was compared to HTx recipient women of childbearing age who did not become pregnant. Eighteen pregnancies, 56% unplanned, occurred in eight patients, 10.1 (2.6–27.0) years after HTx. Immunosuppression was CNI‐based, with a mean dose increase of 48.3% (tacrolimus) and 26.5% (cyclosporine), without rejection. Cardiometabolic complications were high compared to the general Canadian population, including preeclampsia (15.4% vs. 5.5%), hypertension (38.5% vs. 4.6%), and diabetes (15.4% vs. 5.6%). Mean gestational age was 35.1 (23.4–39.6) weeks (72.2% live births; 53.8% prematurity). Mean birthweight was 2418 (660–3612) g. Serum creatinine increased during pregnancy, becoming significant after delivery (P = 0.0239), and returning to preconception level in all but three patients within a year. After 4.6 (1.2–17.2) years of follow‐up, two rejection episodes occurred in one patient. Long‐term mortality was similar to overall HTx women (Kaplan–Meier; P = 0.8071). Pregnancy in HTx carries high cardiometabolic complications and decreased kidney function, but is feasible with acceptable outcomes and no impact on mothers survival.

Cardiopulmonary, biomarkers, and vascular responses to acute hypoxia following cardiac transplantation

Previous studies have suggested good adaptation of cardiac transplant (CTx) recipients to exposure to a high altitude. No studies have investigated the cardiopulmonary and biomarker responses to acute hypoxic challenges following CTx. Thirty‐six CTx recipients and 17 age‐matched healthy controls (HC) were recruited. Sixteen (16) patients (42%) had cardiac allograft vasculopathy (CAV). Cardiopulmonary responses to maximal and submaximal exercise at 21% O2, 20‐minutes hypoxia (11.5% O2), and following a 10‐minute exposure to 11.5% O2 using 30% of peak power output were completed. Vascular endothelial growth factor (VEGF), interleukin‐6 (IL‐6), suppression of tumorigenicity 2 (ST2) were measured at baseline and at peak stress. Endothelial peripheral function was assessed using near‐infrared spectroscopy. Compared with HC, CTx presented a lesser O2 desaturation both at rest (−19.4 ± 6.8 [CTx] vs −24.2 ± 6.0% O2 [HC], P < 0.05) and following exercise (−23.2 ± 4.9 [CTx] vs −26.2 ± 4.7% O2 [HC], P < 0.05). CTx patients exhibited a significant decrease in peak oxygen uptake. IL‐6 and VEGF levels were significantly higher in CTx recipients in basal conditions but did not change in response to acute stress. CTx patients exhibit a favorable ventilatory and overall response to hypoxic stress. These data provide further insights on the good adaptability of CTx to exposure to high altitude.

A comparison of the effects of selective and non-selective mineralocorticoid antagonism on glucose homeostasis of heart failure patients with glucose intolerance or type II diabetes: A randomized controlled double-blind trial

&NA; Mineralocorticoid receptor antagonists (MRAs) decrease morbidity and mortality in patients with heart failure (HF). However, spironolactone, a non‐selective MRA, has been shown to exert a harmful effect on glucose homeostasis. The objective of this multicenter, randomized, controlled, double‐blind trial was to compare the effects of spironolactone to those of the selective MRA eplerenone on glucose homeostasis among 62 HF patients with glucose intolerance or type II diabetes. Trial registration number: NCT01586442.

MOLECULAR IMAGING OF THE HUMAN PULMONARY VASCULAR ENDOTHELIUM IN PULMONARY HYPERTENSION: THE PULMOBIND SAFETY AND PROOF OF PRINCIPLE TRIAL

The adrenomedullin receptor is densely expressed in the pulmonary vascular endothelium. PulmoBind, an adrenomedullin receptor ligand, was developed for molecular diagnosis of pulmonary vascular disease. To evaluate the safety of PulmoBind SPECT imaging and its capacity to detect pulmonary vascular