Dariusz Jastrzębski

Cardiovascular Effects of the Valsalva Maneuver During Static Arm Exercise in Elite Power Lifting Athletes

The objective of the study was to investigate whether a blood pressure increase during static exercises might affect the left ventricular function and whether a possible pressure overload might decrease cardio-respiratory adaptation to aerobic exercise in power lifting athletes. Nine resistance-trained athletes and ten age-matched untrained men participated in high intensity isometric exercise performed during the Valsalva maneuver and in an incremental arm cranking test. All subjects underwent echocardiographic evaluation. The combine effect of exercise and increased intrathoracic pressure due to the Valsalva maneuver was a significant increase in systolic blood pressure in the athletes compared with controls. Echocardiography demonstrated significant differences in left ventricular mass and left ventricular mass index; both being higher in the athletes than in controls. The intraventricular septum diameter and left ventricular posterior wall thickness were significantly greater and the myocardial performance index was lower in the athletes compared with controls, indicating a better left ventricular function in the athletes. A cumulative effect of mechanical compression of peripheral blood vessels by contracting muscles and intrathoracic pressure increase during the Valsalva maneuver did not compromise myocardial contractility and cardiorespiratory adaptation to incremental arm exercise in power lifting athletes.

Circulating concentration of markers of angiogenic activity in patients with sarcoidosis and idiopathic pulmonary fibrosis

BackgroundAngiogenesis is an important process involved in the pathogenesis of diffuse parenchymal lung diseases. The aim of the study was to compare the angiogenic profile of patients with sarcoidosis and idiopathic pulmonary fibrosis (IPF) based on analysis of circulating factors.MethodsSerum concentrations of angiopoietin-2 (Ang-2), follistatin, granulocyte-macrophage-colony stimulating factor (GM-CSF), interleukin-8 (IL-8), platelet derived growth factor-BB (PDGF-BB), platelet endothelial cellular adhesion molecule-1 (PECAM-1) and vascular endothelial growth factors (VEGF) were measured in the patients and the healthy subjects.ResultsSerum concentrations of G-CSF, follistatin, PECAM-1 and IL-8 were significantly higher in the IPF patients in comparison with the control group and the sarcoid patients. PDGF-BB concentrations were also significantly higher in serum of IPF patients than in sarcoid patients, but not than in the controls. In contrast, Ang-2 and VEGF concentrations did not differ significantly between the three groups. In the sarcoid patients, irrespective of the disease activity or the radiological stage, serum concentrations of these cytokines were similar to the control group.ConclusionsThese results indicate that differences may exist in angiogenic activity between patients with parenchymal lung diseases. In contrast to sarcoidosis, IPF is characterized by a higher serum concentration of different molecules involved in the angiogenic processes .

Fatigue in patients with inactive sarcoidosis does not correlate with lung ventilation ability or walking distance. Pilot Study

INTRODUCTION Fatigue is one of many symptoms reported by patients with sarcoidosis. It is believed that fatigue may be the cause of exercise intolerance and reduced quality of life in patients with sarcoidosis. The purpose of the work was to present the frequency of fatigue prevalence in patients with sarcoidosis and to investigate the correlation between fatigue and the results of pulmonary function tests and walking distance. MATERIAL AND METHODS A total of 74 patients with sarcoidosis in a stable phase of the disease, not treated in the past with glucocorticoids or immunosuppressive drugs, and without indications for treatment at the time of the study were examined. In all patients fatigue evaluation was carried out with the use of the Fatigue Assessment Scale questionnaire (FAS); dyspnoea was assessed with the use of the Medical Research Council scale (MRC). Body Mass Index (BMI), spirometry, and a 6-minute walk test were additionally performed. The control group included 30 healthy volunteers who completed the FAS. RESULTS In the examined group of patients fatigue was diagnosed in 36 patients (50%), and in 5 (6.94%) - strong fatigue was observed. The remaining 31 (43.06%) patients felt no fatigue. The average value of points obtained by FAS questionnaire in sarcoidosis patients was significantly higher than the respective value in the control group (p = 0.02). A significantly higher number of points by FAS questionnaire was observed in female patients with sarcoidosis (p = 0.04) in comparison to men. No significant statistical correlation between fatigue index FAS and BMI (r = 0.22, p = 0.11), FEV1 (r = -0.11, p = 0.3), FEV1% pred. (r = 0.01, p = 0.9), FVC (r = -0.03, p = 0.77), FEF25-75 (r = -0.23, p = 0.1) and the distance in the six-minute walk test (6MWT) (r = -0.01, p = 0.9) was observed. However, there was a weak negative correlation between the age of the patients and the FAS index (r = -0.29, p = 0.01). CONCLUSIONS Fatigue in patients with sarcoidosis does not correlate with the results of lung function tests or with walking distance in 6MWT.

Polish Respiratory Society guidelines for the methodology and interpretation of the 6 minute walk test (6MWT).

283 Assoc. Prof. Tadeusz Przybyłowski, MD, PhD Prof. Waldemar Tomalak, MD, PhD Prof. Zenon Siergiejko, MD, PhD Prof. Dariusz Jastrzębski, MD, PhD Dr Marta Maskey-Warzęchowska, MD, PhD Assoc. Prof. Tomasz Piorunek, MD, PhD Dr Emil Wojda, MD, PhD Assoc. Prof. Piotr Boros, MD, PhD Department of Internal Medicine, Pneumonology and Allergology, Medical University of Warsaw, Poland Department of Physiopathology of the Respiratory System, Rabka-Zdrój Branch of the Institute of Tuberculosis and Lung Diseases, Poland Laboratory of Respiratory Diagnostics and Bronchoscopy, Medical University of Białystok, Poland Department of Lung Diseases and Tuberculosis, Medical University of Silesia, Poland Department of Pulmonology Allergology and Pulmonary Oncology, Poznań University of Medical Sciences, Poland Department of Lung Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland Department of Physiopathology of the Respiratory System, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland Reviewers: Prof. Ryszarda Chazan, MD, PhD Prof. Władysław Pierzchała, MD, PhD Prof. Wacław Droszcz, MD, PhD Prof. Adam Antczak, MD, PhD

Left ventricular dysfunction in patients with interstitial lung diseases

To the Editors: The paper by Papadopoulos et al. 1 describes the failure of systolic left ventricular (LV) function in patients with idiopathic lung fibrosis (IPF). Not much is known about LV systolic and diastolic function failure in IPF patients or its influence on rates of survival. In 1998, Vizza et al. 2 examined a large group of patients with advanced lung diseases and estimated that 6% of them had LV failure, in particular patients with primary pulmonary hypertension and Eisenmengers syndrome. However, in a patient group with interstitial lung diseases (ILD) the proportion was lower and reached 3.6%. In 2007, we studied LV systolic function in 18 patients with lung fibrosis and heavy respiratory insufficiency 3. The patients fulfilled the American Thoracic Society (ATS)/European Respiratory …

A functional assessment of patients two years after lung transplantation in Poland.

The aim of the study The aim of the study was to assess the long-term results of lung transplantation (LT) in Poland two years after the procedure. Material and methods The study included patients who underwent LT between December 2004 and December 2009 in the Silesian Center for Heart Diseases in Zabrze. Various lung functions (forced vital capacity – FVC; forced expiratory volume in 1 second – FEV1), the quality of life (SF-36 questionnaire), the level of perceived dyspnea (Medical Research Council – MRC; basic dyspnea index – BDI), and the patients mobility (the 6-minute walking test – 6MWT) were assessed before and approximately 24 months after LT. Among 35 patients who underwent LT, 20 patients were referred to our study (mean age: 46.6 ± 9.03 years). Results After LT, a statistically significant increase was observed in the distance achieved in the 6MWT (323.8 vs. 505.8 m), FVC (1.64 vs. 2.88 L), and FEV1 (1.37 vs. 2.09 L). An improvement in perceived dyspnea in MRC and BDI questionnaires was observed in patients with chronic obstructive pulmonary disease (COPD) after LT. The assessment of the quality of life, excluding perceived pain, showed the most significant improvement in the physical cumulative score (PCS; 25 vs. 45 points), especially in patients with idiopathic pulmonary fibrosis. Conclusions Lung transplantation in Poland, in patients who live longer than 2 years after the procedure, significantly improves the mobility, lung function, perceived dyspnea, and the quality of life.

Endurance Training and the Risk of Bronchial Asthma in Female Cross-Country Skiers

Exercise is one of the crucial factors responsible for asthma development and exacerbation. The purpose of the present study was to assess the risk of bronchial asthma in female athletes. Spirometric evaluations and physical exercise test were performed and exhaled nitric oxide (eNO) levels were measured in 12 female elite cross-country skiers. Serum concentrations of interleukin 1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin 6 (IL-6) were measured in all subjects before exercise, immediately after it, and after 15 min of recovery. Peak eNO values were 18.7±4.8 (ppb) and did not confirm the risk of early bronchial asthma symptoms. A graded exercise test caused significant increases in TNF-α and IL-1β concentration (p<0.05) after 15 min of recovery. A significant negative correlation was found between resting and post-exercise eNO and IL-6 levels (p<0.01). Our study did not confirm an increased risk of bronchial asthma or respiratory tract inflammatory conditions among female cross-country skiers exposed to physical exertion.