Karin Vonbank

Dose-dependent effects of omega-3-polyunsaturated fatty acids on systolic left ventricular function, endothelial function, and markers of inflammation in chronic heart failure of nonischemic origin: A double-blind, placebo-controlled, 3-arm study

BACKGROUND Supplementation with 1 g/d omega-3-polyunsaturated fatty acids (n3-PUFAs) demonstrated a small survival advantage in patients with chronic heart failure (CHF) in the GISSI-HF trial. However, a dose-efficacy relationship was postulated for the beneficial effects of n3-PUFA before. Therefore, we evaluated dose-dependent effects of n3-PUFA in patients with severe CHF. METHODS In a double-blind, randomized, controlled pilot trial, 43 patients with severe, nonischemic heart failure received 1 g/d n3-PUFA (n = 14), 4 g/d n3-PUFA (n = 13), or placebo (n = 16) for 3 months. Changes in left ventricular ejection fraction (LVEF), flow-mediated vasodilation, plasma high-sensitive interleukin 6 and high-sensitive tumor necrosis factor α, and exercise peak oxygen consumption were assessed. RESULTS Left ventricular ejection fraction increased in a dose-dependent manner (P = .01 for linear trend) in the 4 (baseline vs 3 months [mean ± SD]: 24% ± 7% vs 29% ± 8%, P = .005) and 1 g/d treatment groups (24% ± 8% vs 27% ± 8%, P = .02). Flow-mediated vasodilation increased significantly with high-dose 4 g/d n3-PUFA (8.4% ± 4.8% vs 11.6% ± 7.0%, P = .01) but only trendwise with low-dose 1 g/d (8.3% ± 5.3% vs 10.2% ± 4.3%, P = .07). Interleukin 6 significantly decreased with 4 g/d n3-PUFA (3.0 ± 2.9 pg/mL vs 0.7 ± 0.8 pg/mL, P = .03) but only trendwise with 1 g/d (4.5 ± 6.6 pg/mL to 1.6 ± 2.1 pg/mL, P = .1). High-sensitive tumor necrosis factor α decreased trendwise with 4 g/d n3-PUFA but remained unchanged with 1 g/d. In patients with maximal exercise effort, only 4 g/d increased the peak oxygen consumption. No changes in any investigated parameters were noted with placebo. CONCLUSION Treatment with n3-PUFA for 3 months exerts a dose-dependent increase of LVEF in patients with CHF. In parallel, a significant improvement of endothelial function and decrease of interleukin 6 is found with high-dose n3-PUFA intervention.

Right Ventricular Load at Exercise Is a Cause of Persistent Exercise Limitation in Patients With Normal Resting Pulmonary Vascular Resistance After Pulmonary Endarterectomy

BACKGROUND Pulmonary endarterectomy (PEA) provides a potential cure for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, successfully operated patients can continue to suffer from a limitation of exercise capacity, despite normalization of pulmonary vascular resistance (PVR). The purpose of the present study was to explore the cardiopulmonary exercise test (CPET) profile and the pulmonary hemodynamic response to exercise in these patients. METHODS Thirteen successfully operated patients with CTEPH and persistent dyspnea and control subjects underwent a CPET and a right-sided heart catheterization at rest and during exercise. RESULTS The CPET profile of the patients was characterized by mild hyperventilation and decreased peak oxygen uptake (VO2). While there were no differences in resting hemodynamics between patients and control subjects, PVR was higher in the patients after 10 min of exercise (111 ± 46 dynes/s/cm(5) vs 71 ± 42 dynes/s/cm(5), P = .04), and pulmonary arterial compliance (Ca) was lower (5.5 ± 2.3 mL/mm Hg vs 8.1 ± 3.5 mL/mm Hg, P = .048). Ca under exercise correlated with peak VO2 in the patients (R(2) = 0.825, P = .022). CONCLUSIONS After successful PEA, patients with persistent exertional dyspnea display an abnormal pulmonary hemodynamic response to exercise, characterized by increased PVR and decreased Ca. Decreased Ca under exercise is a strong predictor of limited exercise capacity in these patients.

Strength training increases maximum working capacity in patients with COPD--randomized clinical trial comparing three training modalities.

BACKGROUND AND OBJECTIVE Skeletal muscle dysfunction contributes to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). Strength training increases muscle strength and muscle mass, but there is an ongoing debate on the additional effect concerning the exercise capacity. The purpose of this study was to compare the effects of three different exercise modalities in patients with COPD including endurance training (ET), progressive strength training (ST) and the combination of strength training and endurance training (CT). DESIGN A prospective randomized trial. METHODS Thirty-six patients with COPD were randomly allocated either to ET, ST, or CT. Muscle strength, cardiopulmonary exercise testing, lung function testing and quality of life were assessed before and after a 12-week training period. RESULTS Exercise capacity (Wmax) increased significantly in all three training groups with increase of peak oxygen uptake (VO2peak) in all three groups, reaching statistical significance in the ET group and the CT group. Muscle strength (leg press, bench press, bench pull) improved in all three training groups, with a higher improvement in the ST (+39.3%, +20.9%, +20.3%) and the CT group (+43.3%, +18.1%, +21.6%) compared to the ET group (+20.4%, +6.4%, +12.1%). CONCLUSIONS Progressive strength training alone increases not only muscle strength and quality of life, but also exercise capacity in patients with COPD, which may have implications in prescription of training modality. CLINICALTRIALS.GOV IDENTIFIER: NCT01091623.

Abnormal pulmonary arterial pressure limits exercise capacity in patients with COPD

ZusammenfassungZIELE: Das Vorliegen einer pulmonalen Hypertension ist häufig bei Patienten mit chronisch obstruktiver Lungenerkrankung (COPD) anzutreffen. Der mittlere pulmonalarterielle Druck (mPAP) ist in Ruhe oft nur gering erhöht, zeigt aber einen pathologischen Anstieg unter Belastung. Das Ziel dieser Studie ist es, die Leistungsfähigkeit und den pulmonalen Gasaustausch bei COPD Patienten mit und ohne pulmonalarterieller Hypertension zu untersuchen. PATIENTEN UND METHODEN: Bei 42 Patienten mit COPD Grad II-IV (28 Männer, 14 Frauen) wurden eine Bodyplethysmographie, eine symptomlimitierte Fahrradergospirometrie sowie eine Rechtsherzkatheteruntersuchung durchgeführt. RESULTATE: 32 von 42 Patienten (76%) zeigten einen erhöhten mPAP in Ruhe (PH mPAP = 26,8 ± 5,9 mmHg), bei 10 Patienten war der mPAP in Ruhe im Normbereich (NPH, mPAP = 16,8 ± 2 mmHg). Es gab keinen signifikanten Unterschied hinsichtlich der lungenfunktionellen Parameter in beiden Gruppen. Die maximale Sauerstoffaufnahme (VO2max) war signifikant niedriger in der PH Gruppe (785 ± 244 ml/min) im Vergleich zur NPH Gruppe (1052 ± 207 ml/min, p = 0,004). Es zeigte sich in der PH Gruppe eine erhöhte Totraumventilation mit signifikant erhöhtem Atemäquivalent für CO2 (VECO2 47,3 ± 10 vs 38,6 ± 3,5, p = 0,025) und signifikant höherem arterio-endtidalen CO2 Partialdruck [p(a-ET)CO2]. Der pulmonalarterielle Widerstand (PVR) in Ruhe zeigte eine negative Korrelation hinsichtlich der VO2max, VE/VCO2 und dem arterio-endtidalen CO2 Partialdruck [p(a-ET)CO2]. ZUSAMMENFASSUNG: Patienten mit COPD und erhöhter pulmonalarterieller Druckwerte in Ruhe zeigen eine Verschlechterung des pulmonalen Gasaustausches unter Belastung, eine Beeinträchtigung der maximalen Sauerstoffaufnahme und somit eine limitierte Leistungsfähigkeit.SummaryOBJECTIVE: Pulmonary hypertension (PH) is common in patients with chronic obstructive pulmonary disease (COPD). Mean pulmonary artery pressure (mPAP) is often only slightly elevated at rest but is increased by exercise. The purpose of this study was to determine whether abnormal pulmonary artery pressure impairs exercise capacity in patients with COPD. PATIENTS AND METHODS: 42 patients with moderate-to-very-severe COPD (28 men, 14 women) underwent symptom-limited incremental cardiopulmonary exercise testing and also right-heart catheterization at rest. Abnormal pulmonary artery pressure was defined as mPAP > 20 mmHg at rest. RESULTS: Resting mPAP was elevated in 32 patients (PH, mPAP = 26.8 ± 5.9 mmHg) and normal in 10 non-hypertensive (NPH) patients (NPH, mPAP = 16.8 ± 2 mmHg). There were no significant differences in lung function between the PH and NPH groups. Maximum oxygen uptake during exercise (VO2max) was significantly lower in PH (785 ± 244 ml/min) than in NPH (1052 ± 207 ml/min, P = 0.004). Dead-space ventilation (Vd/Vt) was greater in PH (P = 0.05) with higher VE/VCO2 (ratio of minute ventilation to carbon dioxide output = 47.3 ± 10 vs 38.6 ± 3.5, P = 0.025) and significantly higher arterial-end-tidal pCO2 difference [p(a-ET)CO2]. Pulmonary vascular resistance measured at rest correlated significantly with VO2max, VE/VCO2 and p(a-ET)CO2. CONCLUSIONS: In patients with COPD, abnormal pulmonary artery pressure impairs gas exchange, decreases maximum oxygen uptake during exercise and impairs exercise capacity.

Sirolimus in renal transplant recipients with tuberous sclerosis complex: clinical effectiveness and implications for innate immunity

Tuberous sclerosis complex (TSC) is caused by constitutively activated mammalian target of rapamycin (mTOR) resulting in nonmalignant tumours of several organs and consequently renal failure. Recent reports suggest a possible beneficial role of the mTOR‐inhibitor (mTOR‐I) sirolimus for TSC; however, safety and efficiency of sirolimus in TSC patients after renal transplantation, both as primary immunosuppressant as well as anti‐proliferative agent, are still undefined. Moreover, it is currently unknown whether the TSC mutation affects the primary immune response in these patients. In this article, we report on three TSC patients after renal transplantation who have been converted from a calcineurin‐inhibitor (CNI)‐based immunosuppression to sirolimus. During 2 years of follow‐up, renal allograft function was stable or even improved, and no significant sirolimus‐associated side‐effects were noted. Beneficial effects of sirolimus against TSC were detected in the skin, along with improved spirometric measurements and an arrest of astrocytoma progression. We show that the inflammatory immune response was significantly altered in TSC patients as compared with controls and sirolimus potently affected both inflammatory cytokine production and vascular endothelial growth factor levels in these patients. Larger studies are warranted to further examine the relationship between clinical parameters and the molecular response to mTOR‐inhibition in TSC patients after renal transplantation.

Vasoactive intestinal peptide (VIP) receptor expression in monocyte-derived macrophages from COPD patients.

Vasoactive intestinal peptide (VIP) is one of the most abundant molecules found in the respiratory tract. Due to its anti-inflammatory and bronchodilatatory properties, it has been proposed as a novel treatment for chronic obstructive pulmonary disease (COPD). The actions of VIP are mediated via three different G-protein-coupled receptors (VPAC1, VPAC2 and PAC1) which are expressed in the respiratory tract and on immunocompetent cells including macrophages. Alveolar macrophages (AM) are key players in the pathogenesis of COPD and contribute to the severity and progression of the disease. While VPAC1 has been reported to be elevated in subepithelial cells in smokers with chronic bronchitis, little is known about VPAC expression of AM in COPD patients. AM from COPD patients show a strong VPAC1 expression which exceeds VPAC2. A similar receptor expression pattern was also observed in lipopolysaccharide (LPS)-activated monocyte-derived macrophages (MDM) from healthy volunteers and COPD patients. VIP has been shown to down-regulate interleukin 8 (IL-8) secretion significantly in MDM after LPS stimulation. The response to VIP was similar in MDM from COPD patients and healthy volunteers. Our results indicate that VPAC1 up-regulation in macrophages is a common mechanism in response to acute and chronic pro-inflammatory stimuli. Although VPAC1 up-regulation is dominant, both receptor subtypes are necessary for optimal anti-inflammatory signaling. The high VPAC1 expression in AM may reflect the chronic pro-inflammatory environment found in the lung of COPD patients. Treatment with VIP may help to decrease the chronic inflammation in the lung of COPD patients.

Needle image plates compared to conventional CR in chest radiography: is dose reduction possible?

PURPOSE To compare image quality of standard-dose computed radiography and dose reduced needle-technology CR for supine CXR in a clinical setting. MATERIALS AND METHODS We prospectively evaluated 128 radiographs of 32 immunocompromised patients. For each patient four clinical CXR were performed within one week, two with powder image plates (PIP; Fuji ST-V) and two with needle image plates (NIP; Agfa DXS) at standard and half dose, respectively. One experienced radiologist and two residents blinded to dose level and kind of imaging system rated different anatomical structures, image noise, tubes/lines and abnormalities on a image quality scale from 1 to 10 (1=poor, 10=excellent). The rating scores were tested for statistical differences using analysis of variance with repeated measures. RESULTS A statistical difference (p<0.05) was found for the two systems as well as for the two dose levels. Overall rating scores were 6.5 for PIP with full dose, 6.2 for PIP with half dose, 7.6 for NIP with full dose and 7.4 for NIP with half dose. There was a significant difference in favour of the NIP system at the same dose level. Also the NIP images obtained at half dose were ranked significantly better compared to the PIP images at standard dose. The differences in ranking of anatomical structures and abnormalities were more pronounced in low absorption areas (pulmonary vessels, parenchyma) than in high absorption areas (mediastinum, spine). CONCLUSION For supine chest radiograms the NIP technology allows for a dose reduction of 50% while providing higher image quality.

Richtlinien für die ambulante pneumologische Rehabilitation in Österreich

ZusammenfassungDie pneumologische Rehabilitation ist ein wesentlicher Bestandteil der Therapie bei Patienten mit chronischen Lungenerkrankungen. Sie führt zu einer Verbesserung der Leistungsfähigkeit und der Lebensqualität, sowie zu einer Abnahme der Anzahl und Dauer der Spitalsaufenthalte bei Patienten mit COPD und Reduktion der Gesundheitskosten.Diese Überarbeitung der Richtlinien der ambulanten pneumologischen Rehabilitation bezieht sich im Wesentlichen auf das 2013 erschienene Statement der American Thoracic Society und der European Respiratory Society.Die Richtlinien präsentieren Qualitätsnormen zur räumlichen und apparativen Infrastruktur, zu Ausbildungserfordernissen des Personals von Zentren und konkrete Richtlinien zur Durchführung einer umfassenden ambulanten pneumologischen Rehabilitation in Österreich.SummaryPulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.Pulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.

Guidelines for outpatient pulmonary rehabilitation in Austria

ZusammenfassungDie pneumologische Rehabilitation ist ein wesentlicher Bestandteil der Therapie bei Patienten mit chronischen Lungenerkrankungen. Sie führt zu einer Verbesserung der Leistungsfähigkeit und der Lebensqualität, sowie zu einer Abnahme der Anzahl und Dauer der Spitalsaufenthalte bei Patienten mit COPD und Reduktion der Gesundheitskosten.Diese Überarbeitung der Richtlinien der ambulanten pneumologischen Rehabilitation bezieht sich im Wesentlichen auf das 2013 erschienene Statement der American Thoracic Society und der European Respiratory Society.Die Richtlinien präsentieren Qualitätsnormen zur räumlichen und apparativen Infrastruktur, zu Ausbildungserfordernissen des Personals von Zentren und konkrete Richtlinien zur Durchführung einer umfassenden ambulanten pneumologischen Rehabilitation in Österreich.SummaryPulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.Pulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.

Richtlinien für die ambulante pneumologische Rehabilitation in Österreich@@@Guidelines for outpatient pulmonary rehabilitation in Austria

ZusammenfassungDie pneumologische Rehabilitation ist ein wesentlicher Bestandteil der Therapie bei Patienten mit chronischen Lungenerkrankungen. Sie führt zu einer Verbesserung der Leistungsfähigkeit und der Lebensqualität, sowie zu einer Abnahme der Anzahl und Dauer der Spitalsaufenthalte bei Patienten mit COPD und Reduktion der Gesundheitskosten.Diese Überarbeitung der Richtlinien der ambulanten pneumologischen Rehabilitation bezieht sich im Wesentlichen auf das 2013 erschienene Statement der American Thoracic Society und der European Respiratory Society.Die Richtlinien präsentieren Qualitätsnormen zur räumlichen und apparativen Infrastruktur, zu Ausbildungserfordernissen des Personals von Zentren und konkrete Richtlinien zur Durchführung einer umfassenden ambulanten pneumologischen Rehabilitation in Österreich.SummaryPulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.Pulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.