Knowledge of right ventricular (RV) structure and function has historically lagged behind that of the left ventricle (LV). However, advancements in invasive and non-invasive evaluations, combined ...with epidemiological analyses, have advanced the current understanding of RV (patho)physiology across the spectrum of health and disease, and reinforce the centrality of the RV in contributing to clinical outcomes. In the healthy heart, ventricular-arterial coupling is preserved during rest and in response to increased myocardial demand (eg, exercise) due to substantial RV contractile reserve. However, prolonged exposure to increased myocardial demand, such as endurance exercise, may precipitate RV dysfunction, suggesting that unlike the LV, the RV is unable to sustain high levels of contractility for extended periods of time. Emerging data increasingly indicate that both LV and RV function contribute to clinical heart failure. Reductions in quality-of-life, functional capacity and overall clinical outcomes are worsened among patients with heart failure when there is evidence of RV dysfunction. In addition, the RV is adversely impacted by pulmonary vascular disease, and among affected patients, overall RV function differs based on mechanisms of the underlying pulmonary hypertension, which may result from variations in sarcomere function within RV cardiomyocytes.
The post-acute sequalae of SARS-CoV-2, also known as “Long COVID,” is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and ...tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected. This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients. Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.
•Quantitative data regarding the impact of exercise hemodynamics on functional capacity in patients with heart failure with reduced ejection fraction (HFrEF) are lacking.•Patients with HFrEF ...experience marked increases in right- and left-sided filling pressures as well as pulmonary arterial pressures during exercise, in addition to abnormal ventilatory parameters of exercise.
Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF), but quantitative data regarding exertional hemodynamics are lacking.
We sought to characterize exertional cardiopulmonary hemodynamics in patients with HFrEF.
We studied 35 patients with HFrEF (59 ± 12 years old, 30 males) who completed invasive cardiopulmonary exercise testing. Data were collected at rest, at submaximal exercise and at peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO2) were identified.
Left ventricular ejection fraction and cardiac index were 23% ± 8% and 2.9 ± 1.1 L/min/m2, respectively. Peak VO2 was 11.8 ± 3.3 mL/kg/min, and the ventilatory efficiency slope was 53 ± 13. Right atrial pressure increased from rest to peak exercise (4 ± 5 vs 7 ± 6 mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27 ± 13 vs 38 ± 14 mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined.
Patients with HFrEF suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population.
clinicaltrials.gov identifier: NCT03078972
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Mechanisms causing the post-acute sequelae of SARS-CoV-2 (long COVID) remain elusive, but the clinical phenotype is consistent with cardiac deconditioning. We report a case series of patients with ...long COVID whose symptoms improved/resolved with exercise and present exercise training as a novel therapeutic strategy for management of long COVID syndrome. (
).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives
To determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine ...cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria.
Patient and methods
The DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound RBUS and/ or CT urogram CTU). Patients, where urine cytology were performed, were sub‐analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells.
Results
Of the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3–33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed according to grade and stage were as follows: 4 (19%) were ≥ pT2, 2 (9.5%) were G3 pT1, 10 (47.6%) were G3/2 pTa and 5 (23.8%) were G1 pTa. High‐risk cancer was confirmed in 8 (38%) patients. There was a marginal improvement in sensitivity (57.7%) for high‐risk cancers. When urine cytology was combined with imaging, the diagnostic performance improved with CTU (sensitivity 90.2%, specificity 94.9%) superior to RBUS (sensitivity 66.7%, specificity 96.7%). False positive cytology results were confirmed in 22 patients, of which 12 (54.5%) had further invasive tests and 5 (22.7%) had a repeat cytology. No cancer was identified in these patients during follow‐up.
Conclusions
Urine cytology will miss a significant number of muscle‐invasive bladder cancer and high‐risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
We present a conceptual model for initiation of blooms of the estuarine brown-tide pelagophyte
Aureococcus anophagefferens. The model is based on the observation that in addition to its ...well-documented stimulation by organic nutrients,
Aureococcus is pre-adapted to low light levels. Its relatively low maximum (light-saturated) growth rate makes it a poor competitor with other estuarine species at high light under acclimated conditions. Its large photosynthetic antenna and relatively low quota of photoprotective pigments make it more susceptible to photoinhibition than other species to which it is compared. These same characteristics give it a competitive advantage at low light levels. In its shallow habitat, both the light level and the rate of nutrient supply from groundwater and benthic porewater are determined by the degree of benthic coupling. Experimental manipulations in a microcosm and a survey of the literature demonstrate the ability of the sediment-associated microphytobenthos (MPB) to regulate both the light- and nutrient-environment in the overlying water column. The model predicts that the growth dynamics of the MPB are such that the benthic/water column interactions tend towards one of two stable states. In one, a well-developed population of MPB restricts resuspension of particulate material and efflux of dissolved nutrients, resulting in clear and nutrient-poor overlying waters. This condition does not favor growth of
Aureococcus. In the alternative state, erosion of the MPB results in turbid, nutrient-rich waters that do favor bloom initiation. Alternation between the states is caused by external physical forcing, through wind-driven mixing of the water column. Field data from Quantuck Bay, New York (USA), failed to document the transition from non-bloom to bloom conditions. Even so, they are consistent with the model’s predictions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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