Abidan Abulimiti

This study shows that the oxygen cost of breathing is higher in patients with heart failure with preserved ejection fraction and obesity compared with healthy older adults without obesity but is not different from that of healthy older adults with obesity. A higher oxygen cost of breathing is further associated with a greater magnitude of obesity, more pronounced exertional dyspnea, and reduced exercise tolerance.

Some patients with heart failure with preserved ejection fraction (HFpEF) have demonstrated evidence of exercise‐induced arterial hypoxaemia (EIAH). However, EIAH was not quantified using , , and measurements as previously conducted in healthy adults nor was EIAH quantified alongside simultaneous measurements of pulmonary vascular pressures, cardiorespiratory responses, or dyspnoea on exertion (DOE) in these patients. Given the effects of hypoxaemia on pulmonary vasoconstriction, cardiorespiratory responses, and DOE, we tested the hypothesis that patients with HFpEF and EIAH (EIAH ⁺ ) would demonstrate higher pulmonary vascular pressures, worse oxygen uptake, and greater DOE compared with patients without EIAH (EIAH ⁻ ). Sixty patients with HFpEF underwent invasive (pulmonary and radial artery catheters) constant‐load (20 W) and maximal incremental cycle testing. Pulmonary vascular measures (pulmonary artery catheter), arterial blood (radial artery catheter) and expired gases, and ratings of breathlessness (RPB, Borg 0–10) were assessed. EIAH was characterized by one or more of the following criteria: (1) < 93% during exercise, (2) ≥ 25 mmHg from rest to exercise or (3) ≥ 10 mmHg from rest to exercise. About 25 patients had EIAH (EIAH ⁺ ) and 35 did not have EIAH (EIAH ⁻ ). mPAP, PCWP, and pulmonary vascular resistance were similar between groups at rest, 20 W, and peak exercise. Although all cardiorespiratory responses were similar between groups at rest, 20 W, and peak exercise, RPB was greater in EIAH ⁺ throughout rest and peak exercise. Our findings suggest that EIAH has no effect on central haemodynamics and is likely to be a consequence of pulmonary gas exchange abnormalities including ventilation‐perfusion mismatch. image Key points: Patients with HFpEF present with a high incidence (42%) of exercise‐induced arterial hypoxaemia, which is likely to be a consequence of hypoventilation and ventilation‐perfusion mismatching of the lung during exercise. Despite significant impairment in gas exchange and reductions in arterial oxygen, patients with exercise‐induced arterial hypoxaemia did not have an augmented haemodynamic response to exercise but consistently reported increased feelings of breathlessness.

Nutritional Status in Patients Undergoing Phase II Cardiac Rehabilitation by Mini Nutritional Assessment

Malnutrition frequently coexists with heart failure (HF), leading to series of negative consequences. Cheyne–Stokes respiration (CSR) is predominantly detected in patients with HF. However, the effect of CSR and malnutrition on the long-term prognosis of patients with acute decompensated HF (ADHF) remains unclear. We enrolled 162 patients with ADHF (median age, 62 years; 78.4% men). The presence of CSR was assessed using polysomnography and the controlling nutritional status score was assessed to evaluate the nutritional status. Patients were divided into four groups based on CSR and malnutrition. The primary outcome was all-cause mortality. In total, 44% of patients had CSR and 67% of patients had malnutrition. The all-cause mortality rate was 26 (16%) during the 35.9 months median follow-up period. CSR with malnutrition was associated with lower survival rates (log-rank p < 0.001). Age, hemoglobin, albumin, lymphocyte count, total cholesterol, triglyceride, low-density lipoprotein cholesterol, creatinine, estimated glomerular filtration rate, B-type natriuretic peptide, administration of loop diuretics, apnea-hypopnea index and central apnea-hypopnea index were significantly different among all groups (p < 0.05). CSR with malnutrition was independently associated with all-cause mortality. In conclusion, CSR with malnutrition is associated with a high risk of all-cause mortality in patients with ADHF.

Background: Peak oxygen uptake (peak VO₂) and heart rate reserve (HRR) are independent prognostic markers of cardiovascular disease. However, the impact of peak VO₂ and HRR on long‐term prognosis after off‐pump coronary artery bypass grafting (OP‐CABG) remains unclear.Hypothesis: To determine the prognostic impact of peak VO₂ and HRR in patients after OP‐CABG.Results: We enrolled 327 patients (mean age, 65.1 ± 9.3 years; male, 80%) who underwent OP‐CABG and participated in early phase II cardiac rehabilitation. All participants underwent cardiopulmonary exercise testing (CPET) at the beginning of such rehabilitation. Overall, 48 (14.6%) patients died during the median follow‐up period of 103 months. The non‐survivor had significantly lower levels of peak VO₂ (10.6 ± 0.5 vs. 13.7 ± 0.2 ml/kg/min, p < .01) and HRR (24.2 ± 1.8 vs. 32.7 ± 0.8 beats/min, p < .01) than the survivor. In both groups, peak VO₂ significantly correlated with HRR (p < .01). Moreover, patients were divided into four groups according to the peak VO₂ and HRR levels for predicting total mortality. The low‐peak VO₂/low‐HRR group had a significantly higher mortality risk than the other groups (hazards ratio, 5.61; 95% confidence interval, 2.59–12.16; p < .01). After adjusted the confounding factors, peak VO₂ and HRR were independently associated with total mortality (both p < .05).Conclusions: HRR is a simple parameter of CPET and an important prognostic marker for the risk stratification of total mortality even in patients with low‐peak VO₂ after OP‐CABG.

Cardiac rehabilitation refers to a long-term, multifaceted, comprehensive program designed to optimize a patient’s physical, psychological, social, and vocational status. Early mobilization and rehabilitation in intensive care units have become an established position in the Japanese medical insurance system since “early rehabilitation addition (5,000 yen/patient/day, 14-day upper limit)” was newly established in the revision of medical treatment fees in FY2018. The number of older patients with heart failure continues to increase in Japan. For older patients, in addition to increasing the walking distance and confirming the safety of expanding the range of life during hospitalization, it is important to have a rehabilitation program to improve daily life functions such as being able to stand up safely and maintain good balance and stability. Although older patients with heart failure who need to improve their ability to perform activities of daily living need continuous rehabilitation after discharge from acute care hospitals, cardiac rehabilitation in rehabilitation hospitals is rarely performed due to various medical insurance systemic restrictions. In addition, only 7% of patients underwent in-patient and outpatient cardiac rehabilitation. Therefore, there are growing expectations for tele-rehabilitation using digital information and communication technology.