The Time-Up-and-Go (TUG) test is clinical test, used to assess functional mobility in chronic diseases. A modified version, the TUG-10, involving 10 consecutive repetitions of the classic version, has been recently proposed to increase the physiological demand. However, TUG-10 ability to detect exertional desaturation in patients with interstitial lung disease (ILD) has not been investigated. This study aimed to: (i) compare oxygen desaturation during the TUG-10 with 6-minute walk test (6MWT) and cardiopulmonary exercise test (CPET) in patients with ILD; (ii) examine correlations in exertional desaturation among these tests and with lung diffusing capacity (DLCO). Twenty patients with fibrotic-ILD (70.1 ± 7.3years) performed in random order the TUG-10, 6MWT, and CPET (on a cycle ergometer). Correlations between desaturation indices (SpO₂nadir and SpO₂magnitude, ΔSpO₂) across tests and with DLCO were examined. No significant differences were observed in desaturation among TUG-10, 6MWT, and CPET (ΔSpO2: -7.35 ± 3.8
INTRODUCTION:Heart failure with reduced ejection fraction (HFrEF), defined by a left ventricular ejection fraction ≤ 40%, remains a major global health challenge, associated with substantial morbidity, mortality, and impaired quality of life (QoL), particularly in patients with higher NYHA class. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as a cornerstone therapy for HFrEF, significantly reducing hospitalizations and mortality regardless of glycemic status, sex, race, or comorbidities. METHODS:EVOLUTION-HF was an observational, multi-center, longitudinal cohort study involving 257 consecutive patients diagnosed with HFrEF who initiated dapagliflozin in a routine clinical setting in Greece. The primary objectives were to characterize baseline demographic and clinical features of patients newly initiated on dapagliflozin for HFrEF and to evaluate dapagliflozin treatment patterns, including discontinuation timing, reasons for discontinuation, and concomitant heart failure and glucose-lowering therapies over time. The secondary objectives are to describe patient-reported outcomes using the KCCQ-23 and to assess adherence to dapagliflozin among patients with HFrEF. RESULTS:A total of 257 patients were enrolled and the follow-up period lasted for 12 months. Significant improvements among all KCCQ-23 scores were observed from baseline to 12-months post dapagliflozin initiation, revealing that the initiation and optimization of guideline-directed medical therapy in routine clinical practice provides improvement to quality of life over time. CONCLUSIONS:Dapagliflozin was safe and well-tolerated throughout the observation period. Although benefits are observed in most patients, individuals aged > 65 years, with prior myocardial infarction, or recent hospitalizations show a diminished response, underscoring the need for tailored management and closer follow-up in these higher-risk groups.
In COPD patients, acute oxygen supplementation during a functional task significantly improved cerebral oxygenation, and reduced perceived dyspnoea and leg fatigue, suggesting that it may enhance patients' tolerance for daily activities https://bit.ly/3Kn2CZ1.
Severe coronary artery calcification (CAC) remains a major challenge in percutaneous coronary intervention (PCI), driving stent under-expansion and higher rates of restenosis and adverse events. Balloon-based calcium modification remains central to lesion preparation, with the available tools ranging from high-pressure non-compliant balloons and ultra-high-pressure balloons to cutting, scoring, and intravascular lithotripsy (IVL) balloons. While traditional IVL has advanced the field by permitting circumferential fracture of deep calcium through acoustic shockwaves, important drawbacks persist, including problems in deliverability, energy distribution, and questionable efficacy in nodular or eccentric calcium. This review examines all contemporary balloon-based modification strategies and introduces the novel Hertz-contact IVL (HC-IVL), a new technology designed to transmit mechanical energy through direct contact rather than shockwave propagation. Based on Hertzian mechanics, this device may facilitate more focused energy delivery, improved lesion crossing, and enhanced calcium fracture in complex morphologies. A detailed comparison between HC-IVL and standard IVL is provided, along with a proposed algorithm for device selection. Taking into consideration the limitations of current tools, HC-IVL represents a promising mechanistic innovation in balloon-based calcium modification, warranting further validation in randomized, imaging-guided clinical studies.
BACKGROUND:Dyslipidaemia is a key modifiable risk factor for peripheral arterial disease (PAD), and statin therapy for lipid-lowering is well established in its management. Proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors lower lipids and cardiovascular risk; however, their impact on limb-based outcomes in PAD remains uncertain. METHODS:A systematic review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating PCSK9 inhibitor therapy in patients with PAD were eligible for inclusion. RESULTS:Four studies met the inclusion criteria and were included in the review, comprising three randomized controlled trials (RCTs) and 1 prospective case series, with a total of 3,770 patients. The majority of included participants were derived from a large multicenter RCT, FOURIER, which contributed 3,642 patients from its PAD subgroup. In the FOURIER PAD subgroup, Evolocumab significantly reduced major adverse limb events (MALEs) compared with placebo in patients receiving background statin therapy (Hazard Ratio 0.58; 95% Confidence Interval 0.38-0.88). Smaller studies in patients with PAD and chronic limb-threatening ischemia reported improvements in amputation-free survival, wound healing, walking performance, and markers of endothelial function and atherosclerotic burden. CONCLUSION:PCSK9 inhibitors appear to provide limb-related benefits in patients with PAD, without ill-effects. These benefits include decrease in MALEs and improvements in functional and physiological parameters, and may extend beyond lipid lowering alone. However, current evidence is limited, heterogeneous, and exploratory. Dedicated, adequately powered randomized trials focusing on clearly defined limb outcomes are needed to clarify the role of PCSK9 inhibitors in PAD management.
