Systemic sclerosis associated interstitial lung disease (SSc-ILD) is an important source of morbidity and mortality in systemic sclerosis (SSc). Pulmonary function tests (PFTs) are a cornerstone for the diagnosis and follow-up of SSc-ILD, and are important for treatment decision. Aim: To analyze different patterns of evolution of PFTs in SSc. Method: We studied all consecutive SSc patients who performed PFTs in the last year in our department, focusing on those who had prior PFT values available for comparison. We used the ATS/ERS/JRS/ALAT clinical practice guideline PFT cutoffs to define physiological evidence of progressive pulmonary fibrosis (Raghu et al., 2022). Results: Out of 44 SSc patients examined, 24 had previous PFT values (21 females, mean age 59). The follow-up period varied between 3 and 141 months. 13 (56.5%) patients had 5% FVC degradation between any two points during the entire follow-up period, only 7 of them worsening between the last two visits. The mean period between PFT exams showing decline was 28 months. Only 7 of the 13 had restrictive pattern impairment at the time of decline, the other 6 remaining in normal range. DLCO decline was seen in 7 out of 24 patients during a mean period of 39.1 months, only one of them with the lower value in the normal range. Out of the 6 patients that had significant decline in both DLCO and FVC, simultaneous changes were registered only in 4; in 2 of them the FVC degradation preceded the one of DLCO. All patients with functional decline had imagistic proof of interstitial fibrosis. Conclusion: Close follow-up of SSc-ILD with PFT is important since functional evidence of progression may occur with PFT values still in the normal range.

Background: As SSc-ILD can develop progressive pulmonary fibrosis, close monitorization of pulmonary function in these patients is crucial. Aim: To describe the evolution over time of pulmonary functional tests (PFT) results in patients with SSc-ILD. Subjects and method: SSc patients with serial PFT. Change over time was defined by 2 methods: (1): a relative decline in FVC ≥ 10% or a relative decline in DLCO ≥ 15% (Cottin V et al 2018) and (2):an absolute decline in FVC ≥ 5% or absolute decline in DLCO ≥ 10% (Raghu G et al 2022). The lung function decline was first described in 2018 and these patients were followed until 2022. Results: Among 31 patients with SSc who performed PFTs during the year 2018 in our department, 20 patients (17 females, mean age 53,2) had been prior tested at least once in the past; mean period of follow-up was 39,7 months (range 3-84); mean FVC 2,87L - 91,8%, mean DLCO 75,4%. Using the previous criteria (a relative decline in FVC ≥ 10% or a relative decline in DLCO ≥ 15%) we found that 6 patients worsened on FVC and 4 on DLCO. Using the new criteria for defining physiological evidence of disease progression (absolute decline in FVC ≥ 5% or absolute decline in DLCO ≥ 10%) we found another 2 cases (1 worsened in FVC and 1 in DLCO) in this group. Among the 20 patients 11 had a new PFT until 2023: only 6 out of the 9 patients that had a decline either on FVC, on DLCO or in both in 2018 were reevaluated – 5 were stationary or improved and only 1 worsened. Conclusion: We found no important differences between two methods of defining physiological evidence of disease progression in SSc-ILD. Close follow up is useful in adjusting the treatment and can prevent further functional degradation.

Background and objective: Spontaneous pneumomediastinum (SP) is a rare complication of COVID pneumonia; the objective of the study was to identify and characterise these patients. Methods: The observational retrospective study was conducted in our pulmonology department between May 2020 and February 2021, and included all consecutive patients with SP detected on chest CT, without signs of pneumothorax. We observed: time of onset, oxygen saturation in room air, level of inflammation markers and clinical outcome. Results: We identified 9 cases of SP among a total of 316 patients. 8 were men; mean age 57.5. At the time of identifying SP, mean CRP (Reactive Protein C) was 30 mg/l and CT scans showed extended "ground glass" opacities (> 50% of the parenchyma) in all patients. The mean time of detection of the SP was 18.8 days post symptoms onset (range 13-34). 5 patients had much higher levels of CRP before the onset of the SP. Only 6 out of 9 patients had subcutaneous emphysema. 5 patients died; their mean age was 57.2 years, mean CRP 35.3 mg/l. They were in a worse state of the disease, as all of them had oxygen saturation in room air less than 75% and all were on noninvasive or mechanical ventilation at the onset of the SP. The 4 surviving patients had mean CRP 13.9 mg/dl, mean oxygen saturation 82.5% (range 80-85). Repeated CT scans showed recovery in a mean time of 18.5 days (range 8-28). Conclusions: SP is a rare complication of COVID 19 pneumonia: it does not occur at the highest level of inflammation and it does not produce subcutaneous emphysema in all cases. SP does not influence the prognosis of the disease as the deceased patients had a more severe state of the pneumonia at the time of the onset of the SP.

Background: Tocilizumab (TCZ) is an approved therapy for cytokine release syndrome and its role in COVID-19 treatment is still debatable. Objective: To observe the characteristics and clinical outcome of the COVID-19 patients who received TCZ. Methods: The observational retrospective study was conducted between May and July 2020, and it included all consecutive patients who received TCZ for moderate to severe COVID-19 pneumonia with clinical aggravation and persistent inflammation, despite corticotherapy for at least 3 days. We observed inflamation markers, lymphocytes, oxygen saturation in room air and clinical outcome. Results: Among the 19 patients, 10 were women. Mean age was 56. The chest CT showed extended "ground glass" lesions (>50% of the parenchyma) in all patients. At the time we administrated TCZ, mean C Reactive Protein (CRP) was 156 mg/l, mean Interleukin 6 (IL6) was 167 pg/ml and mean oxygen saturation was 77.9%. 10 patients died. Compared to survivors, they had: mean age 58.7 vs. 53.2 years, mean CRP 162.3 vs. 150.8 mg/l, mean IL6 186.8 vs. 109.3 pg/ml, mean lymphocytes 692 vs. 1011/ml and mean oxygen saturation 75.9% vs. 85.5%. CRP levels dropped dramatically after a week in all cases. IL6 spiked in the first 3 days in all patients then decreased continuosly only in the surviving ones. The follow up of the surviving patients showed no episode of infection post TCZ. Conclusions: In our study TCZ administration was safe and reduced inflammation. The surviving patients were younger, with lower level of inflammation, less hypoxemia and lymphopenia. The selection of the patients to receive Tocilizumab could be a key for better outcome.

hemolysis (EVH).Objective: The phase 3, randomized, open-label, controlled PEGASUS trial (NCT03500549) assessed effi cacy and safety of pegcetacoplan compared to eculizumab in patients with PNH.Patients, Interventions, Main Outcome Measures: Patients aged 18 years with PNH and hemoglobin <10.5 g/dL completed a 4-week run-in period with pegcetacoplan plus eculizumab before 1:1 randomization to monotherapy with pegcetacoplan (n=41) or eculizumab (n=39).Primary endpoint: change in hemoglobin from baseline (start of run-in) to week 16.Secondary endpoints: transfusion avoidance, reticulocyte count, lactate dehydrogenase (LDH) level, Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-f ) score, and adverse events (AEs).Hierarchical signifi cance testing for secondary effi cacy endpoints was gated on the success of the primary endpoint.Results: Pegcetacoplan demonstrated superiority to eculizumab in change in hemoglobin at week 16, with an adjusted treatment difference of 3.84 g/dL (p<0.0001).Least squares (LS) mean (SE) changes were 2.37 (0.36) g/dL with pegcetacoplan and -1.47 (0.67) g/dL with eculizumab.Non-inferiority was shown for transfusion avoidance (35/41 [85.4%] pegcetacoplan vs 6/39 [15.4%] eculizumab patients) and reticulocyte count (LS mean [SE] changes, -136 [6.5] and 28 [11.9] 10 9 /L, respectively), but not LDH.FACIT-f score increased with pegcetacoplan (9.2 [1.61]) and decreased with eculizumab (-2.7 [2.82]).As change in LDH did not meet non-inferiority, changes in FACIT-f score were not tested for non-inferiority due to prespecifi ed hierarchical testing.AEs occurred in 36/41 (87.8%) patients receiving pegcetacoplan and 34/39 (87.2%) patients receiving eculizumab, with serious AEs in 7/41 (17.1%) and 6/39 (15.4%), respectively.Breakthrough hemolysis was reported in 4/41 (9.8%) pegcetacoplan and 9/39 (23.1%) eculizumab patients, leading to discontinuation in 3 pegcetacoplan patients.Conclusions: In this phase 3 trial in patients with PNH and suboptimal response to eculizumab, pegcetacoplan demonstrated superiority to eculizumab in change in hemoglobin level at week 16 with improved clinical outcomes including transfusion avoidance in most patients.The safety profi le of pegcetacoplan was comparable to eculizumab.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a highly infectious disease. The pathogenic mechanism of COVID-19 pneumonia involved excessive immune reaction in the host - a "cytokine storm", that determined extensive tissue damage associated with coagulation abnormalities. Severity of this disease is associated with comorbidities such as hypertension, obesity, pulmonary disease or age. Thrombotic complications are reported during COVID-19 evolution even with prophylaxis. OBJECTIVE: In this study, we evaluate hematological and coagulation parameters in order to obtain predictors for an unfavourable evolution of the patient. DESIGN AND SETTING: We performed a prospective study that included all patients admitted in our hospital in Hematology, Pneumology, and Intensive Care Unit (ICU) Department at Colentina Clinical Hospital during April - July 2020. The study group included 144 patients that were split into ICU and non-ICU patients. All patients were SARS-CoV-2-positive by molecular test. The distribution according to gender was as follows: 67 male with median age: 61 (min 22, max 88) and 77 female with median age: 57 (min 17, max 92). RESULTS: Age is an important risk factor for the severity; 50 patients admitted in ICU with median age 67 (min 34, max 92) and 94 non-ICU patients with median age 52.5 (min 17, max 92), p=0.00003. Associated comorbidities were important and were present in both groups. In ICU patients, we obtained lower level of lymphocytes compared with non ICU group median: 1 x 103/L (min 0.04 x 103/L max 3.28 x 103/L) vs 1.57 x 103/L (min 0.39 x 103/L max 23.35 x 103/L), p=0.0001. There are no significant differences between groups for the rest of hematological parameters. The neutrophil/lymphocytes ratio (NLR) is with statistical difference between ICU and non-ICU groups: 2.34 (min 1.06, max 31.90) vs 7.94 (min 2.18, max 90.04), p<0.000001. This indicator seems to be predictor for severe evolution; a high correlation with IL-6 level (r=0.73, p< 0.001) was obtained. NLR in association with IL-6, CRP and ferritin level are important factors in severe evolution of COVID-19 (severe pneumonia-more than 50% of lung evaluated by CT-scan and presence of any complications during COVID-19 evolution), coefficient of determination-R2 =0.69, R2 - adjusted 0.67, p<0.0001). The ICU patients with unfavourable evolution had a higher level of D-Dimers at the admission in hospital compared with ICU patients who were discharged from the hospital (3.42 mg/ml FEU vs 1.09 mg/ml FEU, p=0.01). Patients with thrombosis (stroke, myocardial infarction, deep venous thrombosis, thromboembolism) during COVID-19 evolution have higher level of D Dimers compared with patients without thrombotic complications (7.35 mg/ml FEU vs 0.82 mg/ml FEU), p=0.0001. There are no difference for another coagulation tests (APTT, Quick time) or Protein C, Protein S and Antithrombin III level. CONCLUSIONS: We conclude that NLR in association with feritin, CRP and IL-6 assessment are important to be evaluated in COVID-19 patient in order to expect a severe evolution of the disease. D- Dimer should be an important parameter to be evaluated for all COVID-19 patients in order to identify COVID-19 patients with high risk of thrombotic complications. Disclosures No relevant conflicts of interest to declare.

Abstract Introduction. Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a systemic vasculitis of the small vessels that often associates asthma and blood/tissue eosinophilia. Case presentation. A 58-year-old woman was admitted to our hospital for progressive exertional dyspnea. She had been diagnosed with asthma three years earlier. Recent multiple thoracic computed tomography scans displayed non-fixed interstitial lung abnormalities, whereas the infectious workup (HIV, parasites) was negative. On admission, the clinical examination noted prolonged expiratory phase. Paraclinical tests revealed biological inflammatory syndrome, eosinophilia, polyclonal hypergammaglobulinemia, elevated total IgE level, negative anti-neutrophil cytoplasmic antibodies and proteinuria of nephritic pattern. The pulmonary evaluation reconfirmed the obstructive ventilatory dysfunction and interstitial lung abnormalities - interlobular septal thickening and diffuse ground-glass opacification. The histopathological examination of a transbronchial biopsy specimen identified leukocytoclastic necrotizing vasculitis and tissue eosinophilia. Provided the clinical and paraclinical setting, specifically the asthma, blood and extravascular eosinophilia, paranasal sinus abnormalities, non-fixed pulmonary infiltrates and the histopathologically confirmed necrotizing vasculitis, the diagnosis of EGPA seemed appropriate. Conclusion. In the absence of diagnostic criteria, EGPA diagnosis is often challenging. Although certain clinical and imaging features could assist the diagnosis, biopsy remains the diagnostic gold standard. In the setting of lung involvement, open lung biopsy is usually required for EGPA histopathological proof, but few cases diagnosed by transbronchial biopsy have been reported. This method often identifies discrete, nonspecific lesions or an incomplete spectrum of pathognomonic abnormalities but has the advantage of minimal invasivity that justifies its use as an alternative diagnostic technique.

Objective: Chronic obstructive pulmonary disease (COPD) patients have an increased risk of atrial arrhythmias, with a significant impact on prognosis. Our aim was to determine a prediction score for developing supraventricular arrhythmias (SVT) in COPD patients, for an adequate selection of those who would benefit from Holter monitoring for early diagnosis of SVT. Design and method: COPD patients admitted to our clinic were included in this study, after excluding those with heart failure, decreased systolic function, ischemic heart disease, hemodynamically significant valvular disease, pulmonary embolism, permanent rhythm or conduction abnormalities, antiarrhythmic treatment or pacing/resynchronization therapy. SVT were defined as presence of atrial fibrillation, atrial flutter or atrial tachycardias. The FA2CT score was composed of forced expiratory volume in the first second (FEV1), right atrium diameter (RA), arterial pressure of carbon dioxide (pCO2) and the presence of arterial hypertension (HTN). Results: Of the 43 patients with a mean age of 65.1 ± 9.3 years, 65.1% men, 60.5% presented SVT. In multivariate analysis, FEV1 (p = 0.053), RA (p = 0.028) and pCO2 (p = 0.037) were independent predictors of SVT. In ROC curve analysis, the prediction model FEV1+AD had an AUC of 0.545 (95%CI 0.358–0.733, p = ns), FEV1+AD+pCO2 – AUC 0.713 (95%CI 0.542–0.883, p = 0.020), and the FA2CT prediction model (FEV1+AD+pCO2+HTA) – AUC 0.799 (95%CI 0.663–0.935, p = 0.001). The FA2CT score was derived from the prediction model: FEV1 < 1000 ml (1 point), RA > 35 mm (2 points), pCO2 > 45mmHg (1 point) and presence of HTN (1 point). Scores ranged from 0 to 5, with SVT in 25% of patients with score 0, 40% - score 1, 60% - score 2, 63.63% - score 3, 78.57% - score 4 and 50% - score 5, p for trend = 0.084. The predictive value of the FA2CT model was significantly amplified by adding the presence and number of atrial extrasystoles /24 hours on Holter monitoring (AUC 0.889 (95%CI 0.782–0.986, p < 0.001). Conclusions: Based on routine clinical, imaging and functional tests for patients with COPD, the FA2CT score could be useful in identifying those at high risk of developing supraventricular tachyarrythmias. Patients with an elevated score could benefit from Holter monitoring to diagnose SVT and establish the adequate therapeutic conduct.

Pulmonary rehabilitation (PR) has known benefits, but variable for individual patients. The aim was to assess the benefits of a PR program and to study the characteristics of the responding patients. 16 COPD patients (pt) mean FEV1 49% were evaluated before and after a PR program: segmental body composition, 6MWT and cardiopulmonary exercise testing (CPET), quality of life tests: mMRC scale, CAT and St George9s Respiratory Questionnaire (SGRQ). Responders in exercise capacity were defined as having a 25 m increase in 6MWD or a 5W increase in maximal power at CPET. Responders in quality of life were defined as having a decrease of 1, 2 and 4 points respectively for mMRC, CAT or SGRQ. For each test the responders were compared with nonresponders in their initial parameters. Every patient had a benefit for at least one assessed parameter. 13 pt were responders in exercise capacity: 43% in 6WMT and 62% for CPET. 11 pt were responders in quality of life: 37% for mMRC, 62% for CAT, 50% for SGRQ. The responders for the 6MWT had a more severe SGRQ score than nonresponders (p 0.039). The responders for CPET had greater leg lean mass (p 0.043), fat free mass and skeletal muscle mass than nonresponders. The responders for SGRQ had greater mMRC and CAT scores than nonresponders. The responders for CAT score had greater CAT score, as the mMRC responders who had greater mMRC scores than nonresponders. Conclusions: Every patient had a benefit for at least one assessed parameter. 81 % of them improved their exercise capacity, with the responders for CPET having a greater muscular mass than nonresponders. 68% of the patients improved in quality of life scores. with the responders more disabled than nonresponders.

Background: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk for both supraventricular and ventricular arrhythmias. Autonomic dysregulation may be responsible for the development of arrhythmias in these patients, and its analysis could be useful for identifying those at high risk for arrhythmias. Study Question: Our purpose is to analyze the role of acceleration capacity (AC) and deceleration capacity (DC), novel markers of the autonomic balance, as potential arrhythmic risk predictors in patients with COPD. Study Design: We prospectively included 47 patients diagnosed with COPD, and a control group of 64 age-matched subjects without COPD. AC and DC values were obtained using 24-hour Holter monitoring. The arrhythmias were isolated premature atrial complexes, supraventricular tachycardias, isolated premature ventricular beats (PVC), and combined ventricular arrhythmias consisting in ventricular tachycardias or more than 10 PVC per hour. Results: Supraventricular arrhythmias and isolated PVC were more frequent in the COPD group. The DC was significantly lower (3.10 vs. 5.60, P < 0.0001) and AC higher (−4.60 vs. −6.60, P = 0.002) in patients with COPD. DC was identified as a predictor of arrhythmic events with an area under the curve (AUC) for premature atrial complexes >70/d of 0.72 (0.56–0.87, P = 0.013), for supraventricular tachycardias 0.76 (0.62–0.90, P = 0.002), and for combined ventricular arrhythmias 0.69 (0.54–0.82, P = 0.025). AC was predictor only for combined ventricular arrhythmias with an AUC of 0.74 (0.58–0.85, P = 0.002). Conclusions: Patients with COPD associate a significant autonomic imbalance and a higher incidence of arrhythmias. DC could be a strong predictor for supraventricular and ventricular arrhythmias in patients with COPD with no clinically apparent cardiac disease. AC could be useful alongside with DC regarding the risk for ventricular arrhythmias, but seems to have lesser value as a predictor for supraventricular arrhythmias.

Background: Proteomic candidate biomarkers for systemic sclerosis (Ssc) useful for appropriate patient evaluation and follow-up were identified in mass-spectrometry studies; however, most of these biomarkers were not evaluated and confirmed on independent patient samples. Up-regulation of reticulocalbin 1 (RCN1) and reticulocalbin 3 (RCN3) in the dermal fibroblast secretome originating from Ssc patients was previously described. The aim of the study was to evaluate circulating RCN1 and RCN3 as candidate biomarkers for Ssc clinical expression.Methods: 40 consecutive Ssc patients and 20 gender and age matched controls were included. Serum RCN1 and RCN3 was evaluated using commercial ELISA kits.Results: Serum RCN1 and RCN3 were not statistically significant different between Ssc patients and healthy controls. Serum RCN1 and RCN3 were correlated in both Ssc and healthy control groups (p < 0.001). Serum RCN1 was positively correlated with Ssc disease activity score (EUSTAR, p = 0.02) and remained associated with EUSTAR after adjusting for disease duration in multivariate analysis. 6 Ssc patients (15%) had elevated RCN1 values compared to reference values obtained from healthy control samples. These patients had higher prevalence of digital ulcers, higher disease activity scores, and tended to have esophageal hypomotility, calcinosis, telangiectasia, and diffuse Ssc subtype.Conclusions: RCN1 and RCN3 expression was not statistically significantly different to healthy controls. However, RCN1 was associated with disease activity score and could be used as a stratification biomarker for Ssc patients, as patients with high RCN1 shared a particular disease pattern.

Background: Impaired muscle function and muscular depletion are common systemic manifestations in COPD; muscles from the lower limbs are most severely affected. Aim: To study the variation over time of body composition in COPD patients and the relationship with changes in lung function, 6MWD and CAT scores Methods: 17 COPD male patients performed spirometry, 6MWT, CAT and body composition assessment by direct segmental bioelectrical impedance analysis at baseline and follow-up(median follow-up 17 months). Results: We found a significant decrease in FEV1: mean FEV1 1.26l ± 0.23 at follow-up versus mean FEV1 1.49l ± 0.28 at baseline p<0.001 (FEV1 % mean 43.1% ± 9.4 versus 51.3% ± 11.7, p<0.001). There were no significant decrease in FFMI, SMMI (skeletal muscle mass index), LLM (leg lean mass), body weight, 6MWD, CAT score between baseline and follow-up. We found a significant correlation between the decrease in LLM and the decrease in FFMI (p = 0.023, r = 0,547) and in SMMI (p = 0.024, r = 0.544), and also between the variations between body weight and SMMI (p = 0.037, r = 0.508). The decrease in FFMI, SMMI, LLM did not correlate with the variation of FEV1, 6MWD or CAT scores. Conclusions: We found a significant lung function decline over time which was not correlated with a significant decrease in FFMI, SMMI or leg lean mass. The decrease in FFMI and in SMMI were both correlated with the decrease in LLM, suggesting that muscle loss from the lower limbs are the principal cause of muscular depletion in COPD; segmental body composition evaluation could be useful for an early and more focused detection of muscular impairment in COPD patients.

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk for cardiac arrhythmias. Ventricular late potentials (VLP) on signal-averaged electrocardiography (SAECG) are associated with an increased risk for malignant ventricular arrhythmias. Our aim is to investigate the modifications of SAECG parameters and the presence of VLP as possible indicators of proarrhythmic substrate in patients with COPD. We prospectively enrolled 41 consecutive patients in the COPD group and 63 patients without any history of pulmonary disease, matched for age and hypertension history, in the control group. Pulmonary function tests, arterial blood gases, echocardiography, 24-hour Holter monitoring and SAECG were performed. We measured total filtered QRS duration (QRSf), duration of high frequency, low-amplitude signals <40 V (HFLA40), and root mean square voltage in the last 40 ms (RMS40). VLP were considered if at least two of these parameters were abnormal.Results. We did not register any significant differences in QRSf, HFLA40 or RMS40 between the two groups. In the COPD group there was a non-significant higher percentage of patients with VLP in comparison with the control group. In the COPD patients we registered a significantly higher number of isolated premature ventricular beats and of combined complex ventricular arrhythmias, consisting of polymorphic PVC, couplets, triplets or nonsustained ventricular tachycardias. None of these arrhythmic parameters correlated with SAECG variables or with the presence of VLP.Conclusion. In COPD patients parameters measured on signal-averaged electrocardiography and ventricular late potentials analysis have little value in risk stratification for ventricular arrhythmias.

Abstract Introduction. Chronic obstructive pulmonary disease (COPD) is associated with higher incidence of supraventricular arrhythmias. Atrial late potentials (ALP) detected by P-wave signal-averaged electrocardiography (SAECG) could be useful in detecting the patients at risk for supraventricular arrhythmias. Our objective was to assess the role of P-wave SAECG and ALP detection for arrhythmic risk evaluation of the patients with exacerbated COPD. Methods. We prospectively included 45 patients with exacerbation of COPD and 58 age-matched patients with no history of pulmonary disease in a control group. We performed pulmonary function tests, arterial blood gases, echocardiography, 24-hour Holter monitoring and P-wave SAECG. We measured filtered P-wave duration (FPD), the root mean square (RMS) voltages in the last 40, 30 and 20 ms of the filtered P-wave (RMS 40, RMS 30 and RMS 20), the root mean square voltage of the filtered P-wave potentials (RMS-p), and the integral of the potentials during the filtered P-wave (Integral-p). ALP was defined as FPD > 132 ms and RMS 20 < 2.3 µV. Results. Isolated atrial premature beats (APB) and supraventricular tachycardias (SVT) were more frequent in the COPD group. There were no significant differences between groups regarding the P wave SAECG parameters. In the COPD group none of the supraventricular arrhythmias was correlated with ALP or any P-wave SAECG parameters. Conclusions. The patients with acute exacerbation of COPD but no apparent cardiac disease have a higher incidence of supraventricular arrhythmias. P-wave SAECG analysis and ALP detection have little value in the arrhythmic risk evaluation of these patients.

Background: Body composition assessment is useful in COPD patients for the evaluation of muscular depletion responsible for low exercise capacity. Aims: (a) to describe body composition in COPD patients referred to pulmonary rehabilitation; (b) to examine the relationships between body composition and exercise capacity; (c) to test if segmental wasting of lower limbs muscle mass correlates with exercise capacity. Method: 50 consecutive COPD patients referred for rehabilitation performed six minutes walking test (6MWT) and body composition assessment by direct segmental multifrequency bioelectrical impedance analysis. Results: The prevalence of nutritional depletion (low body mass index and/or low fat free mass index - FFMI) among our COPD patients was 20%. 16% of the patients had low FFMI and 54 % had low SMMI (skeletal muscle mass index). FFMI and SMMI both correlated significantly with 6MWD (r=0.352, p=0.012, and r=0.312, p=0.027, respectively). The segmental body composition assessment revealed that 76% of the patients had unbalanced upper/lower skeletal muscle mass, i.e. mean upper limbs lean mass predicted was greater than lower limb lean mass predicted: 108,8% versus 87,3% These “unbalanced“ patients had significantly lower mean 6MWD: 361.5 m versus 434.6 m, p= 0.038 in “balanced” patients. Conclusions: .The percentage of patients with low SMMI was greater than those with low FFM. FFMI and SSMI correlated significantly with 6MWD. Segmental body composition assessment revealed that “unbalanced” patients had significantly lower 6MWD. These results show that SMMI and segmental body composition evaluation are useful for an early detection of muscular impairment in COPD patients.

Background: Oxygen desaturation during exercise can have important consequences for the prognosis of patients with COPD. Aim: To study the effects of pulmonary rehabilitation on exercise desaturation. Method: We studied 16 COPD patients who performed pulmonary function tests, 6MWT and cardiopulmonary exercise testing (CPET) at the beginning and at the end of a seven weeks outpatient rehabilitation program. Oxygen desaturation after exercise was defined by a decrease (exercise minus resting) ≥ 4% in pulse oximetric saturation (SpO2) or by an postexercise SpO2 < 90%. Results: Among the 16 patients, 8 were desaturators after both 6MWT and CPET, 1 after 6MWT only and 1 after CPET only. Desaturators had lower baseline gas transfer: mean % predicted DLCO 54,5% in the 6MWT desaturators versus 77,1% in nondesaturators, p<0,001; mean % predicted DLCO 53,8% in the CPET desaturators versus 78% in nondesaturators, p=0.013. Two thirds of the patients who desaturated after 6MWT and only 12% of those who desaturated after CPET did not desaturate any longer after completing rehabilitation. Mean postexercise saturation (assessed both after 6MWT and after CPET) was significantly higher after rehabilitation (mean postexercise SpO2 after 6MWT was 89,38% before and 92.06% after rehabilitation, p=0,014; mean postexercise SpO2 after CPET was 88,86% before and 90,71% after rehabilitation, p=0,015). Conclusions: Pulmonary rehabilitation improves exercise desaturation in COPD patients. This improvement is evident in desaturations after 6MWT which is similar with the activities of daily living. Thus, pulmonary rehabilitation can delay desaturation consequences and improve quality of life and disease progression in COPD patients.

Introduction: This study analyzed the respiratory muscle strength in a group of COPD patients and the possible relationship with other functional and non-functional parameters. Subjects and methods : In consecutives, stable COPD patients were evaluated: respiratory muscle strength (maximal inspiratory pressure MIP, maximal expiratory pressure MEP), lung function tests (FEV1, residual volume RV, functional residual capacity FRC), 6 minutes walking test (6MWT), modified Medical Research Council dyspnea scale (mMRC), COPD Assessment Test (CAT), St. George Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS). Results: 70 COPD patients: 11 females / 59 males. Mean age 62.2±11 years. Mean MEP value: 125.4 ±40 cm H20. Mean MIP value: 67.5 ±23 cm H20. Both MIP and MEP values were correlated positively with: 6MWT distance, FEV1 values (p<0.05), and negatively with: dyspnea, age (p<0.05). MEP value was correlated with weight (p<0.05). No relationship was found with RV, FRC values or with CAT, SGRQ, HADS questionnaires. Concerning the MIP, the lowest values were in stage II GOLD (60.1 cm H20) and in 41.4% of cases the values were < 60 cm H20 (inspiratory muscle fatigue threshold). Conclusions: In our group of COPD patients, respiratory muscle pressures were in relationship with age, weight, dyspnea, FEV1 values and 6MWT distance. Inspiratory muscle pressure was seriously affected in almost half of patients.