This study compared the outcomes of post acute coronary syndrome (ACS) patients with versus without performing a cardiac rehabilitation program following the hospitalization, within 4-6 years of further followup. 156 Patients who underwent ACS between years 2006-2008, were included in this retrospective study. 80 had participated in a cardiac rehabilitation program of 3-6 months following the acute event (group A, Age-60+/10.5), while the rest of patients(group B; n=76, Age-64+/-11y) had not. All patients had a documented clinical follow-up of 4-6 years post the ACS event for outcomes including cardiac and non-cardiac hospitalizations, percutaneous trasluminal coronary angioplasties (PTCA/PCI), coronary artery by-pass graftings (CABG), development of heart failure (CHF), cardiac arrhythmias, renal failure and death. Significant differences between groups A and B were observed as follows (respectively): Number of cardiac hospitalizations: 61 vs. 129; Number of non-cardiac hospitalizations: 36 vs. 119; PTCA interventions: 10 vs. 14; CABG interventions: 2 vs. 3; CHF development: 5 vs. 6; Cardiac arrhythmia episodes: 2 vs. 8; Renal failure: 3 vs. 4; and death: 1 vs. 9. We conclude that post ACS patients who performed a rehabilitation program following the event demonstrated a significant better outcome, cardiac and non-cardiac, than those without rehabilitation, within a long term followup period of 4-6 years.

63 patients (pts), 42 males and 21 females, were studied: 16 with lone hypertension treated only with vasodilator agents, 26 with lone hypertension treated only with beta-blocking agents, and 21 hypertensive pts with LV dysfunction treated with beta-blockers along with other medications. A cardiopulmonary exercise test (CPET) was performed in all pts while taking their medications, including beta-blockers, in which the indices: HR, BP, O2-consumption (VO2), O2-pulse (O2P), Ventilatory anaerobic threshold (VAT), and Respiratory exchange ratio (RER) were measured. Peak values of the cardiopulmonary indices were compared among the three groups, for each index separately. The results showed significant differences of the peak-VO2 and VAT values among all the three groups, and of the O2P between groups A or B and group C. A clear tendency of lower values was demonstrated with the beta-blockers. All groups have reached the target value of RER (>1.15), in spite the differences in peak-HR. As the CPET showed a significant physiological disadvantage in the treatment of beta-blockers compared to vasodilators in pts with lone hypertension, and it is even worser in the LV dysfunction group, we conclude that this very test might serve as a tool for personalized medical adjustment in hypertension, as in our study.

Objective: Establish the combination of totalPSA, %freePSA and [-2]proPSA biomarkers and calculation of PHI in the diagnostic algorithm of early prostate cancer. Material and Methods: We examined the serum from 76 suspected prostate cancer patients. All these patients had undergone a TRUS biopsy. We performed an assessment of total PSA and, if the interval of tPSA was between 0-30 ug/l, we also assessed the levels of freePSA and [-2]proPSA and calculated the free PSA percentage (%freePSA) and Prostate Health Index (PHI). The monitored biomarkers were measured using chemiluminescent technology on a DxI 800 (Beckman Coulter, USA). All statistical analyses were calculated using SAS version 9.2. Results: We found a statistically significant increase in levels of [-2]proPSA and PHI in patients diagnosed with prostate cancer through prostate biopsy compared to patients with benign prostate hypertrophy ([-2]proPSA median 14 vs. 27 ng/l, PHI median 35 vs. 77). In contrast, we did not find any significant difference in tPSA and %freePSA (median tPSA 7.1 vs. 7.7 ug/l and %freePSA 16 vs.11.4%). Conclusion: The combination of [-2]proPSA and calculation of PHI with traditional prostate cancer markers appear to be of great benefit for a more accurate differential diagnosis between benign hyperplasia and prostate cancer.

ACT-280778 is an oral, non-dihydropyridine, dual L-/T-type calcium channel blocker. This phase 2a, double-blind, randomized, placebo- and active-controlled study investigated the efficacy and safety of 10 mg ACT-280778. Patients with mild-to-moderate essential hypertension received once-daily placebo ( n =53), ACT-280778 10 mg ( n =52) or amlodipine 10 mg ( n =54) for 4 weeks. The primary end point was the change from baseline to week 4 in placebo-adjusted mean trough sitting diastolic blood pressure (SiDBP) with ACT-280778. Tolerability was assessed by recording treatment-emergent adverse events (TEAEs). Baseline clinical characteristics were similar across groups. No significant difference was observed at week 4 in mean trough SiDBP between placebo (−9.9 (95% confidence limit (CL) −12.7, −7.0) mm Hg) and ACT-280778 (−9.5 (−12.4, −6.5) mm Hg; P =0.86); amlodipine reduced mean trough SiDBP by −16.8 (−19.0, −14.5) mm Hg, confirming assay validity. Change in mean PR interval at week 4 (pre-dose) differed between placebo (−1.0 (95% CL −4.4, 2.3) ms) and ACT-280778 (6.5 (3.5, 9.6) ms); amlodipine did not increase PR interval (1.1 (−1.6, 3.9) ms).Treatment-emergent adverse events (TEAE) frequency was 32.1% (placebo), 32.7% (ACT-280778) and 33.3% (amlodipine). The most common TEAEs were headache, peripheral edema, hypertension and second-degree atrioventricular block. ACT-280778 (10 mg) did not lower blood pressure in mild-to-moderate hypertension.

30 patients (pts) were included in the study. 14 with DM only; 3 with PVD and 13 with both - DM and PVD. 6 were female and 24 males, mean age of 68+/-11y. PVD was confirmed by ankle-brachial index (ABI) of <0.9, with foot symptoms. All pts underwent fool examination twice, at baseline visit and after a month, the third and last visit. It included: BP, HR and ECG; Two questionnaires relating to foot symptoms and sleep disorders; Hemodynamic evaluation by bio-impedance cardiography (ICG) for measuring total peripheral resistance (TPR), SV, CO, among others. 6 parameters were scored - 1 point for each: BP, ABI, SV, TPR and the two subjective questionnaires. A total of 6 points for improvement or [-6] for worsening of these parameters were possible. Two weeks after baseline visit, pts were assessed by the questionnaires alone, while checking adverse events related to the treatment.There were significant release in foot pain, tingling and night pain, as well as sleep disorders (p<0.05). The 6 scoring assessment showed improvements in 17 pts by 3.3 mean scores, worsening in 6 pts by [-1.5], and no changes (0 scores) in 7 pts. The total ICG scores of TPR and SV were +13, the ABI +10, and the BP scores were +5.We conclude that the Magic (Medic) ShoesTM might serve several wide populations with the above mentioned disorders as an additional effective treatment to the conventional one.

Objective: To evaluate and compare retrospectively the physiological effect of beta blockers versus vasodilators in the treatment of hypertensive patients (pts). Methods: 42 diagnosed hypertensive pts (24 male, 18 female) were studied. They were divided into two groups: (1) 16 patients treated with vasodilators only and (2) 26 patients treated only with beta blockers. A cardiopulmonary exercise test (CPET) was performed in all pts while they were taking their medications as usual. The following indices were monitored and measured breath by breath during exercise: heart rate (HR), blood pressure (BP), oxygen consumption (VO2), oxygen pulse (O2P), ventilatory anaerobic threshold (VAT) and respiratory exchange ratio (RER). Maximal exercise capacity was considered as RER having reached a value of at least 1.15. Peak values of the CPET indices were compared between the two groups for each index separately by the two-tailed Student T test. P values < 0.05 were considered statistically significant. Results: No significant differences were observed between groups A and B, respectively, as follows: age 58 ± 13 vs 59 ± 10; RER 1.17 ± 0.12 vs 1.17 ± 0.1; and peak O2P 108 ± 13 vs 102 ± 33. Significant differences between the two groups were observed in: peak HR (% of predicted HR) 90 ± 8 vs 69 ± 12; peak VO2 (% of predicted VO2) 96 ± 9 vs 69 ± 11; and VAT (% of max VO2 predicted) 55 ± 8 vs 43 ± 9 (p < 0.05). Conclusions: Beta blockers in the treatment of hypertensive patients demonstrate a significant physiological disadvantage compared to vasodilator treatment. These findings further validate the CPET as an important tool for physiological evaluation of various treatments in hypertensive patients. J Clin Basic Cardiol 2008; 11 (online): 8–10.

80 consecutive patients (pts) with risk factors for ischemic heart disease (IHD;53 men, 27 women, mean age- 65+ -12y) were studied in order to evaluate the exercise impedance cardiography (ICG) as a screening tool for detecting pts with IHD.All pts have performed exercise ICG by the BioZ system and Thallium SPECT exercise test. The stroke volume (SV) as measured by ICG at rest and at peak exercise was used for the assessment of IHD to compare with the Thallium SPECT test results.48 pts with negative Thallium SPECT test showed a negative ICG test for ischemia as well, while 21 pts with a positive Thallium test showed a positive ICG test as well.Only 7 pts with a negative Thallium test showed a positive ICG test (false positive) While 4 others with a positive Thallium test showed a negative ICG test for ischemia (false negative) (p < 0.001 by X(2) test). We conclude that the exercise ICG test might be a sensitive screening test for detecting pts with IHD.

PURPOSES The aim of the present study was to objectively assess cardiopulmonary function during exercise among subjects suspected of having CAD, and to compare these results with those of conventional exercise stress test interpretation. METHODS Thirty-five supposedly healthy subjects underwent exercise stress test, cardiopulmonary exercise test, and cineangiography, for suspected CAD. RESULTS Analysis of the cineangiography showed that 10 subjects had significant CAD, and 25 had no significant CAD. Standard exercise electrocardiografic criteria identified significant CAD with sensitivity of 90%, but with a specificity and predictive accuracy of only 48% and 60%, respectively. Adding specific cardiopulmonary variables (ventilatory anaerobic threshold, O2pulse at peak exercise, and O2pulse trending phenomenon), identified CAD with a sensitivity of 80%, and specificity of 92%. The overall predictive accuracy of the exercise test, when adding those cardiopulmonary variables to the standard stress ECG, was 88.6%, compared with 60% for the standard criteria of ST-depression, blood pressure, and clinical symptoms. Adding new sample of subjects (N=7) who were tested and evaluated under similar testing and assessment conditions but at different settings, location, and experts, support our original findings concerning the predictive accuracy of the proposed diagnostic equation generated from the cardiopulmonary exercise test (CPET). CONCLUSIONS Using cardiopulmonary exercise testing can greatly improve (by 29%) the diagnostic accuracy of the commonly used exercise stress test.

The pulmonary function test (PFT) alone may be inadequate for predicting work-related exercise capacity in patients who file workers' compensation claims for respiratory limitation and compensation. Two hundred sixteen ambulatory patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 second = 54.1 +/- 16.8% predicted) were administered the PFT and cardiopulmonary exercise test, and the results were analyzed by categorical statistical comparison, based on standard medical impairment classifications. Sixty-five patients (30.1%) were similarly classified by the two methods. Of the remaining patients, 132 (61.1%) were found to be less impaired according to the cardiopulmonary exercise test than according to the PFT, and 19 (8.8%) were more impaired according to the PFT. The results favor the use of the cardiopulmonary exercise test for the routine evaluation of respiratory impairment in patients with chronic obstructive pulmonary disease, particularly for patients with mild or moderate impairment revealed by the PFT. The large discrepancy between the two procedures emphasizes the need for a novel approach.

STUDY OBJECTIVES:To compare the oxygen pulse curve (O(2)P-C) as measured during cardiopulmonary exercise testing (CPET) with left ventricular (LV) ejection fraction (LVEF) rest-exercise response as measured by multigated equilibrium (99m)Tc radionuclide cineangiography (MUGA) in patients with different degrees of ischemic heart disease (IHD). PATIENTS:Forty-six patients (39 men and 7 women; mean plus minus 1 SD age, 59.2 plus minus 11 years) with IHD, with no hypertrophic, valvular, or pericardial disease. METHODS:A supine bicycle ergometer with increments of 25 W every 2 min was used for MUGA, and an electronically braked cycle ergometer was used for upright symptoms-limited CPET. Exercise was increased by 10 to 20 W/min until the target heart rate (HR) was reached (similar peak HR for both studies). MEASUREMENTS AND RESULTS:The O(2)P-C was scored on a 10-point scale as follows: type A, normal curve (10 points); type B, normal-shaped curve with low values (8 points); type C, low and flat curve (5 points); type D, descending curve (3 points). Findings for the MUGA study were classified into four groups by the degree of ischemic response: group 1 (control), normal diastolic function (n = 10), LVEF > 55%, LVEF during exercise minus LVEF at rest [DeltaLVEF] greater-than-or-equal 5%; group 2, mild ischemia (n = 10), LVEF > 55%, < 0 DeltaLVEF < 5%, diastolic dysfunction at exercise (prominent "A" waves); group 3, LV dysfunction (n = 9), LVEF < or = 35% at rest; and group 4, significant ischemia (n = 17), LVEF > 55%, DeltaLVEF < 0, diastolic dysfunction. A highly significant relationship between the O(2)P-C score and the MUGA grouping was observed by Fisher's Exact Test and Pearson's linear regression line (p < 0.001; R = - 0.89). CONCLUSIONS:Exercise-responded O(2)P-C might serve as a good noninvasive, physiologically based, parameter to distinguish between IHD patients with normal and impaired LV function.

dAssessment of the recovery VO2 kinetics following exercise by defined indices was done in 35 patients with congestive heart failure (LVEF =30%) in comparison to 17 normal control subjects. All patients underwent a cardiopulmonary exercise test followed by a full recovery time until the respiratory exchange ratio (RER) reached a value of = 1. Significant differences of the recovery indices between the two groups were observed as follows: 1/2 time recovery of VO2 of 129 +/- 43 vs 84 +/- 19 sec (p <0.01); 1/2 time recovery of O-2-pulse Of 181 +/- 65 vs 101 +/- 30 sec (p <0.01); and full recovery time of VO2 of 9 +/-3.6 vs 7.6 +/-1.2 min (p <0.05) respectively. We concluded that since the cardiopulmonary recovery indices differ significantly in patients with CHF vs normal subjects, the indices are important for a full evaluation of exercise capacity in patients with CHF.

UNLABELLED:In patients with chronic obstructive pulmonary disease (COPD) the limitation on unsupported arm exercise (UAE) is predominantly respiratory muscle function-dependent. It is characterized by neuromechanical dysfunction (thoracoabdominal dyssynchrony) of the inspiratory muscles (diaphragm, accessory), superimposed by lung mechanics dysfunction. The undergoing mechanism is probably multifactorial. To study the relationship of resting pulmonary function and UAE performance in patients with COPD. Twenty-one patients, mean age 63 +/- 7 years, with COPD [forced expiratory volume in the first second (FEV1) 42 +/- 12% of predicted] underwent assessment of resting lung function (inspiratory capacity 57 +/- 17%; functional residual capacity 204 +/- 38% of predicted), maximal inspiratory pressure (67 +/- 14 cmH2O), upper arm circumference (30 +/- 2 cm), and symptom-limited cardiopulmonary UAE assessments. UAE consisted of bilateral anterior arm elevation to shoulder level at a rate of 40 arm strokes.minute-1. A series of stepwise multiple regression models were fitted to the data to predict exercise time from resting pulmonary function indices.RESULTS:Statistically significant correlations (r) were found between exercise time and inspiratory capacity (% of predicted) (r = 0.67, p = 0.0008), maximal inspiratory pressure (cmH2O) (r = 0.47, p = 0.03), upper arm circumference (r = 0.74, p = 0.0001), FEV1 (% of predicted) (r = 0.62, p = 0.0026), oxygen uptake (r = 0.56, p = 0.0085) and functional residual capacity (% of predicted) (r = -0.41, p = 0.06, borderline). Inspiratory capacity (% of predicted), functional residual capacity (% of predicted), upper arm circumference (cm) and FEV1 (% of predicted) explained 77% of the variance in exercise time. Therapeutic strategies that aim to increase inspiratory capacity or decrease functional residual capacity, or increase inspiratory muscle strength and upper arm/torso muscle endurance are likely to alleviate symptoms and improve UAE performance in patients with COPD.

UNLABELLED:Cardiovascular disease (CVD) is associated with dyslipidemia and frequently with insulin resistance, both of which are in general no alleviated by antilipidemic drugs. Our objective was to examine whether a dietary supplement containing omega-3 fatty acids (n-3 FA) can reduce the levels of serum lipids, fasting insulin and glucose in documented CVD patients treated by statins or bezafibrates. In a double-blind placebo-controlled trial of parallel design, 52 patients, age 69.2 years +/- 3.6 treated by antilipidemic drugs, were randomly assigned to receive daily 7 gr of a dietary concentrated supplement containing 67% n-3 FA (185 mg EPA and 465 mg/g DHA) in a form of spread (Yamega Ltd, Israel) or olive oil spread (placebo) and recommended to reduce the consumption of omega-6 fatty acids for 12 weeks. The average values +/- SD before and after dietary supplementations were compared. RESULTS:44 patients (23 in the n-3 FA group) completed the study. In the n-3FA group we observed a significant decrease (p < 0.05) of total cholesterol (12.2%). LDL-cholesterol (16.8%), triglycerides (36.1%), insulin in hyperinsulinemic subjects (> 20 microunits/ml) (34.9%), and no significant changes in HDL-cholesterol and glucose. No hyperglycemia was detected. In the olive oil group we observed a significant decrease (p < 0.05) in the LDL-cholesterol values of 15.5% and no significant changes in the other parameters. No side effects were reported during the study in any of the participants. Our findings demonstrate that the incorporation of the dietary supplement containing EPA and DHA omega-3 fatty acids reduces significantly the above risk factors for CVD.