Search

Background: \ud Cachexia is common in patients with chronic heart failure and is associated with poor prognosis. How best to measure body composition is not clear.\ud \ud Methods and results: \ud We characterized body composition in 120 patients with chronic heart failure: mean (SD) age 70 (10) years, left ventricular ejection fraction 44 (10) %, and median (Q1–Q3) N-terminal pro B-type natriuretic peptide 845 (355–1368) ng/L. We measured body composition using dual-energy X-ray absorptiometry (DEXA) and a multi-frequency bioelectrical impedance analysis (BIA) device (Tanita BIA MC-180MA). Mean (SD) fat mass (FM) was 27.2 (11.7) kg by BIA and 32.3 (12.2) kg by DEXA (mean difference −5.1 kg, 95% limits of agreement: −11.7, 1.5; 4% of values outside limit of agreement); mean (SD) lean mass (LM) was 56.6 (10.9) kg by BIA and 51.1 (9.9) kg by DEXA (mean difference 5.5 kg, 95% limits of agreement: −1.3, 12.3; 6% of values outside limit of agreement); and mean (SD) bone mass (BM) was 3.0 (0.5) kg by BIA and 2.8 (0.6) kg by DEXA (mean difference 0.2 kg, 95% limits of agreement: −0.5, 0.8; 5% of values outside limit of agreement). There was a close correlation between DEXA and BIA for both LM and FM (LM: r = 0.95, P < 0.001; FM: r = 0.96, P < 0.001) but less so for BM (r = 0.84, P < 0.001). Both DEXA and BIA body composition measurements correlated well with other measures of body size (body mass index, hip circumference, and waist circumference).\ud \ud Conclusions: \ud There are differences in the measurements of FM, LM, and BM between the two techniques, which should not be used interchangeably.

Aims:\ud \ud Plasma concentrations of high-sensitivity C-reactive protein (hsCRP) are often raised in chronic heart failure (CHF) and might indicate inflammatory processes that could be a therapeutic target. We aimed to study the associations between hsCRP, mode and cause of death in patients with CHF.\ud Methods and results:\ud \ud We enrolled 4423 patients referred to a heart failure clinic serving a local population. CHF was defined as relevant symptoms or signs with either a reduced left ventricular ejection fraction 125 pg/mL). The median [interquartile range (IQR)] plasma hsCRP for patients diagnosed with CHF (n = 3756) was 3.9 (1.6–8.5) mg/L and 2.7 (1.3–5.1) mg/L for those who were not (n = 667; P

Aims:\ud \ud Even if treatment controls symptoms, patients with heart failure may still be congested. We aimed at assessing the prevalence and clinical relevance of congestion in outpatients with chronic heart failure.\ud Methods and results:\ud \ud We recorded clinical and ultrasound [lung B‐lines; inferior vena cava (IVC) diameter; internal jugular vein diameter before and after a Valsalva manoeuvre (JVD ratio)] features of congestion in heart failure patients during a routine check‐up. Of 342 patients who attended, predominantly in New York Heart Association class I or II (n = 257; 75%), 242 (71%) had at least one feature of congestion, either clinical (n = 139; 41%) or by ultrasound (n = 199; 58%). Amongst patients (n = 203, 59%) clinically free of congestion, 31 (15%) had ≥ 14 B‐lines, 57 (29%) had a dilated IVC (> 2.0 cm), 38 (20%) had an abnormal JVD ratio (

Aims and methods: Even if treatment controls symptoms, patients with heart failure may still be congested. We recorded clinical and ultrasound (lung B-lines; inferior vena cava (IVC) diameter; internal jugular vein diameter before and after Valsalva (JVD ratio)) features of congestion in patients with heart failure during a routine check-up to assess their prevalence, relationships and prognostic significance.\ud \ud Results: Of 342 patients, predominantly in NYHA I or II (257; 75%), who attended, 242 (71%) had at least one feature of congestion, either clinical (139; 41%) or by ultrasound (199; 58%). Amongst patients (n=203, 59%) clinically free of congestion, 31 (15%) had >14 B-lines, 57 (29%) had a dilated IVC (> 2.0 cm), 38 (20%) had an abnormal JVD ratio (

Background: \ud Patients with chronic conditions, such as heart failure, swim regularly and most rehabilitation exercises are conducted in warm hydrotherapy pools. However, little is known about the acute effects of warm water immersion (WWI) on cardiac haemodynamics in patients with chronic heart failure (CHF).\ud \ud Methods: \ud Seventeen patients with CHF (NYHA I and II; mean age 67 years, 88% male, mean left ventricular ejection fraction 33%) and 10 age-matched normal subjects were immersed up to the neck in a hydrotherapy pool (33-35°C). Cardiac haemodynamics were measured non-invasively, and echocardiography was performed at baseline, during WWI, 3 minutes after kicking in the supine position and after emerging.\ud \ud Results: \ud In patients with CHF, compared to baseline, WWI immediately increased stroke volume (SV, mean ±standard deviation; from 65 ±21 to 82 ±22 ml, P

Background:\ud \ud Low serum chloride is common in patients with chronic heart failure (CHF) and is associated with worse outcomes. We investigated the clinical and prognostic associations, including cause of death associations, of low serum chloride in patients referred to a secondary care clinic with suspected heart failure.\ud Methods and results:\ud \ud Patients with echocardiogram and serum chloride were evaluated (n = 5613). CHF was defined as signs and symptoms of the disease and either left ventricular systolic dysfunction (LVSD) worse than mild [heart failure with reduced ejection fraction (HFrEF)] or LVSD mild or better and raised amino‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) levels (>125 ng/L) [heart failure with preserved ejection fraction (HFpEF)]. Hypochloraemia was defined as greater than two standard deviations below the mean in the local normal distribution (

Aims:\ud \ud The PARADIGM-HF trial showed that sacubitril–valsartan, an ARB–neprilysin inhibitor, is more effective than enalapril for some patients with heart failure (HF). It is uncertain what proportion of patients with HF would be eligible for sacubitril–valsartan in clinical practice.\ud Methods and results:\ud \ud Between 2001 and 2014, 6131 patients consecutively referred to a community HF clinic with suspected HF were assessed. The criteria required to enter the randomized phase of PARADIGM-HF, including symptoms, NT-proBNP, and current treatment with or without target doses of ACE inhibitors or ARBs, were applied to identify the proportion of patients eligible for sacubitril–valsartan. Recognizing the diversity of clinical opinion and guideline recommendations concerning this issue, entry criteria were applied singly and in combination. Of 1396 patients with reduced left ventricular ejection fraction (≤40%, HFrEF) and contemporary measurement of NT-proBNP, 379 were on target doses of an ACE inhibitor or ARB at their initial visit and, of these, 172 (45%) fulfilled the key entry criteria for the PARADIGM-HF trial. Lack of symptoms (32%) and NT-proBNP

Condensers are widely used in chemical industry, refrigeration, air-conditioning and power generation systems. In this paper, the thermal design of a desuperheater-condenser has been carried out manually as well as using HTRI software. The paper provides information about the types and classification of condensers. The primary objective of this study is to design a desuperheater-condenser for Ammonia-Water system. Ammonia-Water system is widely used in the refrigeration industry. The manual calculations are based on standard co-relations available in various literatures. The results have been compared with HTRI. After comparative analysis the reasons for variation have been identified, critically reviewed and discussed. It has been observed that manual calculations often become lengthy and iterative. HTRI has a rigorous and integral approach which gives more accurate results as well. HTRI is the most widely used software in the industry. But it is also important to verify the results with manual calculations. Likewise, manual design should also be verified with industrial software like HTRI. It may happen sometimes that due to human error, manual design results may come out to be somewhat inaccurate. So in order to have a good and optimized design, manual and software based calculations should be carried out simultaneously and verified with each other.