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51. The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance

Author

Osadnik CR, Loeckx M, Louvaris Z, Demeyer H, Langer D, Rodrigues FM, Janssens W, Vogiatzis I, and Troosters T

Subjects
Clinical Respiratory Medicine, lcsh:RC705-779, Physical activity, COPD, lcsh:Diseases of the respiratory system, Exercise and Pulmonary Rehabilitation
Abstract

Christian R Osadnik,1–4,* Matthias Loeckx,1,5,6,* Zafeiris Louvaris,1,7 Heleen Demeyer,1,6 Daniel Langer,1,6 Fernanda M Rodrigues,1,6 Wim Janssens,6,8 Ioannis Vogiatzis,7,9 Thierry Troosters1,6 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; 2Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia; 3Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia; 4Institute for Breathing and Sleep, Melbourne, Victoria, Australia; 5Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg; 6Respiratory Division, University Hospitals, KU Leuven, Leuven, Belgium; 7Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece; 8Department of Chronic Disease, Metabolism and Aging, KU Leuven, Leuven, Belgium; 9Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK *These authors contributed equally to this work Purpose: Pulmonary rehabilitation (PR) enhances exercise tolerance in patients with COPD; however, improvements in physical activity (PA) are not guaranteed. This study explored the relationship between baseline exercise tolerance and changes in PA after PR.Materials and methods: Patient data from prospective clinical trials in the PR settings of Athens and Leuven (2008–2016) were analyzed. Validated PA monitors were worn for 1 week before and after a 12-week program. The proportion of patients who improved PA levels ≥1,000 steps/day (“PA responders”) after PR was compared between those with initial 6-minute walk distance [6MWDi]

Published
2018

60. Greater exercise tolerance in COPD during acute interval, compared to equivalent constant-load, cycle exercise: physiological mechanisms

Author

Louvaris, Z. Chynkiamis, N. Spetsioti, S. Asimakos, A. Zakynthinos, S. Wagner, P.D. Vogiatzis, I.

Abstract

Key points: Exercise intolerance is common in chronic obstructive pulmonary disease (COPD) patients. In patients with COPD, we compared an interval exercise (IE) protocol (alternating 30 s at 100% peak work rate (WRpeak) with 30 s at 50% WRpeak) with moderate-intensity constant-load exercise (CLE) at 75% WRpeak, which yielded the same work rate. Exercise endurance time and total work output were almost twice as high for IE than CLE. At exercise isotime (when work completed was the same between IE and CLE), IE was associated with less dynamic hyperinflation, lower blood lactate concentration, and greater respiratory and locomotor muscle oxygenation, but there were no differences in ventilation or cardiac output. However, at the limit of tolerance for each modality, dynamic hyperinflation was not different between IE and CLE, while blood lactate remained lower and muscle oxygenation higher with IE. Taken together, these findings suggest that dynamic hyperinflation and not muscle-based factors dictate the limits of tolerance in these COPD patients. Abstract: The relative importance of ventilatory, circulatory and peripheral muscle factors in determining tolerance to exercise in patients with chronic obstructive pulmonary disease (COPD) is not known. In 12 COPD patients (forced expiratory volume in one second: 58 ± 17%pred.) we measured ventilation, cardiac output, dynamic hyperinflation, local muscle oxygenation, blood lactate and time to exhaustion during (a) interval exercise (IE) consisting of 30 s at 100% peak work rate alternating with 30 s at 50%, and (b) constant-load exercise (CLE) at 75% peak work rate, designed to produce the same average work rate. Exercise time was substantially longer during IE than CLE (19.5 ± 4.8 versus 11.4 ± 2.1 min, p = 0.0001). Total work output was therefore greater during IE than CLE (81.3 ± 27.7 versus 48.9 ± 23.8 kJ, p = 0.0001). Dynamic hyperinflation (assessed by changes from baseline in inspiratory capacity, ΔIC) was less during IE than CLE at CLE exhaustion time (isotime, p = 0.009), but was similar at exhaustion (ΔICCLE: -0.38 ± 0.10 versus ΔICIE: -0.33 ± 0.12 l, p = 0.102). In contrast, at isotime, minute ventilation, cardiac output and systemic oxygen delivery did not differ between protocols (P > 0.05). At exhaustion in both protocols, the vastus lateralis and intercostal muscle oxygen saturation were higher in IE than CLE (p = 0.014 and p = 0.0002, respectively) and blood lactate concentrations were lower (4.9 ± 2.4 mmol l-1 versus 6.4 ± 2.2 mmol l-1, p = 0.039). These results suggest that (1) exercise tolerance with COPD is limited by dynamic hyperinflation; and (2) cyclically lower (50%) effort intervals in IE help to preserve muscle oxygenation and reduce metabolic acidosis compared with CLE at the same average work rate; but these factors do not appear to determine time to exhaustion. © 2020 The Authors. The Journal of Physiology © 2020 The Physiological Society

Published
2020

61. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Author

Zeymer, U., Ludman, P., Danchin, N., Kala, P., Maggioni, A. P., Weidinger, F, P Gale, C, Beleslin, B, Budaj, A, Chioncel, O, Dagres, N, Danchin, N, Emberson, J, Erlinge, D, Glikson, M, Gray, A, Kayikcioglu, M, P Maggioni, A, K Nagy, V, Nedoshivin, A, A-S, Petronio, Roos-Hesselink, J, Wallentin, L, Zeymer, U, Franz, Weidinger, Uwe, Zeymer, Nicolas, Danchin, Peter, Ludman, Peter, Sinnaeve, Petr, Kala, Roberto, Ferrari, Maggioni, Aldo P., Artan, Goda, Parounak, Zelveian, Kiril, Karamfilov, Zuzana, Motovska, Bent, Raungaard, Toomas, Marandi, Sameh Mohamed Shaheen, Rosa-Maria, Lidon, Pasi Paavo Karjalainen, Zviad, Kereselidze, Dimitrios, Alexopoulos, David, Becker, Martin, Quinn, Zaza, Iakobishvili, Hasan, Al-Farhan, Masoumeh, Sadeghi, Roberto, Caporale, Francesco, Romeo, Erkin, Mirrakhimov, Pranas, Serpytis, Andrejs, Erglis, Sasko, Kedev, Matthew Mercieca Balbi, Alice May Moore, Dariusz, Dudek, Jacek, Legutko, Jorge, Mimoso, Gabriel, Tatu-Chitoiu, Sinisa, Stojkovic, Evgeny, Shlyakhto, Khalid, F AlHabib, Matjaz, Bunc, Martin, Studencan, Mohamed Sami Mourali, Gani, Bajraktari, Marème, Konte, Florian, Larras, Elin Folkesson Lefrancq, Souad, Mekhaldi, Cécile, Laroche, Goda, A, Shuka, N, Pavli, E, Tafaj, E, Gishto, T, Dibra, A, Duka, A, Gjana, A, Kristo, A, Knuti, G, Demiraj, A, Dado, E, Hasimi, E, Simoni, L, Siqeca, M, Sisakian, H, Hayrapetyan, H, Markosyan, S, Galustyan, L, Arustamyan, N, Kzhdryan, H, Pepoyan, S, Zirkik, A, D Von Lewinski, Paetzold, S, Kienzl, I, Matyas, K, Neunteufl, T, Nikfardjam, M, Neuhold, U, Mihalcz, A, Glaser, F, Steinwender, C, Reiter, C, Grund, M, Hrncic, D, Hoppe, U, Hammerer, M, Hinterbuchner, L, Hengstenberg, C, G Delle Karth, Lang, I, Winkler, W, Hasun, M, Kastner, J, Havel, C, Derntl, M, Oberegger, G, Hajos, J, Adlbrecht, C, Publig, T, M-C, Leitgeb, Wilfing, R, Jirak, P, C-Y, Ho, Puskas, L, Schrutka, L, Spinar, J, Parenica, J, Hlinomaz, O, Fendrychova, V, Semenka, J, Sikora, J, Sitar, J, Groch, L, Rezek, M, Novak, M, Kramarikova, P, Stasek, J, Dusek, J, Zdrahal, P, Polasek, R, Karasek, J, Seiner, J, Sukova, N, Varvarovsky, I, Lazarák, T, Novotny, V, Matejka, J, Rokyta, R, Volovar, S, Belohlavek, J, Motovska, Z, Siranec, M, Kamenik, M, Kralik, R, Raungaard, B, Ravkilde, J, E Jensen, S, Villadsen, A, Villefrance, K, C Schmidt Skov, Maeng, M, Moeller, K, Hasan-Ali, H, A Ahmed, T, Hassan, M, Elguind, A, M Farouk Ismail, A Ibrahim Abd El-Aal, A El-sayed Gaafar, H Magdy Hassan, M Ahmed Shafie, M Nabil El-khouly, Bendary, A, Darwish, M, Ahmed, Y, Amin, O, Abdelhakim, A, Abosaif, K, Kandil, H, M A, G Galal, E El Hefny, E, M El Sayed, Aly, K, Mokarrab, M, Osman, M, Abdelhamid, M, Mantawy, S, R Ali, M, D Kaky, S, A Khalil, V, M E, A Saraya, Talaat, A, Nabil, M, M Mounir, W, Aransa, K. Mahmoud A., Kazamel, G, Anwar, S, Al-Habbaa, A, M Abd el Monem, Ismael, A, Amin Abu-Sheaishaa, M., M Abd Rabou, M, T M, A Hammouda, Moaaz, M, Elkhashab, K, Ragab, T, Rashwan, A, Rmdan, A, Abdelrazek, G, Ebeid, H, H Soliman Ghareeb, Farag, N, Zaki, M, Seleem, M, Torki, A, Youssef, M, A AlLah Nasser, N, Rafaat, A, Selim, H, M Makram, M, Khayyal, M, Malasi, K, Madkou, A, Kolib, M, Alkady, H, Nagah, A, Yossef, M, Wafa, A, Mahfouz, E, Faheem, G, M Magdy Moris, Ragab, A, Ghazal, M, Mabrouk, A, El-Masry, M, Naseem, M, Samir, S, Marandi, T, Reinmets, J, Allvee, M, Saar, A, Ainla, T, Vaide, A, Kisseljova, M, Pakosta, U, Eha, J, Lotamois, K, Sia, J, Myllymaki, J, Pinola, T, P Karjalainen, P, Paana, P, Mikkelsson, J, Ampio, M, Tsivilasvili, J, Zurab, P, Kereselidze, Z, Agladze, R, Melia, A, Gogoberidze, D, Khubua, N, Totladze, L, Metreveli, I, Chikovani, A, Eitel, I, Pöss, J, Werner, M, Constantz, A, Ahrens, C, Tolksdorf, H, Klinger, S, Sack, S, Heer, T, Lekakis, J, Kanakakis, I, Xenogiannis, I, Ermidou, K, Makris, N, Ntalianis, A, Katsaros, F, Revi, E, Kafkala, K, Mihelakis, E, Diakakis, G, Grammatikopoulos, K, Voutsinos, D, Alexopoulos, D, Xanthopoulou, I, Mplani, V, Foussas, S, Papakonstantinou, N, Patsourakos, N, Dimopoulos, A, Derventzis, A, Athanasiou, K, P Vassilikos, V, Papadopoulos, C, Tzikas, S, Vogiatzis, I, Datsios, A, Galitsianos, I, Koutsampasopoulos, K, Grigoriadis, S, Douras, A, Baka, N, Spathis, S, Kyrlidis, T, Hatzinikolaou, H, G Kiss, R, Becker, D, Nowotta, F, Tóth, K, Szabó, S, Lakatos, C, Jambrik, Z, Ruzsa, J, Ruzsa, Z, Róna, S, Toth, J, A Vargane Kosik, K S, B Toth, G Nagy, G, Ondrejkó, Z, Körömi, Z, Botos, B, Pourmoghadas, M, Salehi, A, Massoumi, G, Sadeghi, M, Soleimani, A, Sarrafzadegan, N, Roohafza, H, Azarm, M, Mirmohammadsadeghi, A, Rajabi, D, Rahmani, Y, Siabani, S, Najafi, F, Hamzeh, B, Karim, H, Siabani, H, Saleh, N, Charehjoo, H, Zamzam, L, Al-Temimi, T, Al-Farhan, H, Al-Yassin, A, Mohammad, A, Ridha, A, Al-Saedi, G, Atabi, N, Sabbar, O, Mahmood, S, Dakhil, Z, F Yaseen, I, Almyahi, M, Alkenzawi, H, Alkinani, T, Alyacopy, A, Kearney, P, Twomey, K, Iakobishvili, Z, Shlomo, N, Beigel, R, Caldarola, P, Rutigliano, D, L Sublimi Saponetti, Locuratolo, N, Palumbo, V, Scherillo, M, Formigli, D, Canova, P, Musumeci, G, Roncali, F, Metra, M, Lombardi, C, Visco, E, Rossi, L, Meloni, L, Montisci, R, Pippia, V, F Marchetti, M, Congia, M, Cacace, C, Luca, G, Boscarelli, G, Indolfi, C, Ambrosio, G, Mongiardo, A, Spaccarotella, C, S De Rosa, Canino, G, Critelli, C, Caporale, R, Chiappetta, D, Battista, F, Gabrielli, D, Marziali, A, Bernabò, P, Navazio, A, Guerri, E, Manca, F, Gobbi, M, Oreto, G, Andò, G, Carerj, S, Saporito, F, Cimmino, M, Rigo, F, Zuin, G, Tuccillo, B, F Scotto di Uccio, L Scotto di Uccio, Lorenzoni, G, Meloni, I, Merella, P, M Polizzi, G, Pino, R, Marzilli, M, Morrone, D, Caravelliorsini, P, Orsini, E, Mosa, S, Piovaccari, G, Santarelli, A, Cavazza, C, Romeo, F, Fedele, F, Mancone, M, Straito, M, Salvi, N, Scarparo, P, Severino, P, Razzini, C, Massaro, G, Cinque, A, Gaudio, C, Barillà, F, Torromeo, C, Porco, L, Mei, M, Lorio, R, Nassiacos, D, Barco, B, Sinagra, G, Falco, L, Priolo, L, Perkan, A, Strana, M, Bajraktari, G, Percuku, L, Berisha, G, Mziu, B, Beishenkulov, M, Abdurashidova, T, Toktosunova, A, Kaliev, K, Serpytis, P, Serpytis, R, Butkute, E, Lizaitis, M, Broslavskyte, M, G Xuereb, R, M Moore, A, M Mercieca Balbi, Paris, E, Buttigieg, L, Musial, W, Dobrzycki, S, Dubicki, A, Kazimierczyk, E, Tycinska, A, Wojakowski, W, Kalanska-Lukasik, B, Ochala, A, Wanha, W, Dworowy, S, Sielski, J, Janion, M, Janion-Sadowska, A, Dudek, D, Wojtasik-Bakalarz, J, Bryniarski, L, Z Peruga, J, Jonczyk, M, Jankowski, L, Klecha, A, Legutko, J, Michalowska, J, Brzezinski, M, Kozmik, T, Kowalczyk, T, Adamczuk, J, Maliszewski, M, Kuziemka, P, Plaza, P, Jaros, A, Pawelec, A, Sledz, J, Bartus, S, Zmuda, W, Bogusz, M, Wisnicki, M, Szastak, G, Adamczyk, M, Suska, M, Czunko, P, Opolski, G, Kochman, J, Tomaniak, M, Miernik, S, Paczwa, K, Witkowski, A, P Opolski, M, D Staruch, A, Kalarus, Z, Honisz, G, Mencel, G, Swierad, M, Podolecki, T, Marques, J, Azevedo, P, A Pereira, M, Gaspar, A, Monteiro, S, Goncalves, F, Leite, L, Mimoso, J, Manuel Lopes dos Santos, W., Amado, J, Pereira, D, Silva, B, Caires, G, Neto, M, Rodrigues, R, Correia, A, Freitas, D, Lourenco, A, Ferreira, F, Sousa, F, Portugues, J, Calvo, J, Almeida, F, Alves, M, Silva, A, Caria, R, Seixo, F, Militaru, C, Ionica, E, Tatu-Chitoiu, G, Istratoaie, O, Florescu, M, Lipnitckaia, E, Osipova, O, Konstantinov, S, Bukatov, V, Vinokur, T, Egorova, E, Nefedova, E, Levashov, S, Gorbunova, A, Redkina, M, Karaulovskaya, N, Bijieva, F, Babich, N, Smirnova, O, Filyanin, R, Eseva, S, Kutluev, A, Chlopenova, A, Shtanko, A, Kuppar, E, Shaekhmurzina, E, Ibragimova, M, Mullahmetova, M, Chepisova, M, Kuzminykh, M, Betkaraeva, M, Namitokov, A, Khasanov, N, Baleeva, L, Galeeva, Z, Magamedkerimova, F, Ivantsov, E, Tavlueva, E, Kochergina, A, Sedykh, D, Kosmachova, E, Skibitskiy, V, Porodenko, N, Litovka, K, Ulbasheva, E, Niculina, S, Petrova, M, Harkov, E, Tsybulskaya, N, Lobanova, A, Chernova, A, Kuskaeva, A, Kuskaev, A, Ruda, M, Zateyshchikov, D, Gilarov, M, Konstantinova, E, Koroleva, O, Averkova, A, Zhukova, N, Kalimullin, D, Borovkova, N, Tokareva, A, Buyanova, M, Khaisheva, L, Pirozhenko, T, Novikova, T, Yakovlev, A, Tyurina, T, Lapshin, K, Moroshkina, N, Kiseleva, M, Fedorova, S, Krylova, L, Duplyakov, D, Semenova, Y, Rusina, A, Ryabov, V, Syrkina, A, Demianov, S, Reitblat, O, Artemchuk, A, Efremova, E, Makeeva, E, Menzorov, M, Shutov, A, Klimova, N, Shevchenko, I, Elistratova, O, Kostyuckova, O, Islamov, R, Budyak, V, Ponomareva, E, U Ullah Jan, M Alshehri, A, Sedky, E, Alsihati, Z, Mimish, L, Selem, A, Malik, A, Majeed, O, Altnji, I, Alshehri, M, Aref, A, Alhabib, K, Aldosary, M, Tayel, S, M Abd AlRahman, N Asfina, K, G Abdin Hussein, Butt, M, N Markovic Nikolic, Obradovic, S, Djenic, N, Brajovic, M, Davidovic, A, Romanovic, R, Novakovic, V, Dekleva, M, Spasic, M, Dzudovic, B, Jovic, Z, Cvijanovic, D, Cvijanovic, S, Ivanov, I, Cankovic, M, Jarakovic, M, Kovacevic, M, Trajkovic, M, Mitov, V, Jovic, A, Hudec, M, Gombasky, M, Sumbal, J, Bohm, A, Baranova, E, Kovar, F, Samos, M, Podoba, J, Kurray, P, Obona, T, Remenarikova, A, Kollarik, B, Verebova, D, Kardosova, G, Studencan, M, Alusik, D, Macakova, J, Kozlej, M, Bayes-Genis, A, Sionis, A, C Garcia Garcia, R-M, Lidon, A Duran Cambra, C Labata Salvador, F Rueda Sobella, J Sans Rosello, M Vila Perales, T Oliveras Vila, M Ferrer Massot, Bañeras, J, Lekuona, I, Zugazabeitia, G, Fernandez-Ortiz, A, A Viana Tejedor, Ferrera, C, Alvarez, V, Diaz-Castro, O, M Agra-Bermejo, R, Gonzalez-Cambeiro, C, Gonzalez-Babarro, E, J Domingo-Del Valle, Royuela, N, Burgos, V, Canteli, A, Castrillo, C, Cobo, M, Ruiz, M, Abu-Assi, E, M Garcia Acuna, J, U., Zeymer, P., Ludman, N., Danchin, P., Kala, A. P., Maggioni, F., Weidinger, STEMI Investigators, Ac, and Spaccarotella, C.

Subjects
Registrie, medicine.medical_specialty, Acute coronary syndrome, Registry, medicine.medical_treatment, Cardiology, Reperfusion therapy, Retrospective Studie, Medical, medicine, Humans, cardiovascular diseases, Myocardial infarction, Registries, Disease management (health), Acute Coronary Syndrome, Societies, Medical, Quality of Health Care, Retrospective Studies, Acca, biology, business.industry, Health Policy, Primary percutaneous coronary intervention, Percutaneous coronary intervention, Disease Management, Retrospective cohort study, medicine.disease, biology.organism_classification, primary percutaneous coronary intervention, registry, reperfusion therapy, ST-elevation myocardial infarction, Cardiac surgery, Europe, surgical procedures, operative, Emergency medicine, ST Elevation Myocardial Infarction, Societies, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Aims The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. Methods and results Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission. Conclusion The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Published
2019

65. Both moderate and severe exacerbations accelerate physical activity decline in COPD patients

Author

Demeyer, H. Costilla-Frias, M. Louvaris, Z. Gimeno-Santos, E. Tabberer, M. Rabinovich, R.A. De Jong, C. Polkey, M.I. Hopkinson, N.S. Karlsson, N. Serra, I. Vogiatzis, I. Troosters, T. Garcia-Aymerich, J. Ivanoff, N. Karlsson, N. Corriol-Rohou, S. Jarrod, I. Erzen, D. Scuri, M. Montacchini, R. McBride, P. Kamel, N. Tabberer, M. Troosters, T. Janssens, W. Demeyer, H. Dobbels, F. De Boer, P. Kulich, K. Polkey, M.I. Hopkinson, N.S. Vogiatzis, I. Nikai, E. Van Der Molen, T. De Jong, C. Rabinovich, R.A. MacNee, B. Puhan, M.A. Frei, A.

Published
2018

67. Increasing implementation and delivery of pulmonary rehabilitation: key messages from the new ATS/ERS policy statement

Author

Vogiatzis, I, Rochester, Cl, Spruit, Ma, Thierry Troosters, T, Clini, Enrico, and on behalf of the American Thoracic Society/European Respiratory Society Task Force on Policy in Pulmonary Rehabilitation

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Rehabilitation, business.industry, Statement (logic), medicine.medical_treatment, rehabilitation, policy, health care, health care, rehabilitation, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Nursing, Health care, Key (cryptography), Physical therapy, Humans, Medicine, Pulmonary rehabilitation, 030212 general & internal medicine, business, Societies, Medical, policy
Abstract

The goal of the New Policy Statement is to expand provision of pulmonary rehabilitation to suitable patients worldwidehttp://ow.ly/ZcBJv

Published
2016
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68. Cardiac output measurement during exercise in COPD: A comparison of dye dilution and impedance cardiography

Author

Louvaris, Z. Spetsioti, S. Andrianopoulos, V. Chynkiamis, N. Habazettl, H. Wagner, H. Zakynthinos, S. Wagner, P.D. Vogiatzis, I.

Abstract

Introduction: Impedance cardiography (IC) derived from morphological analysis of the thoracic impedance signal is now commonly used for noninvasive assessment of cardiac output (CO) at rest and during exercise. However, in Chronic Obstructive Pulmonary Disease (COPD), conflicting findings put its accuracy into question. Objectives: We therefore compared concurrent CO measurements captured by IC (PhysioFlow: CO IC ) and by the indocyanine green dye dilution method (CO DD ) in patients with COPD. Methods: Fifty paired CO measurements were concurrently obtained using the two methods from 10 patients (FEV 1 : 50.5 ± 17.5% predicted) at rest and during cycling at 25%, 50%, 75% and 100% peak work rate. Results: From rest to peak exercise CO IC and CO DD were strongly correlated (r = 0.986, P

Published
2019

69. ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

Author

Radtke, T. Crook, S. Kaltsakas, G. Louvaris, Z. Berton, D. Urquhart, D.S. Kampouras, A. Rabinovich, R.A. Verges, S. Kontopidis, D. Boyd, J. Tonia, T. Langer, D. De Brandt, J. Goërtz, Y.M.J. Burtin, C. Spruit, M.A. Braeken, D.C.W. Dacha, S. Franssen, F.M.E. Laveneziana, P. Eber, E. Troosters, T. Neder, J.A. Puhan, M.A. Casaburi, R. Vogiatzis, I. Hebestreit, H.

Abstract

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients’ perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8-to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data. © ERS 2019.

Published
2019

70. Progression of physical inactivity in COPD patients: The effect of time and climate conditions – A multicenter prospective cohort study

Author

Boutou, A.K. Raste, Y. Demeyer, H. Troosters, T. Polkey, M.I. Vogiatzis, I. Louvaris, Z. Rabinovich, R.A. Van Der Molen, T. Garcia-Aymerich, J. Hopkinson, N.S.

Abstract

Purpose: Longitudinal data on the effect of time and environmental conditions on physical activity (PA) among COPD patients are currently scarce, but this is an important factor in the design of trials to test interventions that might impact on it. Thus, we aimed to assess the effect of time and climate conditions (temperature, day length and rainfall) on progression of PA in a cohort of COPD patients. Patients and methods: This is a prospective, multicenter, cohort study undertaken as part of the EU/IMI PROactive project, in which we assessed 236 COPD patients simultaneously wearing two activity monitors (Dynaport MiniMod and Actigraph GT3X). A multivariable generalized linear model analysis was conducted to describe the effect of the explanatory variables on PA measures, over three time points (baseline, 6 and 12 months). Results: At 12 months (n=157; FEV1% predicted=57.7±21.9) there was a significant reduction in all PA measures (Actigraph step count (4284±3533 vs 3533±293)), Actigraph moderate- to vigorous-intensity PA ratio (8.8 (18.8) vs 6.1 (15.7)), Actigraph vector magnitude units (374,902.4 (265,269) vs 336,240 (214,432)), MiniMod walking time (59.1 (34.9) vs 56.9 (38.7) mins) and MiniMod PA intensity (0.183 (0) vs 0.181 (0)). Time had a significant, negative effect on most PA measures in multivariable analysis, after correcting for climate factors, study center, age, FEV1% predicted, 6MWD and other disease severity measures. Rainfall was the only climate factor with a negative effect on most PA parameters. Conclusion: COPD patients demonstrate a significant decrease in PA over 1 year follow-up, which is further affected by hours of rainfall, but not by other climate considerations. © 2019 Boutou et al.

Published
2019

71. ERS statement on respiratory muscle testing at rest and during exercise

Author

Laveneziana, P. Albuquerque, A. Aliverti, A. Babb, T. Barreiro, E. Dres, M. Dubé, B.-P. Fauroux, B. Gea, J. Guenette, J.A. Hudson, A.L. Kabitz, H.-J. Laghi, F. Langer, D. Luo, Y.-M. Neder, J.A. O'Donnell, D. Polkey, M.I. Rabinovich, R.A. Rossi, A. Series, F. Similowski, T. Spengler, C. Vogiatzis, I. Verges, S.

Abstract

Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/ European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system. © ERS 2019.

Published
2019

72. Evaluation of a 12 weeks smartphone-based physical activity telecoaching intervention in chronic obstructive pulmonary disease: patient experience and lessons for implementation

Author

Troosters, Thierry, Loeckx, Matthias, Rabinovich, R, Demeyer, Heleen, Louvaris, Zafeiris, Tanner, R, Rubio, N, Frei, A, De Jong, C, Gimeno-Santos, E, Rodrigues, FM, Buttery, SC, Hopkinson, NS, Buesching, G, Strassman, A, Serra, I, Vogiatzis, I, Garcia-Aymerich, J, and Polkey, M

Abstract

ispartof: Journal of Medical Internet Research status: accepted

Published
2018

76. BLOOD PRESSURE LEVELS AND HOSPITALIZATIONS IN HEART FAILURE PATIENTS

Author

Koutsampasopoulos, K., primary, Imprialos, K., additional, Stavropoulos, K., additional, Vogiatzis, I., additional, Pittaras, A., additional, Grassos, C., additional, Manolis, A.J., additional, Faselis, C., additional, Kokkinos, P., additional, Alataki, S., additional, Bakaloudi, D., additional, and Doumas, M., additional

Published
2019
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78. The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance.

Author

Loeckx M., Troosters T., Vogiatzis I., Langer D., Janssens W., Osadnik C.R., Rodrigues F.M., Demeyer H., Louvaris Z., Loeckx M., Troosters T., Vogiatzis I., Langer D., Janssens W., Osadnik C.R., Rodrigues F.M., Demeyer H., and Louvaris Z.

Abstract

Purpose: Pulmonary rehabilitation (PR) enhances exercise tolerance in patients with COPD; however, improvements in physical activity (PA) are not guaranteed. This study explored the relationship between baseline exercise tolerance and changes in PA after PR. Material(s) and Method(s): Patient data from prospective clinical trials in the PR settings of Athens and Leuven (2008-2016) were analyzed. Validated PA monitors were worn for 1 week before and after a 12-week program. The proportion of patients who improved PA levels >=1,000 steps/day ("PA responders") after PR was compared between those with initial 6-minute walk distance [6MWDi] <350 m and >=350 m. Baseline predictors of PA change were evaluated via univariate and multivariate logistic regression analyses. Result(s): Two hundred thirty-six patients with COPD (median [IQR] FEV1 44 [33-59] % predicted, age 65+/-8 years, 6MWDi 416 [332-486] m) were included. The proportion of "PA responders" after PR was significantly greater in those with higher vs lower 6MWDi (37.9% vs 16.4%, respectively; P<0.001). 6MWDi group classification was the strongest baseline independent predictor of PA improvement (univariate OR 3.10, 95% CI 1.51-6.36). Conclusion(s): The likelihood of improving PA after PR is increased with greater 6MWDi. Baseline exercise tolerance appears as an important stratification metric for future research in this field.Copyright © 2018 Osadnik et al.

Published
2019

80. Near-infrared spectroscopy using indocyanine green dye for minimally invasive measurement of respiratory and leg muscle blood flow in patients with COPD

Author

Louvaris, Z. Habazettl, H. Wagner, H. Zakynthinos, S. Wagner, P. Vogiatzis, I.

Abstract

Reliability of near-infrared spectroscopy, measuring indocyanine green (ICG) for minimally invasive assessment of relative muscle blood flow during exercise has been examined in fit young individuals but not in chronic obstructive pulmonary disease (COPD). Here we ask whether it could be used to evaluate respiratory and locomotor muscle perfusion in COPD patients. Vastus lateralis muscle blood flow (MBF, the reference method calculated from arterial and muscle ICG concentration curves) and a blood flow index [BFI, calculated using only the (same) muscle ICG concentration curves] were compared in 10 patients (forced expiratory volume in 1 s: 51 6% predicted) at rest and during cycling at 25, 50, 75, and 100% of peak work rate (WRpeak). Intercostal muscle MBF and BFI were also compared during isocapnic hyperpnea at rest, reproducing ventilation levels up to those at WRpeak. Intercostal and vastus lateralis BFI increased with increasing ventilation during hyperpnea (from 2.5 0.3 to 4.5 0.7 nM/s) and cycling load (from 1.0 0.2 to 12.8 1.9 nM/s), respectively. There were strong correlations between BFI and MBF for both intercostal (r 0.993 group mean data, r 0.872 individual data) and vastus lateralis (r 0.994 group mean data, r 0.895 individual data). Fold changes from rest in BFI and MBF did not differ for either the intercostal muscles or the vastus lateralis. Group mean BFI data showed strong interrelationships with respiratory and cycling workload, and whole body metabolic demand (r ranged from 0.913 to 0.989) simultaneously recorded during exercise. We conclude that BFI is a reliable and minimally invasive tool for evaluating relative changes in respiratory and locomotor muscle perfusion from rest to peak exercise in COPD patient groups. NEW & NOTEWORTHY We show that noninvasive near-infrared spectroscopic (NIRS) detection of indocyanine green dye (ICG) after peripheral venous injection adequately reflects intercostal and locomotor muscle perfusion during exercise and hyperpnea in patients with chronic obstructive pulmonary disease (COPD). Mean, individual, and fold change responses from rest to exercise or hyperpnea correlated closely with the reference method, which requires arterial sampling. NIRS-ICG is a reliable, robust, and essentially noninvasive tool for assessing relative changes in intercostal and locomotor muscle perfusion in COPD patient groups. © 2018 the American Physiological Society

Published
2018

81. Smartphone-based physical activity telecoaching in chronic obstructive pulmonary disease: Mixed-methods study on patient experiences and lessons for implementation

Author

Loeckx, M. Rabinovich, R.A. Demeyer, H. Louvaris, Z. Tanner, R. Rubio, N. Frei, A. De Jong, C. Gimeno-Santos, E. Rodrigues, F.M. Buttery, S.C. Hopkinson, N.S. Büsching, G. Strassmann, A. Serra, I. Vogiatzis, I. Garcia-Aymerich, J. Polkey, M.I. Troosters, T.

Abstract

Background: Telecoaching approaches can enhance physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD). However, their effectiveness is likely to be influenced by intervention-specific characteristics. Objective: This study aimed to assess the acceptability, actual usage, and feasibility of a complex PA telecoaching intervention from both patient and coach perspectives and link these to the effectiveness of the intervention. Methods: We conducted a mixed-methods study based on the completers of the intervention group (N=159) included in an (effective) 12-week PA telecoaching intervention. This semiautomated telecoaching intervention consisted of a step counter and a smartphone app. Data from a project-tailored questionnaire (quantitative data) were combined with data from patient interviews and a coach focus group (qualitative data) to investigate patient and coach acceptability, actual usage, and feasibility of the intervention. The degree of actual usage of the smartphone and step counter was also derived from app data. Both actual usage and perception of feasibility were linked to objectively measured change in PA. Results: The intervention was well accepted and perceived as feasible by all coaches present in the focus group as well by patients, with 89.3% (142/159) of patients indicating that they enjoyed taking part. Only a minority of patients (8.2%; 13/159) reported that they found it difficult to use the smartphone. Actual usage of the step counter was excellent, with patients wearing it for a median (25th-75th percentiles) of 6.3 (5.8-6.8) days per week, which did not change over time (P=.98). The smartphone interface was used less frequently and actual usage of all daily tasks decreased significantly over time (P

Published
2018

82. Progressive dehydration in junior laser class sailors during world championship

Author

Arnaoutis, G. Verginadis, P. Seal, A.D. Vogiatzis, I. Sidossis, L.S. Kavouras, S.A.

Abstract

The purpose of this article is to assess the hydration status of elite young sailing athletes during World Championship competition. Twelve young, elite, male, Laser Class sailors (age: 15.8 ± 1.1 y, height: 1.74 ± 0.1 m, weight: 65.1 ± 1.5 kg, body fat: 12.5 ± 3.1%, training experience: 7.0 ± 1.2 y) participated in this descriptive study. After three-day baseline bodyweightmeasurements, hydration status was assessed via pre- and post-race body weights, urine-specific gravity, and thirst ratings via a visual analog scale during four consecutive days of racing. Measurements and data collection took place at the same time each racing day, with mean environmental temperature, humidity, and wind speed at 23.0 ± 0.8°C, 64-70%, and 9 ± 1 knots, respectively. Average racing time was 130 ± 9 min. Body weight was significantly decreased following each race-day as compared to prerace values (Day 1: -1.1 ± 0.2, Day 2: -2.5 ± 0.1, Day 3: -2.8 ± 0.1, and Day 4: -3.0 ± 0.1% of body weight; p < 0.05). The participants exhibited dehydration of -2.9 ± 0.2 and -5.8 ± 0.2% of body weight before and after the fourth racing day as compared to the three-day baseline body weight. Urine-specific gravity (pre-post→Day 1: 1.014-1.017; Day 2: 1.019-1.024; Day 3: 1.021-1.026; Day 4: 1.022-1.027) and thirst (pre- post→Day 1: 2.0-5.2; Day 2: 3.2-5.5; Day 3: 3.7-5.7; Day 4: 3.8-6.8) were also progressively and significantly elevated throughout the four days of competition. The data revealed progressive dehydration throughout four consecutive days of racing as indicated by decreased body weight, elevated urine concentration, and high thirst. © 2018 Human Kinetics, Inc.

Published
2018

83. Clinical features, follow-up, and reprogramming of patients with pacemaker in a secondary care center

Author

Vogiatzis, I, Sdogkos, E, Galitsianos, I, Koutsambasopoulos, K, and Stalidou, Z

Subjects
Research Article
Abstract

Introduction: During recent years, several recommendations and guidelines regarding cardiac pacing have been published in the literature. However, only a few studies have examined the implementation of these guidelines in clinical practice. The current study aimed to record and evaluate the effects of the mainstream studies, and the experience gathered by all patients who have been followed-up at the pacemaker Unit of Veroia Hospital, which is a secondary care center. Methods and results: Epidemiological, clinical, and electrocardiographic data were collected and studied for patients with a permanent pacemaker that have been followed-up in our hospital from 2002 to 2017. The total number of patients of the study was 3,902 (2,164 men; 55.45 %) with a mean age of 73.4 ± 12.6 years. Third degree atrioventricular (AV) block was the most common cause of pacing. Dysfunction of the sinus node involved the majority of cases with bradycardia-tachycardia syndrome. At 18 patients, the cause of permanent pacemaker implantation was carotid sinus syndrome and at 13 of them, cardio-vascular type of neurocardiogenic syncope. Dizziness and syncope were the most common symptoms. Dual-chamber pacing was the most common type of pacing, which has been increasing in recent years. In follow-up visits, the most frequent examinations concerned battery condition, as the stimulation and sensing threshold. Reprogramming of the device was required in 1,434 patients (36.75 %), especially during the first year after implantation. Conclusion: Pacing indications have been unchanged during all the years of the study and have been based on confirmed bradycardia and major symptoms. Reprogramming of the device was needed in an increased number of patients. HIPPOKRATIA 2018, 22(2): 75-79.

Published
2018

84. Validation of impedance cardiography in pulmonary arterial hypertension

Author

Panagiotou, M. Vogiatzis, I. Jayasekera, G. Louvaris, Z. Mackenzie, A. Mcglinchey, N. Baker, J.S. Church, A.C. Peacock, A.J. Johnson, M.K.

Abstract

Background: Non-invasive methods of measuring cardiac output are highly desirable in pulmonary arterial hypertension (PAH). We therefore sought to validate impedance cardiography (ICG) against thermodilution (TD) and cardiac magnetic resonance (CMR) in the measurement of cardiac output in patients under investigation for PAH. Methods: A prospective, cross-sectional study was performed to compare single-point measurements of cardiac output obtained by impedance cardiography (COICG) technology (PhysioFlow®) with (i) contemporaneous TD measurements (COTD) at rest and steady-state exercise during right heart catheterization and (ii) CMR measurements (COCMR) at rest obtained within 72 h. Results: Paired COICG and COTD measurements were obtained in 25 subjects at rest and 16 subjects at exercise. COCMR measurements were obtained in 16 subjects at rest. There was unsatisfactory correlation and agreement between COICG and COTD at rest (r = 0·42, P = 0·035; bias: 1·21 l min−1, 95% CI: −2·33 to 4·75 l min−1) and exercise (r =.65, P =.007; bias: 1·41 l min−1; 95% CI: −3·99 to 6·81 l min−1) and in the change in COICG and COTD from rest to exercise (r = 0·53, P = 0·033; bias: 0·76 l min−1, 95% CI: −3·74 to 5·26 l min−1). There was also a lack of correlation and unsatisfactory agreement between resting COICG and COCMR (r = 0·38, P = 0·1; bias: 1·40 l min−1, 95% CI: −2·48 to 5·28 l min−1). In contrast, there was close correlation and agreement between resting COTD and COCMR (r = 0·87, P

Published
2018

85. The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance

Author

Osadnik, C.R. Loeckx, M. Louvaris, Z. Demeyer, H. Langer, D. Rodrigues, F.M. Janssens, W. Vogiatzis, I. Troosters, T.

Abstract

Purpose: Pulmonary rehabilitation (PR) enhances exercise tolerance in patients with COPD; however, improvements in physical activity (PA) are not guaranteed. This study explored the relationship between baseline exercise tolerance and changes in PA after PR. Materials and methods: Patient data from prospective clinical trials in the PR settings of Athens and Leuven (2008-2016) were analyzed. Validated PA monitors were worn for 1 week before and after a 12-week program. The proportion of patients who improved PA levels ≥1,000 steps/day (“PA responders”) after PR was compared between those with initial 6-minute walk distance [6MWDi]

Published
2018

87. Cerebral oxygen availability during exercise in COPD patients with cognitive impairment

Author

Andrianopoulos, V. Vogiatzis, I. Gloeckl, R. Bals, R. Koczulla, R.A. Kenn, K.

Abstract

Insufficient cerebral blood flow regulation to meet increasing metabolic demand during physical exertion could be associated with cognitive impairment. We compared cerebral oxygen availability during exercise in cognitively impaired (CI) to cognitively normal (CN) COPD patients. Fifty-two patients (FEV1: 51 ± 16%) were classified as CN or CI according to the Montreal Cognitive Assessment. Patients performed cycle-ergometry at 75% peak capacity with continuous measurement of Near-Infrared Spectroscopy frontal-cortex Tissue oxygen Saturation Index (TSI), cerebral haemoglobin indices (oxy/deoxy/total- Hb), transcutaneous carbon-dioxide partial pressure (TcPCO2), and arterial oxygen saturation (SpO2). Twenty-one patients (40%) presented evidences of CI. During exercise, CN and CI patients exhibited mild to moderate SpO2decline (nadir[Δ]≥ −3 ± 2% and −5 ± 3%, respectively) but preserved baseline frontal-cortex TSI levels, whilst presenting small TcPCO2 perturbations and increased cerebral total-Hb (post [Δ]≥ 2.0 ± 3 μM sec−1). CI patients preserve the capacity to adequately maintain cerebral oxygen availability during submaximal exercise. Therefore, rehabilitative exercise training in CI patients with COPD exhibiting mild to moderate exercise-induced SpO2 decline does not appear to lead to reduced cerebral oxygen availability. © 2018 Elsevier B.V.

Published
2018

88. Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on Atrial Fibrillation

Author

Nieuwlaat R., Prins M. H., Le Heuzey J. -Y., Vardas P. E., Aliot E., Santini M., Cobbe S. M., Widdershoven J. W. M. G., Baur L. H., Levy S., Crijns H. J. G. M., Olsson B., Breithardt G., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J. -J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M. F., Alonso A., Lopez-Sendon J. L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., Andresen D., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventis, Grigoryan S. V., Apetyan I., Aroyan S., Camm A. J., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L. A., Davies W., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Capucci A., Borisov B., Petrov V. A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y. A., Ibrahim B. S. S., Tammam K., Saad A., Elghawaby H., Sherif H. Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F. F., Rubio J., Malpartida F., Corona M., Sanchez L. T., Miguel J., Herrera L., Quesada A., Garcia A. J. M., Gonzalez C. S., Juango M. S. A., Berjon-Reyero J., Alegret J. M., Fernandez J. M. C., Carrascosa C., Romero R. A. F., Lara M. G., Sendon J. L. L., de Diego J. J. G., Martin L. S., Irurita M., Guttierez N. H., Rubio J. R. S., Antorrena I., Paves A. B., Salvador A., Orriach M. D., Garcia A. A., Epelde F., Martinez V. B., Sanchez A. B., Galvez C. P., Rivero R. F., Madrid A. H., Baron-Esquivias G., Peinado R., Guindal J. A. G., Vera T. R., Fernandez E. L., Gayan R., Garcia J., Bodegas A., Lopez J. T., Florez J. M., Cabezas C. L., de Castroviejo E. V. R., Bellido J. M., Ruiz M. E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J. C., Lecocq G., Poulain C., Cleland J. G. F. C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N. A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G. -P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G. M., Fioranelli M., Naccarella F., Maranga S. S., Lepera G., Bresciani B., Seragnoli E., Forti M. C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S. M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A. A., op Reimer W. S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D. C. A., Veerhoek M. J., Kamps M., Haan D., van Rijn N., Bootsma A., van den A., Fransen H., Eurlings L., Meeder J., De Boer M. J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A. -M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J. M. F. R., Ferreira R., Freitas A., Morais J. C. A., Pires R., Gomes M. J. V., Gago P., Candeias R. A. C., Nunes L., Sa J. V. M., Ventura M., de Oliveira M., Alves L. B., Bostaca I., Olariu C. T., Dan G. A., Dan A., Podoleanu C., Frigy A., Georgescu G. I. M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D. L., Rancea R., Shubik Y. V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M. I., Makienko N. V., Potpara T., Knezevic S., Randjelovic M., Nieuwlaat R., Prins M.H., Le Heuzey J.-Y., Vardas P.E., Aliot E., Santini M., Cobbe S.M., Widdershoven J.W.M.G., Baur L.H., Levy S., Crijns H.J.G.M., Olsson B., Breithardt G., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J.-J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M.F., Alonso A., Lopez-Sendon J.L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., Andresen D., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventi, Grigoryan S.V., Apetyan I., Aroyan S., Camm A.J., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L.A., Davies W., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Capucci A., Borisov B., Petrov V.A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y.A., Ibrahim B.S.S., Tammam K., Saad A., Elghawaby H., Sherif H.Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F.F., Rubio J., Malpartida F., Corona M., Sanchez L.T., Miguel J., Herrera L., Quesada A., Garcia A.J.M., Gonzalez C.S., Juango M.S.A., Berjon-Reyero J., Alegret J.M., Fernandez J.M.C., Carrascosa C., Romero R.A.F., Lara M.G., Sendon J.L.L., de Diego J.J.G., Martin L.S., Irurita M., Guttierez N.H., Rubio J.R.S., Antorrena I., Paves A.B., Salvador A., Orriach M.D., Garcia A.A., Epelde F., Martinez V.B., Sanchez A.B., Galvez C.P., Rivero R.F., Madrid A.H., Baron-Esquivias G., Peinado R., Guindal J.A.G., Vera T.R., Fernandez E.L., Gayan R., Garcia J., Bodegas A., Lopez J.T., Florez J.M., Cabezas C.L., de Castroviejo E.V.R., Bellido J.M., Ruiz M.E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J.C., Lecocq G., Poulain C., Cleland J.G.F.C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N.A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G.-P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G.M., Fioranelli M., Naccarella F., Maranga S.S., Lepera G., Bresciani B., Seragnoli E., Forti M.C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S.M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A.A., op Reimer W.S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D.C.A., Veerhoek M.J., Kamps M., Haan D., van Rijn N., Bootsma A., van den A., Fransen H., Eurlings L., Meeder J., De Boer M.J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A.-M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J.M.F.R., Ferreira R., Freitas A., Morais J.C.A., Pires R., Gomes M.J.V., Gago P., Candeias R.A.C., Nunes L., Sa J.V.M., Ventura M., de Oliveira M., Alves L.B., Bostaca I., Olariu C.T., Dan G.A., Dan A., Podoleanu C., Frigy A., Georgescu G.I.M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D.L., Rancea R., Shubik Y.V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M.I., Makienko N.V., Potpara T., Knezevic S., and Randjelovic M.

Subjects
Male, medicine.medical_specialty, Rate control, Heart Diseases, Heart disease, Prognosi, Hemorrhage, Risk Assessment, Anticoagulation, Electrocardiography, Internal medicine, Atrial Fibrillation, Humans, Medicine, Sinus rhythm, Prospective Studies, Mortality, Prospective cohort study, Stroke, Survival rate, Aged, Progression, medicine.diagnostic_test, business.industry, Anticoagulant, Anticoagulants, Atrial fibrillation, Prognosis, medicine.disease, Management, Survival Rate, Prospective Studie, Heart Disease, Treatment Outcome, Heart failure, Disease Progression, Cardiology, Rhythm control, Female, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Aims: To gain insight in the prognosis and treatment of atrial fibrillation (AF) patients during 1-year follow-up in the Euro Heart Survey (EHS) on AF. Methods and results: The EHS enrolled 5333 AF patients in 2003-2004. One-year follow-up data were available for 80%. Of first detected AF patients, 46% did not have a recurrence during 1 year, paroxysmal AF largely remained paroxysmal AF (80%), and 30% of persistent AF progressed to permanent AF. Many treatment changes occurred since baseline. Oral anticoagulation was started in 19% and discontinued in 16% of all patients. Of patients initially on rhythm control 27% did not receive rhythm control during follow-up, whereas 15% of patients initially on rate control received rhythm control. Mortality was highest in permanent AF (8.2%), but also substantial in first detected AF (5.7%). In multivariable analysis, sinus rhythm at baseline was associated with lower mortality, but no significant effect was observed regarding the application of either rhythm or rate control. Conclusion: The EHS on AF provides unique prospective observational data on AF progression, long-term treatment, prognosis, and determinants of adverse outcome of the total clinical spectrum of AF in a European cardiology-based patient cohort. © The Author 2008.

Published
2008
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90. Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation

Author

Nieuwlaat R., Capucci A., Lip G. Y. H., Olsson S. B., Prins M. H., Nieman F. H., Lopez-Sendon J., Vardas P. E., Aliot E., Santini M., Crijns H. J. G. M., Andresen D., Camm A. J., Davies W., Levy S., Breithardt G., Cobbe S., Le Heuzey J. -Y., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J. -J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M. F., Alonso A., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventis, Grigoryan S. V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L. A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V. A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y. A., Ibrahim B. S. S., Tammam K., Saad A., Elghawaby H., Sherif H. Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F. F., Rubio J., Malpartida F., Corona M., Sanchez L. T., Miguel J., Herrera L., Quesada A., Garcia A. J. M., Gonzalez C. S., Juango M. S. A., Berjon-Reyero J., Alegret J. M., Fernandez J. M. C., Carrascosa C., Romero R. A. F., Lara M. G., Sendon J. L. L., de Diego J. J. G., Martin L. S., Irurita M., Guttierez N. H., Rubio J. R. S., Antorrena I., Paves A. B., Salvador A., Orriach M. D., Garcia A. A., Epelde F., Martinez V. B., Sanchez A. B., Galvez C. P., Rivero R. F., Madrid A. H., Baron-Esquivias G., Peinado R., Guindal J. A. G., Vera T. R., Fernandez E. L., Gayan R., Garcia J., Bodegas A., Lopez J. T., Florez J. M., Cabezas C. L., de Castroviejo E. V. R., Bellido J. M., Ruiz M. E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J. C., Lecocq G., Poulain C., Cleland J. G. F. C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N. A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G. -P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G. M., Fioranelli M., Naccarella F., Maranga S. S., Lepera G., Bresciani B., Seragnoli E., Forti M. C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S. M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A. A., op Reimer W. S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D. C. A., Veerhoek M. J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M. J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A. -M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J. M. F. R., Ferreira R., Freitas A., Morais J. C. A., Pires R., Gomes M. J. V., Gago P., Candeias R. A. C., Nunes L., Sa J. V. M., Ventura M., de Oliveira M., Alves L. B., Bostaca I., Olariu C. T., Dan G. A., Dan A., Podoleanu C., Frigy A., Georgescu G. I. M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D. L., Rancea R., Shubik Y. V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M. I., Makienko N. V., Potpara T., Knezevic S., Randjelovic M., Nieuwlaat R., Capucci A., Lip G.Y.H., Olsson S.B., Prins M.H., Nieman F.H., Lopez-Sendon J., Vardas P.E., Aliot E., Santini M., Crijns H.J.G.M., Andresen D., Camm A.J., Davies W., Levy S., Breithardt G., Cobbe S., Le Heuzey J.-Y., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J.-J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M.F., Alonso A., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventi, Grigoryan S.V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L.A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V.A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y.A., Ibrahim B.S.S., Tammam K., Saad A., Elghawaby H., Sherif H.Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F.F., Rubio J., Malpartida F., Corona M., Sanchez L.T., Miguel J., Herrera L., Quesada A., Garcia A.J.M., Gonzalez C.S., Juango M.S.A., Berjon-Reyero J., Alegret J.M., Fernandez J.M.C., Carrascosa C., Romero R.A.F., Lara M.G., Sendon J.L.L., de Diego J.J.G., Martin L.S., Irurita M., Guttierez N.H., Rubio J.R.S., Antorrena I., Paves A.B., Salvador A., Orriach M.D., Garcia A.A., Epelde F., Martinez V.B., Sanchez A.B., Galvez C.P., Rivero R.F., Madrid A.H., Baron-Esquivias G., Peinado R., Guindal J.A.G., Vera T.R., Fernandez E.L., Gayan R., Garcia J., Bodegas A., Lopez J.T., Florez J.M., Cabezas C.L., de Castroviejo E.V.R., Bellido J.M., Ruiz M.E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J.C., Lecocq G., Poulain C., Cleland J.G.F.C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N.A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G.-P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G.M., Fioranelli M., Naccarella F., Maranga S.S., Lepera G., Bresciani B., Seragnoli E., Forti M.C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S.M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A.A., op Reimer W.S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D.C.A., Veerhoek M.J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M.J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A.-M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J.M.F.R., Ferreira R., Freitas A., Morais J.C.A., Pires R., Gomes M.J.V., Gago P., Candeias R.A.C., Nunes L., Sa J.V.M., Ventura M., de Oliveira M., Alves L.B., Bostaca I., Olariu C.T., Dan G.A., Dan A., Podoleanu C., Frigy A., Georgescu G.I.M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D.L., Rancea R., Shubik Y.V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M.I., Makienko N.V., Potpara T., Knezevic S., and Randjelovic M.

Subjects
Adult, Male, medicine.medical_specialty, Oral anticoagulation, Guideline, Risk Assessment, Electrocardiography, Fibrinolytic Agents, Risk Factors, Drug Combination, Antithrombotic, medicine, Humans, Outpatient clinic, Risk factor, Multivariate Analysi, Stroke, Risk stratification, Aged, Antithrombotic therapy, Fibrinolytic Agent, Framingham Risk Score, business.industry, Risk Factor, Atrial fibrillation, Middle Aged, medicine.disease, Drug Combinations, Multivariate Analysis, Practice Guidelines as Topic, Emergency medicine, Physical therapy, Female, Guideline Adherence, Cardiology and Cardiovascular Medicine, business, Cardioversions, Risk assessment, Human
Abstract

Aims To describe guideline adherence and application of different stroke risk stratification schemes regarding antithrombotic therapy in real-life atrial fibrillation (AF) patients and to assess which factors influence antithrombotic management decisions. Methods and results The Euro Heart Survey enrolled 5333 AF patients in 35 countries, in 2003 and 2004. Prescription of antithrombotic drugs, especially oral anticoagulation (OAC), was hardly tailored to the patient's stroke risk profile as indicated by the joint guidelines of the American College of Cardiology, American Heart Association, and the European Society of Cardiology, ACCP guidelines, or CHADS2 and Framingham risk scores. In multivariable analysis, only a limited number of the well-known stroke risk factors triggered OAC prescription. In contrast, less relevant factors, of which clinical type of AF and availability of an OAC monitoring outpatient clinic were the most marked, played a significant role in OAC prescription. Electrical cardioversions and catheter ablations clearly triggered OAC prescription, whereas pharmacological cardioversions even in the presence of stroke risk factors did not. Conclusion Antithrombotic therapy in AF is hardly tailored to the patient's stroke risk profile. Factors other than well-known stroke risk factors were significantly involved in antithrombotic management decisions. To facilitate this tailored treatment, guideline writers and physician educators should focus on providing one uniform and easy to use stroke risk stratification scheme.

Published
2006
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92. Differences in content and organisational aspects of pulmonary rehabilitation programmes

Author

Spruit, Ma, Pitta, F., Garvey, C., Zuwallack, Rl, Roberts, Cm, Collins, Eg, Goldstein, R., Mcnamara, R., Surpas, P., Atsuyoshi, K., López Campos, J., Vogiatzis, I., Williams, Ja, Lareau, S., Brooks, D., Troosters, T., Singh, Sj, Hartl, S., Clini, Enrico, EFM W. o. u. t. e. r. s. On behalf of ERS Scientific Groups 0. 1., 02, 0. 9., 02, Aacvpr, ATS Pulmonary Rehabilitation Assembly, ERS COPD Audit team, Pulmonologie, RS: CAPHRI School for Public Health and Primary Care, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, and RS: CAPHRI - Asthma and COPD

Subjects
Pulmonary and Respiratory Medicine, Program evaluation, Process metrics, Performance metrics, COPD, Pulmonary rehabilitation, SYSTEMIC INFLAMMATION, Referral, medicine.medical_treatment, EXERCISE, Audit, CONTROLLED-TRIAL, DISEASE, Case mix index, Nursing, Medicine, Reimbursement, Chronic care, Rehabilitation, business.industry, EFFICACY, COMORBIDITIES, NATIONAL-SURVEY, business
Abstract

The aim was to study the overall content and organisational aspects of pulmonary rehabilitation programmes from a global perspective in order to get an initial appraisal on the degree of heterogeneity worldwide. A 12-question survey on content and organisational aspects was completed by representatives of pulmonary rehabilitation programmes that had previously participated in the European Respiratory Society (ERS) COPD Audit. Moreover, all ERS members affiliated with the ERS Rehabilitation and Chronic Care and/or Physiotherapists Scientific Groups, all members of the American Association of Cardiovascular and Pulmonary Rehabilitation, and all American Thoracic Society Pulmonary Rehabilitation Assembly members were asked to complete the survey via multiple e-mailings. The survey has been completed by representatives of 430 centres from 40 countries. The findings demonstrate large differences among pulmonary rehabilitation programmes across continents for all aspects that were surveyed, including the setting, the case mix of individuals with a chronic respiratory disease, composition of the pulmonary rehabilitation team, completion rates, methods of referral and types of reimbursement. The current findings stress the importance of future development of processes and performance metrics to monitor pulmonary rehabilitation programmes, to be able to start international benchmarking, and to provide recommendations for international standards based on evidence and best practice.

Published
2013
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93. Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial

Author

Demeyer, H, Louvaris, Z, Frei, A, Rabinovich, RA, De Jong, C, Gimeno-Santos, E, Loeckx, M, Buttery, SC, Rubio, N, Van der Molen, T, Hopkinson, NS, Vogiatzis, I, Puhan, MA, Garcia-Aymerich, J, Polkey, MI, Troosters, T, On behalf of the Mr Papp PROactive study group and the PROactive consortium, Dobbels, Fabienne, Groningen Research Institute for Asthma and COPD (GRIAC), University of Zurich, and Troosters, T

Subjects
Male, medicine.medical_treatment, INACTIVITY, Respiratory System, law.invention, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Randomized controlled trial, law, Medicine and Health Sciences, Pulmonary Rehabilitation, 030212 general & internal medicine, Patient group, Netherlands, COPD, OUTCOMES, Rehabilitation, Greece, Middle Aged, Prognosis, Telemedicine, 3. Good health, Exercise Therapy, Treatment Outcome, STEPS/DAY, TESTS, Female, Life Sciences & Biomedicine, Switzerland, Pulmonary and Respiratory Medicine, REHABILITATION, medicine.medical_specialty, Pronòstic mèdic, Chronic Obstructive Pulmonary Disease, SOCIETY, Physical activity, 610 Medicine & health, OBSTRUCTIVE PULMONARY-DISEASE, 03 medical and health sciences, medicine, Humans, Pulmonary rehabilitation, In patient, Exercise, Aged, Science & Technology, Intention-to-treat analysis, business.industry, A100, 1103 Clinical Sciences, 10060 Epidemiology, Biostatistics and Prevention Institute (EBPI), ADULTS, Physical fitness, medicine.disease, United Kingdom, LIFE, 030228 respiratory system, 2740 Pulmonary and Respiratory Medicine, ACTIVITY MONITORS, Spirometry, Physical therapy, business, Condició física
Abstract

RATIONALE: Reduced physical activity (PA) in patients with COPD is associated with a poor prognosis. Increasing PA is a key therapeutic target, but thus far few strategies have been found effective in this patient group. OBJECTIVES: To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA in patients with COPD in a multicentre European randomised controlled trial. METHODS: 343 patients from six centres, encompassing a wide spectrum of disease severity, were randomly allocated to either a usual care group (UCG) or a telecoaching intervention group (IG) between June and December 2014. This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application. The latter provided an individualised daily activity goal (steps) revised weekly and text messages as well as allowing occasional telephone contacts with investigators. PA was measured using accelerometry during 1 week preceding randomisation and during week 12. Secondary outcomes included exercise capacity and health status. Analyses were based on modified intention to treat. MAIN RESULTS: Both groups were comparable at baseline in terms of factors influencing PA. At 12 weeks, the intervention yielded a between-group difference of mean, 95% CI (lower limit - upper limit; ll-ul) +1469, 95% CI (971 to 1965) steps/day and +10.4, 95% CI (6.1 to 14.7) min/day moderate PA; favouring the IG (all p, Rationale Reduced physical activity (PA) in patients with COPD is associated with a poor prognosis. Increasing PA is a key therapeutic target, but thus far few strategies have been found effective in this patient group. Objectives To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA in patients with COPD in a multicentre European randomised controlled trial. Methods 343 patients from six centres, encompassing a wide spectrum of disease severity, were randomly allocated to either a usual care group (UCG) or a telecoaching intervention group (IG) between June and December 2014. This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application. The latter provided an individualised daily activity goal (steps) revised weekly and text messages as well as allowing occasional telephone contacts with investigators. PA was measured using accelerometry during 1 week preceding randomisation and during week 12. Secondary outcomes included exercise capacity and health status. Analyses were based on modified intention to treat. Main results Both groups were comparable at baseline in terms of factors influencing PA. At 12 weeks, the intervention yielded a between-group difference of mean, 95% CI (lower limit – upper limit; ll-ul) +1469, 95% CI (971 to 1965) steps/day and +10.4, 95% CI (6.1 to 14.7) min/day moderate PA; favouring the IG (all p≤0.001). The change in 6-min walk distance was significantly different (13.4, 95% CI (3.40 to 23.5) m, p

Published
2017

95. Heterogeneity of blood flow and metabolism during exercise in patients with chronic obstructive pulmonary disease

Author

Louvaris, Z. Habazettl, H. Asimakos, A. Wagner, H. Zakynthinos, S. Wagner, P.D. Vogiatzis, I.

Subjects
human activities, circulatory and respiratory physiology
Abstract

The study investigated whether the capacity to regulate muscle blood flow (Q) relative to metabolic demand (VO2) is impaired in COPD. Using six NIRS optodes over the upper, middle and lower vastus lateralis in 6 patients, (FEV1:46 ± 12%predicted) we recorded from each: a) Q by indocyanine green dye injection, b) VO2/Q ratios based on fractional tissue O2 saturation and c) VO2 as their product, during constant-load exercise (at 20%, 50% and 80% of peak capacity) in normoxia and hyperoxia (FIO2:1.0). At 50 and 80%, relative dispersion (RD) for Q, but not for VO2, was greater in normoxia (0.67 ± 0.07 and 0.79 ± 0.08, respectively) compared to hyperoxia (0.57 ± 0.12 and 0.72 ± 0.07, respectively). In both conditions, RD for VO2 and Q significantly increased throughout exercise; however, RD of VO2/Q ratio was minimal (normoxia: 0.12–0.08 vs hyperoxia: 0.13–0.09). Muscle Q and VO2 appear closely matched in COPD patients, indicating a minimal impact of heterogeneity on muscle oxygen availability at submaximal levels of exercise. © 2016 Elsevier B.V.

Published
2017

96. Exercice-induced bronchoconstriction among athletes: Assessment of bronchial provocation tests

Author

Vakali, S. Vogiatzis, I. Florou, A. Giavi, S. Zakynthinos, S. Papadopoulos, N.G. Gratziou, C.

Subjects
parasitic diseases, human activities, respiratory tract diseases
Abstract

Diagnosis of exercise-induced bronchoconstriction (EIB) requires the use of bronchial provocation tests (BPTs). We assessed exercise-induced respiratory symptoms (EIRS), EIB and asthma in athletes and evaluated the validity of BPTs in the diagnosis of EIB. Rhinitis and atopy were also assessed. Athletes with (n = 55) and without previous asthma diagnosis (n = 145) were tested by skin prick tests, lung function and eNO measurements. EIRS were recorded and EIB was assessed by methacholine (Mch), eucapnic voluntary hyperpnoea (EVH), mannitol and exercise test. EIRS were highly reported and history of asthma was common among athletes. A high prevalence of atopy (48.7%) and allergic rhinitis (30.5%) was found. Athletes with asthma had a higher response rate to Mch and to EVH, as compared with athletes without a previous asthma diagnosis (P = 0.012 and P = 0.017 respectively). Report of EIRS, rhinitis and atopy were not associated with a positive BPT response. Screening athletes for EIB using BPTs is suggested, irrespective of reported EIRS or a previous asthma diagnosis. © 2016 Elsevier B.V.

Published
2017

97. Cognitive impairment in COPD: Should cognitive evaluation be part of respiratory assessment?

Author

Andrianopoulos, V. Gloeckl, R. Vogiatzis, I. Kenn, K.

Abstract

Cognitive impairment is highly prevalent in patients with COPD and demonstrates multiple detrimental effects on many aspects of patient state and therapeutic outcomes. It is attributed to several overlapping pathophysiological factors, with the most common being the low level of oxygen saturation due to respiratory insufficiency. Despite the impact of cognitive impairment on clinical outcomes, the screening for coexisting cognitive deficits which may interfere with the successful progress of respiratory treatment is yet neglected. There is a special consideration that cognitive deficits should be taken into account when developing respiratory therapy plans. Cognitively impaired patients are likely to require more support and have need of an individualised respiratory care plan which can also be beneficial for their cognitive deficits. Pulmonary rehabilitation as a multidisciplinary approach could be prioritised for COPD patients with cognitive impairment. © 2017, European Respiratory Society. All rights reserved.

Published
2017

98. Heart Rate Recovery After 6-min Walking Test Predicts Acute Exacerbation in COPD

Author

Rodríguez, D.A. Kortianou, E.A. Alison, J.A. Casas, A. Giavedoni, S. Barberan-Garcia, A. Arbillaga, A. Vilaró, J. Gimeno-Santos, E. Vogiatzis, I. Rabinovich, R. Roca, J.

Abstract

Introduction: Abnormalities of autonomic function have been reported in patients with chronic obstructive pulmonary disease (COPD). Our objectives were to identify determinants of abnormal heart rate recovery at 1 min (HRR1) following completion of the 6-min walk test (6MWT) in COPD and to establish whether abnormal HRR1 predicts acute exacerbations (AECOPD). Methods: Hundred one COPD patients (FEV1 (SD) 53 (19) % predicted) were prospectively recruited in a multi-center study. HRR1 after the 6MWT was evaluated as the difference between heart rate at the end of the test and 1 min into the recovery (HRR1). Linear and logistic regression was used to identify predictors of HRR1 and AECOPD, respectively. The best HRR1 cut-off point to predict AECOPD was selected using the receiver operating characteristics (ROC) curves. The follow-up period was 12 months. Results: Distance covered during the 6MWT (m) and DLco (% predicted) were independently associated with HRR1 (r2 = 0.51, p = 0.001). Among several potential covariates, HRR1 emerged as the most significant predictor of AECOPD (Odds ratio [OR], 0.91 per beat of recovery; 95% confidence interval [CI], 0.85–0.97; p = 0.02). The ROC analysis indicated that subjects with HRR1 less than 14 beats (AUC, 0.71 [CI] 0.60–0.80; p = 0.0001) were more likely to suffer an exacerbation during the follow-up period (for HRR1, p = 0.004 [log-rank test]). Conclusions: HRR1 after the 6MWT is an independent predictor factor for AECOPD. Further studies are warranted to examine the physiological mechanisms associating a delayed HRR and acute exacerbations in COPD patients. © 2017, Springer Science+Business Media, LLC.

Published
2017

99. From the authors

Author

Panagiotou, M. Vogiatzis, I. Louvaris, Z. Jayasekera, G. McKenzie, A. McGlinchey, N. Baker, J.S. Church, A.C. Peacock, A.J. Johnson, M.K.

Published
2017

100. Home-based maintenance telerehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits

Author

Vasilopoulou, M. Papaioannou, A.I. Kaltsakas, G. Louvaris, Z. Chynkiamis, N. Spetsioti, S. Kortianou, E. Genimata, S.A. Palamidas, A. Kostikas, K. Koulouris, N.G. Vogiatzis, I.

Abstract

Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits. Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based maintenance telerehabilitation (n=47) with 12 months of hospital-based, outpatient, maintenance rehabilitation (n=50) and also to 12 months of usual care treatment (n=50) without initial PR. In a multivariate analysis during the 12-month follow-up, both home-based tele-rehabilitation and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389–0.687, and IRR 0.635, 95% CI 0.473–0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100–0.358, and IRR 0.375, 95% CI 0.207–0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI 0.072–0.185). Home-based maintenance tele-rehabilitation is equally effective as hospital-based, outpatient, maintenance PR in reducing the risk for acute COPD exacerbation and hospitalisations. In addition, it encounters a lower risk for ED visits, thereby constituting a potentially effective alternative strategy to hospital-based, outpatient, maintenance PR. Copyright ©ERS 2017

Published
2017

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