Search

Abnormal thyroid function (TF) is associated with cardiac dysfunction and may result in decompensation in patients with pre-existing heart failure (HF). International HF guidelines recommend routine assessment and treatment of TF. It is unclear to what extent TF is monitored in Canadian clinics, what the incidence of abnormal TF is in HF patients, and how TF abnormalities impact outcomes. METHODS: Retrospective review was performed for all patients managed at 3 hospital-based HF clinics in Calgary from November 2010 to January 2011. RESULTS: Charts of 773 patients were reviewed. Of these, 719 (93.0%) patients had some documentation of Thyroid Function Tests (TFTs); 592 (76.6%) had TFTs in the previous 12 months, and 54 (7.0%) had no record of TFTs. 21.3% (165) of patients had documented abnormal TF. Of 658 patients with normal TFTs (treated or not), 30.2% (199) decompensated compared to 41.0% (25) with abnormal TFTs (P=0.1109). Decompensation rates in patients with normal TFTs versus patients whose TFTs were abnormal or never measured were 30.2% (199) and 47.8% (55) respectively (P=0.0003). CONCLUSIONS: TF abnormalities are common in Calgary HF Clinic patients. The rate of HF decompensation is significantly lower in patients with normal TFTs than in those with unmeasured or abnormal TFTs. Further investigation is required to further evaluate the role of assessment and treatment of TF in reducing HF decompensation. [ABSTRACT FROM AUTHOR]

Background: Exercise prehabilitation is an evidence-based, safe, and effective method to increase quality of life, physical fitness and function, and post-surgical outcomes in solid organ transplant (SOT) patients. However, few prehabilitation programs for SOT patients exist in practice. Furthermore, there is a lack of multimodal prehabilitation programs that include behavior change support. To address this need, the Transplant Wellness Program (TWP) was designed., Objectives: The objective of the TWP is to assess both the effectiveness and implementation of a comprehensive and multimodal exercise and wellness behavior change intervention for patients undergoing kidney or liver transplant., Design: The TWP is a hybrid effectiveness-implementation trial consisting of exercise and wellness behavior change support., Patients: Individuals who are in evaluation or listed for kidney or liver transplant in Southern Alberta, Canada., Measurements: The primary outcomes of self-reported exercise and quality of life are assessed at intake, post-exercise intervention, 6 months post-intake, 12 weeks post-transplant, and annually for 5 years after program completion. Functional fitness measures will be assessed at intake, post-exercise intervention, 12 weeks post-transplant, 6 months post-intake, and 1-year post-intake. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework is used to determine the impact of TWP at the individual and health care system level., Methods: Recruitment began in November 2023 and will continue until November 2028. Participants take part in a 12-week exercise intervention and are offered individualized and group behavior change support. Continued exercise support is offered through maintenance classes after the completion of the 12-week intervention., Limitations: The design of the hybrid effectiveness-implementation trial with a single experimental group will not allow for comparisons to a control or usual care group, potentially impacting internal validity. Differences in number of participants between organ groups (kidney vs liver) and cohorts (pre-transplant vs post-transplant) will likely be uneven, requiring consideration when running and interpreting analyses., Conclusions: The TWP aims to support patients throughout the transplant journey through a multimodal and comprehensive exercise and wellness behavior change program. Results from this study will determine the effectiveness of the program and inform future scale-up and sustainability., Trial Registry Number: NCT06367244., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Nitroglycerin (NTG) dilates capacitance veins and resistance arterioles, but its relative effects on veins and arterioles are not known., Objectives: To compare NTG-induced changes in capacitance and conductance., Animals and Methods: Aortic, left ventricular and portal venous (P(port)) pressures, portal flow and relative changes in intestinal blood volume (IBV) ((99m)technetium blood-pool scintigraphy) were measured in seven isoflurane-anesthetized, splenectomized dogs. Changes in intestinal vascular capacitance and conductance (mean portal flow/[mean aortic pressure - mean P(port)]) were determined when NTG was continuously administered (0.8 to 150 microg/kg/min) into a jugular vein. Pressure-volume (ie, P(port)-IBV) curves were defined by impeding portal flow, and capacitance was defined as the IBV at P(port)=7.5 mmHg., Results: At lower doses, NTG increased capacitance without increasing conductance, but conductance increased considerably with little further increase in capacitance at higher doses. Dose-response analysis revealed that the half-maximum capacitance effect was achieved at an NTG infusion rate of 3.5 microg/kg/min, whereas a rate of 35 microg/kg/min was required for the half-maximum conductance effect., Conclusions: At lower doses, NTG dilates capacitance vessels primarily, and that effect approaches its maximum before significant dilation of conductance vessels is manifest. However, at higher doses, the increase in conductance is substantial with little additional effect on capacitance.