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Stroke patients with hemiplegia can sometimes achieve independent life at home or in light care facilities after rehabilitation. This study examined the outcomes of rehabilitation in stroke patients with severe hemiplegia.This study included 50 patients with Brunnstrom recovery stage I-II hemiplegia at the start of rehabilitation for stroke. Good outcome after rehabilitation was defined as independent life with functional independence measure (FIM) score of 100 or greater. Predictors for post-rehabilitation functional recovery were statistically analyzed.FIM scores of 100 or greater in 12 of 50 patients (24%) allowed independent life after stroke rehabilitation. According to univariate analysis, factors associated with a FIM score of 100 or greater and good prognosis after rehabilitation were younger age (70 years), paralysis caused by intracerebral hematoma (ICH), no cortical lesions, short time from admission to comprehensive inpatient rehabilitation (CIR) for stroke (within 1 month), and good status at the start of early rehabilitation and CIR. Eleven of the 12 patients with good prognosis (FIM ≥100) had ICH and a basal ganglia lesion with no cortical damage. Analysis of the location of lesions suggested that many patients with basal ganglia ICH lesions and little cortical involvement have good prognoses.Stroke patients with severe hemiplegia showed a slightly different distribution of lesions between ICH and cerebral ischemia. Cortical involvement may be a prognostic factor for outcome after rehabilitation in stroke patients with severe hemiplegia. More aggressive rehabilitation interventions may be important for patients with severe hemiplegia, especially without cortical involvement.

Background: Identification of elevation in pulmonary pressures during exercise may provide prognostic and therapeutic implications in patients with connective tissue disease (CTD). Interstitial lung disease (ILD) is common in CTD patients and subtle interstitial abnormalities detected by lung ultrasound could predict exercise-induced pulmonary hypertension (PH). Methods and Results: Echocardiography and lung ultrasound were performed at rest and bicycle exercise in CTD patients (n=41) and control subjects without CTD (n=24). Ultrasound B-lines were quantified by scanning four intercostal spaces in the right hemithorax. We examined the association between total B-lines at rest and the development of exercise-induced PH during ergometry exercise. Compared to controls, the number of total B-lines at rest was higher in CTD patients (0 [0, 0] vs. 2 [0, 9], p

Background Anaerobic threshold (AT) and peak oxygen uptake ( V ˙ O 2 ) are well known as indicators of severity and prognosis of heart failure. Since these parameters are regulated by many factors, multiple organ dysfunction may occur in chronic heart failure, and these two parameters would vary among patients. However, it is not clear whether AT and peak V ˙ O 2 deteriorate similarly. Therefore, we planned to compare the degree of deterioration of these two parameters using a ratio of AT and peak V ˙ O 2 (%AT/peak), and evaluated its significance in heart failure subjects. Methods One hundred ninety-four stable heart failure patients who had optimal medical treatment for at least 3 months were enrolled. Cardiopulmonary exercise testing, echocardiography, and blood sampling were examined within one week. Since %AT/peak varied from 50.3% to 108.5%, we divided patients into tertiles of %AT/peak [Group A, 50.1–70.0 (n = 112), Group B, 70.1–90.0 (n = 64), Group C, 90.1–110.0 (n = 18)], and compared factors relating with skeletal muscle and heart failure among these 3 groups. Results In Group A, ratio of measured AT against predicted value (%AT) and measured peak V ˙ O 2 against predicted value (%peak V ˙ O 2 ) were similar (80.3 ± 19.0% and 80.4 ± 17.1%, respectively). Peak V ˙ O 2 became lower as %AT/peak increased (Group B; 65.6 ± 14.8%, p Conclusions %AT/peak showed negative correlation with peak V ˙ O 2 . In chronic heart failure, muscle weakness occurs at an early stage, and this can be evaluated using %AT/peak.

Background Myocardial ischemia induces cardiac dysfunction, resulting in insufficient oxygen supply to peripheral tissues and mismatched energy production during exercise. To relieve the insufficient oxygen supply, heart rate (HR) response is augmented; however, beta-adrenergic receptor blockers (BB) restrict HR response. Although BB are essential drugs for angina pectoris, the effect of BB on exercise tolerance in patients with angina has not been studied. The aim of this study was to clarify the importance of HR augmentation to preserve exercise tolerance in patients with angina pectoris. Methods Forty-two subjects who underwent cardiopulmonary exercise testing (CPX) to detect myocardial ischemia were enrolled. CPX was performed until exhaustion or onset of significant myocardial ischemia using a ramp protocol. Subjects were assigned to three groups (Group A: with ST depression during CPX with significant coronary stenosis and taking BB; Group B: with ST depression and not taking BB; Group C: without ST depression and not taking BB). HR response to exercise was evaluated during the following two periods: below and above ischemic threshold (IT). In Group C, it was evaluated during the first 2 min and the last 2 min of a ramp exercise. Results No significant differences were observed among the three groups with regard to patients’ basic characteristics. Below IT, there were no differences in oxygen pulse/watt (O2 pulse increasing rate), HR/watt (ΔHR/ΔWR), and Δ V ˙ O 2 / Δ WR . Above IT, O2 pulse increasing rate was greater in Group A than in Group B. ΔHR/ΔWR was smaller in Group A than in Group B. Δ V ˙ O 2 / Δ WR became smaller in Group A than in Group B. There was no difference in anaerobic threshold, and peak V ˙ O 2 was smaller in Group A than in Group B. Conclusions Restriction of HR response by a BB is shown to be one of the important factors in diminished exercise tolerance.

Although exercise oscillatory ventilation has emerged as a potent independent risk factor for adverse prognosis in heart failure, it is not well known whether cardiac rehabilitation can improve oscillatory ventilation. In this study, we investigated the magnitude of oscillations in ventilation before and after cardiac rehabilitation in chronic heart failure patients with exercise oscillatory ventilation. Cardiac rehabilitation (5-month program) was performed in 26 patients with chronic heart failure who showed an oscillatory ventilation pattern during cardiopulmonary exercise testing (CPX). After the 5-month rehabilitation program was completed, the patients again underwent CPX. To determine the magnitude of oscillations in ventilation, the amplitude and cycle length of the oscillations were calculated and compared with several other parameters, including biomarkers that have established prognostic value in heart failure. At baseline before cardiac rehabilitation, both oscillation amplitude (R = 0.625, P

Background:Postoperative atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG). We investigated the risk factors for postoperative AF and analyzed the relationship between blood sugar concentration (BS) and AF after CABG.Methods and Results:A total of 199 consecutive patients who underwent isolated CABG were retrospectively examined and classified according to the presence (n=95) or absence (n=104) of postoperative AF. On univariate analysis mean postoperative BS (P