| Validity, prognostic value and optimal cutoff of respiratory muscle strength in patients with chronic heart failure changes with beta-blocker treatment. | |
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MedLine Citation:
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PMID: 19474739 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Training studies frequently use maximum inspiratory mouth occlusion pressure (PImax) as a therapeutic target and surrogate marker. For patients on beta-blocker (BBL), prognostic data allowing this extrapolation do not exist. Furthermore, the effects of BBL, mainstay of modern chronic heart failure therapy, on respiratory muscle function remain controversial. Finally, no proper separate cutoff according to treatment exists. DESIGN: Prospective, observational inclusion of patients with stable systolic chronic heart failure and recording of 1 year and all-time mortality for endpoint analysis. METHODS: In 686 patients, 81% men, 494 patients on BBL, PImax was measured along with clinical evaluation. The median follow-up was 50 months (interquartile range: 26-75 months). RESULTS: Patients with or without BBL did not differ significantly for PImax, percentage of predicted PImax or other marker of disease severity. PImax was a significant (hazard ratio: 0.925; 95% confidence interval: 0.879-0.975; chi(2): 8.62) marker of adverse outcome, independent of BBL-status or aetiology. Percentage of predicted PImax was not independent of PImax. The cutoff identified through receiver-operated characteristics for 1-year mortality was 4.14 kPa for patients on BBL and 7.29 kPa for patients not on BBL. When separated accordingly, 1-year mortality was 8.5 versus 21.4%, P=0.02, for patients not on BBL and 4.3 versus 16.2%, P<0.001, for patients on BBL. CONCLUSION: This study fills the gap between trials targeting respiratory muscle on a functional basis and the resultant prognostic information with regard to BBL. BBL lowered the optimal PImax cutoff values for risk stratification without changing the measured values of PImax. This should be considered at inclusion and evaluation of trials and interpretation of exercise parameters. |
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Authors:
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Lutz Frankenstein; Manfred Nelles; F Joachim Meyer; Caroline Sigg; Dieter Schellberg; B Andrew Remppis; Hugo A Katus; Christian Zugck |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology Volume: 16 ISSN: 1741-8275 ISO Abbreviation: Eur J Cardiovasc Prev Rehabil Publication Date: 2009 Aug |
Date Detail:
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Created Date: 2009-07-30 Completed Date: 2009-10-29 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101192000 Medline TA: Eur J Cardiovasc Prev Rehabil Country: England |
Other Details:
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Languages: eng Pagination: 424-9 Citation Subset: IM |
Affiliation:
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Department of Cardiology, University of Heidelberg, Heidelberg, Germany. Lutz.Frankenstein@med.uni-heidelberg.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use* Atrial Natriuretic Factor / blood Chi-Square Distribution Exercise Test Female Follow-Up Studies Heart Failure / blood, drug therapy*, physiopathology* Humans Male Middle Aged Muscle Strength / physiology* Prognosis Proportional Hazards Models Prospective Studies Protein Precursors / blood ROC Curve Respiratory Muscles / physiopathology* Statistics, Nonparametric Survival Analysis Systole / physiology |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/N-terminal proatrial natriuretic peptide; 0/Protein Precursors; 85637-73-6/Atrial Natriuretic Factor |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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