Patterns of pulmonary function and mortality in chronic heart failure, results from the MyoVasc study

Background

Preclinical evidence suggests that pulmonary fibrosis due to left heart disease may represent end-organ damage in heart failure (HF). Vice versa, decreased pulmonary function is related to worsening of heart failure in the absence of obstructive airway pattern.

Purpose

This study investigated the relationship between patterns of pulmonary function (i.e. obstruction and restriction) and mortality in chronic HF.

Methods

For the present analysis data from the MyoVasc-study (N=3,289) were analysed. During a five-hour examination in the dedicated study center, systematic phenotyping was performed in a highly standardized setting. Chronic HF was defined as American Heart Association HF Stage C/D. Information on pulmonary function was assessed via body plethysmography (MasterScreen Body, Carefusion, Germany). Participants with forced expiratory ratio <0.7 or COPD were categorized as obstructive, while restriction was defined as reduction in total lung capacity. Information on vital status was obtained via registration offices.

Results

The analysis sample comprised 1,509 individuals with chronic heart failure and information on pulmonary function, of whom 286 had HF with reduced ejection fraction (HFrEF), 559 HF with preserved ejection fraction (HFpEF), and 333 HFpEFborderline. The mean age was 64.6±11.3 years, 38.7% were female. In the sample 124 subjects had pulmonary restriction and 400 individuals had an obstruction. During a median time to follow up of 3.70 (inter quartile range 1.25 to 4.00) years, death occurred in 170 individuals. Among clusters of pulmonary function most participants died in the restriction group (25.0%), followed by pulmonary obstruction (12.2%) and normal pulmonary function (7.3%, P for trend <0.001). Cox- regression analysis adjusted for age, sex and height revealed pulmonary restriction (hazard ratio (HR) 3.00 [95% confidence interval 2.04–4.42], P<0.001] and obstruction (HR 1.61 [1.11–2.35], P=0.01) as predictors of all-cause death. After additional controlling for traditional cardiovascular risk factors and the clinical profile only pulmonary restriction remained an independent predictor of mortality (HRrestriction 2.12 [1.50–3.43]; P=0.002; HRobstruction 1.35 [0.91–2.00]; P=0.10). Among HF phenotypes obstruction was only in individuals with HFpEF an independent predictor of all-cause death (HRHFpEF 2.60 [1.29–5.23]; P=0.007; HRHFpEFborderline 1.58 [0.70–3.57]; P=0.27; HRHFrEF 0.96 [0.52–1.78]; P=0.90), while pulmonary restriction was found to be predictive for death only in subjects with HFpEFborderline (HRHFpEF 2.15 [0.70–6.64]; P=0.18; HRHFpEFborderline: HR 5.47 [2.56–11.68]; P<0.001; HRHFrEF 1.74 [0.88–3.46]; P=0.11)

Conclusion

In chronic heart failure, pulmonary restriction was a stronger predictor of mortality than obstructive airway pattern. The present analysis supports the hypothesis of pulmonary fibrosis as end-organ damage in HF, and may potentially represent a therapeutic target.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): German Center for Cardiovascular Research (DZHK)

Feasibility, preliminary efficacy, and accessibility of a twitter-based social support group vs Fitbit only to decrease sedentary behavior in women

BACKGROUND

Health behavior change interventions delivered by social media allow for real-time, dynamic interaction, peer social support, and experimenter-provided content.

AIMS

We tested the feasibility, acceptability, and preliminary efficacy of a novel Twitter-based walking break intervention with daily behavior change strategies and prompts for social support, combined with a Fitbit, vs. Fitbit alone.

METHODS

In a 2-group pilot, 45 sedentary women from a heart clinic were randomized to Twitter + Fitbit activity tracker (Tweet4Wellness, n = 23) or Fitbit-only (control, n = 22). All received a Fitbit and 13 weeks of tailored weekly step goals. Tweet4Wellness consisted of a private Twitter support group, with daily automated behavior change "tweets" informed by behavior change theory, and encouragement to communicate within the group. Feasibility outcomes included recruitment and enrollment numbers, implementation challenges, and number and type of help requests from participants throughout the study period. Preliminary efficacy outcomes provided by Fitbit data were sedentary minutes, number of hours with >250 steps, maximum sitting bout, weighted sedentary median bout length, total steps, intensity minutes (>3.0 METS), and ratio of time spent sitting-to-moving. Acceptability outcomes included level of Twitter participation within Tweet4Wellness, and Likert scale plus open-ended survey questions on enjoyment and perceived effectiveness of intervention components. Survey data on acceptability of the features of the intervention were collected at 13 weeks (end-of-treatment [EOT]) and 22 weeks (follow-up).

RESULTS

The study was feasible, with addressable implementation challenges. Tweet4Wellness participants changed significantly from baseline to EOT relative to control participants on number of active hours p = .018, total steps p = .028, and ratio of sitting-to-moving, p = .014. Only sitting-to-moving was significant at follow-up (p = .047). Among Tweet4Wellness participants, each tweet sent during treatment was associated with a 0.11 increase in active hours per day (p = .04) and a 292-step increase per day (p < .001). Tweet4Wellness participants averaged 54.8 (SD = 35.4) tweets, totaling 1304 tweets, and reported liking the accountability and peer support provided by the intervention.

CONCLUSION

A Twitter-delivered intervention for promoting physical activity among inactive women from a heart clinic was feasible, acceptable, and demonstrated preliminary efficacy in increasing daily active hours, daily total steps, and the ratio of sitting-to-moving from pre to post for the intervention compared with the control. Lessons learned from this pilot suggest that the next study should expand the recruitment pool, refine the intervention to increase group engagement, and select active hours, total steps, and ratio of sitting-to-movement as primary sedentary behavior measures.

Effects of work-family conflict and job insecurity on psychological distress

Background

Work-family conflict (WFC) and job insecurity are important determinants of workers' mental health.

Aims

To examine the relationship between WFC and psychological distress, and the co-occurring effects of WFC and job insecurity on distress in US working adults.

Methods

This study used cross-sectional data from the 2010 National Health Interview Survey (NHIS) for adults aged 18-64 years. The 2010 NHIS included occupational data from the National Institute for Occupational Safety and Health (NIOSH) sponsored Occupational Health Supplement. Logistic regression models were used to examine the independent and co-occurring effects of WFC and job insecurity on distress.

Results

The study group consisted of 12059 participants. In the model fully adjusted for relevant occupational, behavioural, sociodemographic and health covariates, WFC and job insecurity were independently significantly associated with increased odds of psychological distress. Relative to participants reporting WFC only, participants reporting no WFC and no job insecurity had lower odds of moderate and severe distress. Co-occurring WFC and job insecurity was associated with significantly higher odds of both moderate [odds ratio (OR) = 1.55; 95% confidence interval (CI) 1.25-1.9] and severe (OR = 3.57; 95% CI 2.66-4.79) distress.

Conclusions

Rates of WFC and job insecurity were influenced by differing factors in working adults; however, both significantly increased risk of adverse mental health outcomes, particularly when experienced jointly. Future studies should explore the temporal association between co-occurring WFC and job insecurity and psychological distress.

MRI appearance of disseminated osseous tuberculosis

Disseminated osseous tuberculosis is a rare disease. This is a report of two cases of disseminated osseous tuberculosis imaged with MRI at 1.5-T, CT, plain radiography and bone scintigraphy. CT and plain radiography demonstrated either highly destructive or cystic lesions with sclerotic margins. Bone scintigraphy and plain radiography were quite insensitive in detecting areas of involvement compared to MRI. On MRI the abnormal areas had short T-1 relaxation values, which is an atypical appearance for bony infections, and prolonged T-2 relaxation values. The reason for the T-1 relaxation behavior is uncertain. MRI also provided delineation of epidural extent.

Traumatic pericardial hematoma simulating tricuspid valve obstruction

A large pericardial hematoma caused profound hypoxia, cyanosis, and hypotension in a patient who had sustained trauma in an automobile accident. Angiographic and cardiac catheterization findings suggested intracardiac obstruction at the level of the tricuspid valve. This case emphasizes that localized accumulations of blood or fluid within the pericardial space can simulate intracardiac masses or valve obstruction. Partial pericardiectomy was curative in this patient.