A new EJG section entitled “Geographic Insights in Brief”

We are happy to announce a new European Journal of Geography (EJG) section titled ‘Geographic Insights in brief’. This initiative complements the new approach of EJG publishing (immediate publication of papers after the end of the review process) The short papers in this section will be published as part of each issue of the journal and will be reviewed only by the editorial team, in order to achieve fast dissemination of new and interesting ideas and applications. This section will accept two kinds of papers: First, papers announcing new ideas, breakthroughs and innovations in all Geographical areas that need to be immediately communicate to all geographers. The authors can later proceed to publish a fully developed traditional paper. Second, brief reports focusing on short, clear and pointed geographical research results and data. These shorter and more digestible items will help geographers to get a better understanding about specific spatial dimensions of environmental, social and economic phenomena and interactions that can feed an ongoing policy discussion with just a small amount of original visual analytics and geographical data. That is, present a smart and successive visualization or datasets, such as cartograms, mental maps, web-GIS platforms, real-time geographies and so on. This process provides new opportunities for intellectual communications and benefits for both researchers and practitioners to present new theoretical and empirical findings from new research and/or innovative geospatial applications.

European Journal of Geography (Year 2023): Reviewer Appreciation & Publication Recap

Dear Readers, As we begin a new year full of potential and opportunity, we wish each of you much joy and success. As we embark on this journey, we also celebrate a significant milestone – the fifteenth anniversary of the European Journal of Geography. Over the past decade and a half, our journal has become a beacon of excellence in the field of geography and the social sciences. This journey has been characterised by unwavering commitment and tireless dedication, a collective endeavour led by the dedicated members of our editorial team and the European Association of Geographers (EUROGEO). Their diligence and passion have been instrumental in making our journal the respected publication it is today. Looking back on our shared history, we are proud to have published over 310 articles dealing with key topics in geography, planning and development. These scholarly contributions have not only explored and analysed important topics, but have also introduced new ideas (Koutsopoulos, 2022; Manetos et al., 2022), methods (Cramer-Greenbaum, 2023; Krevs et al., 2023; Morawski & Wolff-Seidel, 2023) and data (Hojati & Mokarram, 2016) that will inspire future generations of geographers to transcend conventional disciplinary boundaries. The richness of our content encompasses numerous facets and includes the fields of geography education (Fraile-Jurado & Periáñez-Cuevas, 2023; Humble, 2023; Martínez-Hernández et al., 2023; Mašterová, 2023; Puertas-Aguilar et al., 2023), physical geography (Sánchez-Martínez & Cabrera, 2015), sustainability (Leininger-Frézal et al., 2023; Mally, 2021), tourism (Bandt et al., 2022; Jovanovic et al., 2022), geoinformatics (Batsaris et al., 2023; Vestena et al., 2023), spatial analysis (Agourogiannis et al., 2021; Bartzokas-Tsiompras & Photis, 2020; Wieland, 2022), remote sensing (Younes et al., 2023), maps (Nedkov et al., 2018; Papaioannou et al., 2020), geoinformation (Bartha & Kocsis, 2011; Bartzokas-Tsiompras, 2022), economic (Doukissas et al., 2020; Mikhaylova, 2018), social (Mei & Liempt, 2022; Roșu et al., 2015), political (Kevicky, 2023; Tsitsaraki & Petracou, 2023) and cultural (Gusman & Otero-Varela, 2023) geography, geopolitics (Morgado, 2023) as well as environmental (Burić et al., 2023; Prodanova & Varadzhakova, 2022), urban (Chondrogianni & Stephanedes, 2021; Lagarias et al., 2022) and transport (Garrido, 2013; Kellerman, 2023; Koktavá & Horák, 2023) geography/planning (González, 2017). Each article, a testament to the diversity and depth of knowledge within our community, has played a crucial role in energising discourse in our academic environment. Several EJG articles addressed current global crises and challenges such as climate change, COVID-19, wars and economic recession. They show how important geography is when it comes to finding solutions and new insights to the many problems that threaten our world. This interconnected approach underlines the journal's commitment to engaging with both the specialised academic discourse and the broader global challenges of our time. Authors, editors, board members, reviewers and readers are the lifeblood of this academic platform, and we recognise and appreciate your invaluable role in the success of the European Journal of Geography. Your commitment has fuelled our growth and you are an essential part of our legacy. We take our fifteenth anniversary as an opportunity to invite and encourage you to contribute to the continued success of the journal by submitting new and original geographical research articles. Here's to another year of scholarly work, meaningful collaborations and the continued advancement of geographical knowledge. We would also like to take a moment to recognise the incredible efforts of 95 professors and researchers who served as reviewers for the European Journal of Geography in 2023. Their expertise and dedication have been invaluable in maintaining the quality of our publications. In addition, the journal features 18 distinguished editorial board members from 12 countries, including renowned experts (60% men, 40% women) from various geographical research fields (This year we welcome 10 esteemed new members to our Editorial Board). In particular, we would like to express our sincere thanks to the following editorial board members for their help and support: • Alvanides Seraphim, Northumbria University, UK • ‪Bednarz W. Sarah, Texas A&M University, USA • Capello Roberta, Politecnico di Milano, Italy • Cretan Remus, West University of Timisoara, Romania • De Miguel Gonzalez Rafael, University of Zaragoza, Spain • Eeva-Kaisa Prokkola, University of Oulu, Finland • Jerry T. Mitchell, University of South Carolina, USA • Kavroudakis Dimitris, University of the Aegean, Greece • Kiss Éva, CSFK Geographical Institute, Hungary • Knecht Petr, Masaryk University, Czech Republic • Kounadi Ourania, University of Vienna, Austria • Kolvoord Bob, James Madison University, USA • Leininger-Frezal Caroline, Université de Paris, France • Margaritis Efstathios, University of Southampton, UK • Specht Doug, University of Westminster, UK • Strobl Josef, University of Salzburg, Austria • Theobald Rebecca, University of Colorado Colorado Springs, USA • Yilmaz Ari, Bandirma Onyedi Eylul University, Turkey In 2023, we received a total of 116 submissions. Of these, 24 outstanding papers were published online (acceptance rate 21% - 2023), while 92, although commendable, did not make it to publication. Remarkably, these submissions included the contributions of 63 authors from 20 countries. The average review speed of the articles is about 7-9 weeks for the first round and about 4-6 weeks for the second round. The reviewers came from 31 countries, which shows a global co-operation: UK, USA, Austria, Belgium, France, Germany, Greece, Norway, Poland, Portugal, Ireland, Spain, Netherlands, Japan, Hungary, Iceland, Croatia, Czech Republic, Finland, Slovakia, Slovenia, Turkey, Romania and others. Thank you for your continued support and your contributions to this journal. Look forward to an exciting journey of discovery and innovation in the pages of the European Journal of Geography. Join us as we continue to shape the ever-evolving canvas of geographical exploration and knowledge. List of Reviewers 2023: • Alessandro Del Ponte, University of Alabama, USA • Ali Enes Dingil, Czech Technical University in Prague, Czech Repuplic • Alvanides Seraphim, Northumbria University, UK • András J. Molnár, Christian-Albrecht University of Kiel, Germany • Anja du Plessis, University of South Africa, Johannesburg, South Africa • Anqi Huang, Nanjing University of Information Science and Technology, China • Apostolia Galani, National and Kapodistrian University of Athens, Greece • Ari Yilmaz, Bandirma Onyedi Eylül Üniversitesi, Turkey • Audur Palsdottir , University of Iceland, Iceland • Barbara Szejgiec-Kolenda, Polish Academy of Sciences, Poland • Beth Schlemper, The University of Toledo, USA • Blaž Repe, University of Ljubljana, Slovenia • Bob Kolvoord, James Madison University, USA • Carina Peter, Philipps-University Marburg, Germany • Carlos Lopez Escolano, University of Zaragoza, Spain • Caroline Leininger, Université de Paris, France • Charalampos Tsavdaroglou, University of Amsterdam, The Netherlands • Christian Weismayer, Modul University Vienna GmbH, Austria • Darra Athanasia, National Technical University of Athens, Greece • Denise Blanchard, Texas State University, USA • Dimitris Kavroudakis, University of the Aegea, Greece • Don MacKeen, City of Glasgow College, UK • Doug Specht, University of Westminster, UK • Dragan Burić, University of Montenegro, Montenegro • Eeva-Kaisa Prokkola , University of Oulu, Finland • Efstathios Margaritis, University of Southampton, UK • Emmanuel Eze, University of Nigeria, Nigeria • Eva Psatha, University of Thessaly, Greece • Evangelos Rasvanis, University of Thessaly, Greece • Femke van Esch, Utrecht University, The Netherlands • František Petrovič, Constantine the Philosopher University, Slovakia • George Revill, The Open University, UK • Géza Tóth, University of Miskolc, Hungary • Grayson R. Morgan, University of South Carolina, USA • Hristina Prodanova, National Institute of Geophysics, Geodesy and Geography - Bulgarian Academy of Sciences, Bulgaria • Huda Jamal Jumaah, Northern Technical University, Iraq • İlkay Südas, Ege University, Turkey • Ilse van liempt, Utrecht University, The Netherlands • Isabel María Gómez-Trigueros, University of Alicante, Spain • Italo Sousa de Sena, University College Dublin, Ireland • Iva Miranda Pires, NOVA University Lisbon, Portugal • Iwona Anna Jażdżewska, University of Lodz, Poland • Jaime Diaz Pacheco, Universidad de La Laguna, Spain • Jan Christoph Schubert, Friedrich-Alexander-University Erlangen-Nuremberg, Germany • Jens Dangschat , TU Wien, Austria • Jernej Zupančič, University of Ljubljana, Slovenia • Jerry T. Mitchell, University of South Carolina, USA • Joan Rossello, Universitat de les Illes Balears, Spain • Joseph J. Kerski, ESRI, USA • Karina Standal, CICERO Center for International Climate Research, Oslo, Norway • Karl Donert, EUROGEO, Belgium • Koshiro Suzuki , University of Toyama, Japan • Kristine Juul, University of Roskilde , Denmark • Lauren Hammond, University College London, UK • Mahmood Shoorcheh, University of Isfahan, Iran • Maria Angeles Rodriguez-Domenech, Universidad Castilla La Mancha, Spain • María Lois , Universidad Complutense de Madrid, Spain • María-Luisa de Lázaro-Torres , Universidad Nacional de Educación a Distancia, Spain • Marko Krevs, University of Ljubljana, Slovenia • Marta Gallardo, Universidad Nacional de Educación a Distancia, Spain • Md Galal Uddin, University of Galway, Ireland • Kausar Alam, Brac University, Bangladesh • Michaela Spurná, Masaryk University, Czech Repuplic • Miha Pavšek, Research Centre of the Slovenian Academy of Sciences and Arts, Slovenia • Muhammad Haroon Stanikzai , Kandahar University, Afghanistan • Neli Heidari, University of Hamburg, Germany • Nicholas Wise, Arizona State University, USA • Nikola Šimunić, Institute of Social Sciences Ivo Pilar, Croatia • Nikolaos Karachalis , University of the Aegean, Greece • Nuno Morgado, Corvinus University of Budapest, Hungary • Pablo Fraile-Jurado, Universidad de Sevilla, Spain • Panagiotis G. Tzouras, National Technical University of Athens, Greece • Peter T. Dunn, University of Washington, USA • Petr Knecht, Masaryk University, Czech Repuplic • Polyxeni Kechagia, University of Thessaly, Greece • Qi Zhou, China University of Geosciences, China • Rafael de Miguel González, University of Zaragoza, Spain • Rebecca Theobald, University of Colorado, USA • Remus Cretan, West University of Timisoara, Romania • Roberto Falanga, University of Lisbon, Institute of Social Sciences, Portugal • Saheed Adekunle Raji, University of Lagos, Nigeria • Sandra Sprenger, University of Hamburg, Germany • Sarah Bednarz, Texas A&M University, USA • Sebastien Bourdin, EM Normandie Bussiness School, France • Serafin Pazos-Vidal , European Association for Innovation in Local Development, Belgium • Susannah Cramer-Greenbaum, University of Warwick, UK, UK • Teemu Makkonen, University of Eastern Finland, Finland • Teresa Sadoń-Osowiecka, University of Gdansk, Poland • Theano S. Terkenli , University of the Aegean, Greece • Theodore Metaxas , University of Thessaly, Greece • Uwe Krause, Fontys School of the Arts, The Netherlands • Valériane Mistiaen , Université libre de Bruxelles, Belgium • Vesna Skrbinjek, International School for Social and Business Studies, Slovenia • Vincent Nzabarinda, Institute of Ecology and Geography, Chinese Academy of Sciences, China • Zsolt Tibor Kosztyán, University of Pannonia, Hungar

Changes in skeletal muscle microcirculation after a hemodialysis session correlates with adequacy of dialysis

Chrysoula Pipili,1 Eirini Grapsa,1 Elli-Sophia Tripodaki,1 Sophia Ioannidou,2 Christos Manetos,1 Maria Parisi,1 Serafim Nanas1 1First Critical Care Department, 2Laboratory of Biochemistry, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece Background: Monitoring of the microcirculation may add additional information in terms of improving the adequacy of hemodialysis (HD) for patients. Withdrawal of liquid and complement activation during a HD session reduces the external pressure on the microcirculation and leads to an increased dilatation of the peripheral capillaries. The purposes of this study were to assess the effect of a single HD or hemodiafiltration session on the thenar microcirculation in patients with end-stage renal disease (ESRD) with or without diabetes, investigate the possible relationship between changes in the microcirculation and adequacy of dialysis (including Kt/V and parameters indicating secondary hyperparathyroidism), and compare microcirculation measurements obtained from patients with ESRD and those from healthy controls. Methods: This pilot prospective observational study including eleven patients with ESRD on maintenance HD (nine men of mean age 73±10.5 years, ten [91%] with hypertension), nine patients with ESRD on maintenance hemodiafiltration (six men of mean age 65.5±13.2 years, five [55.5%] with diabetes and four [44.5%] with hypertension), and eight healthy volunteers. Two paired microcirculation assessments were recorded for each HD patient before and after a dialysis session. Near infrared spectroscopy and the vascular occlusion test were used to assess the microcirculation, and blood work samples were collected before and after dialysis when the pump slowed down. Results: Patients with ESRD showed an increase in thenar cell metabolism at rest after a 4-hour HD session, and changes in cell metabolism correlated with the Kt/V of the session. Pre-dialysis tissue oxygen saturation over the 4-hour HD session correlated with pre-dialysis serum calcium and parathyroid hormones. Vascular reactivity was lower in ESRD patients receiving HD or hemodiafiltration than in healthy controls. Conclusion: Improvement in skeletal muscle microcirculation noted after a HD session was related to adequacy of dialysis. Evaluation of the microcirculation may provide additional information for management of patients on HD and identify novel targets for treatment. These preliminary findings need to be tested using a larger data set. Keywords: hemodiafiltration, near infrared spectroscopy, end stage renal disease, single-pool Kt/V&nbsp

Muscle microcirculation alterations and relation to dipping status in newly diagnosed untreated patients with arterial hypertension—A pilot study

Objective: The importance of abnormalities observed in the microcirculation of patients with arterial hypertension (AH) is being increasingly recognized. The authors aimed to evaluate skeletal muscle microcirculation in untreated, newly diagnosed hypertensive patients with NIRS, a noninvasive method that evaluates microcirculation. Methods: We evaluated 34 subjects, 17 patients with AH (13 males, 49±13 years, BMI: 26±2 kg/m2) and 17 healthy controls (12 males, 49±15 years, BMI: 25±3 kg/m2). The thenar muscle StO2 (%) was measured by NIRS before, during and after 3-minutes vascular occlusion to calculate OCR (%/min), EF (%/min), and RHT (minute). The dipping status of hypertensive patients was assessed. Results: The RHT differed between AH patients and healthy subjects (2.6±0.3 vs 2.1±0.3 minutes, P<.001). Dippers had higher EF than nondippers (939±280 vs 710±164%/min, P=.05). Conclusions: The study suggests an impaired muscle microcirculation in newly diagnosed, untreated AH patients. © 2017 John Wiley & Sons Lt

Attenuated microcirculatory response to maximal exercise in patients with chronic heart failure

PURPOSE: Exercise training programs improve microcirculatory alternations in patients with chronic heart failure (CHF). However less is known about the acute effect of maximum exercise on the skeletal muscle microcirculation. We aimed to assess the effect of acute exercise on peripheral microcirculation of patients with CHF, as assessed by near-infrared spectroscopy with vascular occlusion technique. METHODS: Tissue oxygenation was evaluated in 8 stable patients with CHF (7 males; mean age, 60) 9 years; body mass index, 26.3) 3.8 kg/m2 ) and 8 healthy subjects (matched for age, sex, and body mass index) before and after cardiopulmonary exercise testing. Tissue oxygen saturation (StO 2 ), StO 2peak , oxygen consumption rate, and endothelial function (reperfusion rate), before and after maximum exercise, were assessed. RESULTS: Patients with CHF had lower StO 2 and reperfusion rate compared with healthy subjects (71.4%) 9.8% vs 81.0%) 5.4% and 9) 1 %/min vs 13.9) 5.8%/min, respectively; P < .05) at rest. Oxygen consumption rate increased after exercise in patients with CHF and healthy subjects (from - 31.7) 8.2 to - 43.7) 12.7 and from - 35.7) 6.7 to - 42.4) 6.4, respectively; P < .05). StO2decreased significantly after maximal exercise in patients with CHF (from 71.4) 9.8 to 65.2) 12.7; P < .05), whereas it returned to the preexercise values in healthy subjects (from 81.0) 5.4 to 80.3) 7.0). There was a significant between-group difference ( P < .05). CONCLUSIONS: Patients with CHF present microcirculatory alternations. Acute exercise exerts an effect on microcirculation in peripheral, nonexercising muscles, with altered response in patients with CHF compared with healthy subjects. Copyright © 2016 Wolters Kluwer Health, Inc

Hormonal imbalance in relation to exercise intolerance and ventilatory inefficiency in chronic heart failure

Background: Skeletal muscle wasting is associated with altered catabolic/anabolic balance and poor prognosis in patients with chronic heart failure (CHF). This study evaluated catabolic and anabolic abnormalities in relation to disease severity in CHF patients. Methods: Forty-two stable CHF patients (34 men; aged 56±12 years, body mass index, 27±5 kg/m2) receiving optimal medical treatment underwent incremental symptom-limited cardiopulmonary exercise testing on a cycle ergometer. Blood samples were drawn within 10 days to determine serum cortisol, plasma adrenocorticotropin (ACTH), and serum dehydroepiandrosterone sulfate, insulin-like growth factor 1, growth hormone, and total testosterone in men. Results: Patients with higher cortisol levels presented with impaired peak oxygen uptake (Vo2 peak: 18.3±3.9 vs 14.2±3.7 ml/kg/min, p<0.01), ventilatory (Ve) response to exercise (Ve/carbon dioxide output [Vco2] slope: 36±6 vs 30±5, p<0.01), and chronotropic reserve ([peak heart rate [HR] - resting HR/220 - age - resting HR]×100%: 40±19 vs 58±18, p=0.01) compared with those with lower serum cortisol. Cortisol was inversely correlated with Vo 2 peak, (r = -0.57; p<0.01) and was correlated with Ve/Vco 2 slope (r = 0.47; p<0.01) and chronotropic reserve (r = 0.44; p = 0.017). In multivariate regression analysis, cortisol was an independent predictor of Vo2peak (R2 = 0.365, F = 12.5, SE = 3.4; p≤0.001) and Ve/Vco2 slope (R2 = 0.154; F = 8.5; SE = 5.96; p = 0.006), after accounting for age, body mass index, sex, CHF etiology, creatinine, left ventricular ejection fraction, and ACTH in all patients. In men, cortisol and dehydroepiandrosterone levels were both independent predictors of Vo2peak (R2 = 0.595, F = 24.53, SE = 2.76; p<0.001) after accounting also for all measured hormones, whereas cortisol remained the only independent predictor of Ve/Vco2 slope (R2 = 0.133; F = 6.1; SE = 6.2; p = 0.02). Conclusions: Enhanced catabolic status is significantly associated with exercise intolerance, ventilatory inefficiency, and chronotropic incompetence in CHF patients, suggesting a significant contributing mechanism to their limited functional status. © 2013 International Society for Heart and Lung Transplantation

Skeletal muscle microcirculatory abnormalities are associated with exercise intolerance, ventilatory inefficiency, and impaired autonomic control in heart failure

Background: Several skeletal muscle abnormalities have been identified in patients with chronic heart failure (CHF), including endothelial dysfunction. We hypothesized that skeletal muscle microcirculation, assessed by near-infrared spectroscopy (NIRS), is impaired in CHF patients and is associated with disease severity. Methods: Eighty-three stable patients with mildmoderate CHF (72 males, mean age 54 ± 14 years, body mass index 26.7 ± 3.4 kg/m 2) and 8 healthy subjects, matched for age, gender and body mass index, underwent NIRS with the vascular occlusion technique and cardiopulmonary exercise testing (CPET) evaluation on the same day. Tissue oxygen saturation (StO 2, %), defined as the percentage of hemoglobin saturation in the microvasculature compartments, was measured in the thenar muscle by NIRS before, during and after 3-minute occlusion of the brachial artery. Measurements included StO 2, oxygen consumption rate (OCR, %/min) and reperfusion rate (RR, %/min). All subjects underwent a symptom-limited CPET on a cycle ergometer. Measurements included VO 2 at peak exercise (VO 2peak, ml/kg/min) and anaerobic threshold (VO 2AT, ml/kg/min), VE/VCO 2 slope, chronotropic reserve (CR, %) and heart rate recovery (HRR 1, bpm). Results: CHF patients had significantly lower StO 2 (75 ± 8.2 vs 80.3 ± 6, p < 0.05), lower OCR (32.3 ± 10.4 vs 37.7 ± 5.5, p < 0.05) and lower RR (10 ± 2.8 vs 15.7 ± 6.3, p < 0.05) compared with healthy controls. CHF patients with RR <9.5 had a significantly greater VO 2peak (p < 0.001), VO 2AT (p < 0.01), CR (p = 0.01) and HRR 1 (p = 0.01), and lower VE/VCO 2 slope (p = 0.001), compared to those with RR <9.5. In a multivariate analysis, RR was identified as an independent predictor of VO 2peak, VE/VCO 2 slope and HRR 1. Conclusions: Peripheral muscle microcirculation, as assessed by NIRS, is significantly impaired in CHF patients and is associated with disease severity. © 2011 International Society for Heart and Lung Transplantation. All rights reserved

Peripheral muscle microcirculatory alterations in patients with pulmonary arterial hypertension: A pilot study

Background: Pulmonary microcirculation abnormalities are the main determinants of pulmonary arterial hypertension (PAH) pathophysiology. We hypothesized that PAH patients have peripheral tissue microcirculation alterations that might benefit from hyperoxic breathing. We evaluated peripheral muscle microcirculation with near-infrared spectroscopy, before and after hyperoxic breathing. Methods: Eight PAH subjects, 8 healthy subjects (controls) matched for age, sex, and body mass index, and 16 subjects with chronic heart failure and matched for functional capacity with the PAH subjects underwent near-infrared spectroscopy. Tissue O2 saturation, defined as the hemoglobin saturation (%) in the microvasculature compartments, was measured on the thenar muscle. Then the 3-min brachial artery occlusion technique was applied before, during, and after 15 min of breathing 100% O2. We calculated the oxygen consumption rate (%/min), the reactive hyperemia time, and the time needed for tissue O2 saturation to reach its baseline value after the release of the occlusion. Results: Compared to the controls, the PAH subjects had a significantly lower resting tissue O2 saturation (65.8 ± 14.9% vs 82.1 ± 4.0%, P = .005), a trend toward a lower oxygen consumption rate (35.3 ± 9.1%/min vs 43.4 ± 19.7%/min, P = .60), and a significantly higher reactive hyperemia time (3.0 ± 0.6 min vs 2.0 ± 0.3 min, P <.001). The PAH subjects also had lower tissue O2 saturation (P =.08), lower peripheral arterial oxygen saturation (P = .01), and higher reactive hyperemia time (P = .02) than the chronic heart failure subjects. After hyperoxic breathing, the PAH subjects had increased tissue O2 saturation (65.8 ± 14.9% to 71.4 ± 14.5%, P =.01), decreased oxygen consumption rate (35.3 ± 9.1%/min to 25.1 ± 6.6%/min, P = .01), and further increased reactive hyperemia time (3.0 ± 0.6 min to 4.2 ± 0.7 min, P = .007). Conclusions: The PAH subjects had substantial impairments of peripheral muscle microcirculation, decreased tissue O2 saturation (possibly due to hypoxemia), slower reactive hyperemia time, (possibly due to endothelium dysfunction), and peripheral systemic vasoconstriction. Acute hyperoxic breathing improved resting tissue O2 saturation (an expression of higher oxygen delivery) and decreased the oxygen consumption rate and reactive hyperemia time during reperfusion, possibly due to increased oxidative stress and evoked vasoconstriction. © 2013 Daedalus Enterprises

Chronotropic incompetence and abnormal heart rate recovery early after left ventricular assist device implantation

Background: Chronotropic response to exercise and heart rate recovery immediately after exercise (HRR1) are valid prognostic markers in patients with chronic heart failure (CHF). The aim of this study was to evaluate heart rate profile during and after exercise in CHF patients early after left ventricular assist device (LVAD) implantation. Methods: We enrolled seven stable consecutive CHF patients (five males, mean age: 45 ± 16 years) after 1 month of LVAD (HeartMate II; Thoratec Corp, Pleasanton, CA, USA) implantation, seven healthy subjects, and 14 patients with advanced HF (HF control group) who performed an incremental symptom-limited cardiopulmonary exercise testing (CPET). CHF patients performed CPET at 1 and 3 months after LVAD. HRR1 was defined as the HR difference from peak to 1 minute after exercise and chronotropic response to exercise as the chronotropic reserve ([CR, %]=[peak HR-resting HR/220-age-resting HR]à - 100). Results: LVAD patients 3 months after implantation had a significantly different HR profile during exercise compared to healthy controls, with significantly lower CR (57 ± 31 vs 90 ± 14, %, P < 0.001) and HRR 1 (14 ± 6 vs 28 ± 8, bpm, P < 0.01). HR profile during exercise did not significantly change 1 and 3 months after LVAD implantation. There was no statistical difference compared to HF control group and LVAD group regarding cardiopulmonary parameters. Conclusions: LVAD patients present an impaired CR and an abnormal HRR1 after implantation, indicating significant cardiac autonomic abnormalities. These alterations seem to remain unaltered 3 months after LVAD implantation. © 2011, The Authors. Journal compilation

Respiratory drive and breathing pattern abnormalities are related to exercise intolerance in chronic heart failure patients

Background: Patients with chronic heart failure (CHF) are characterized by exercise intolerance and ventilatory abnormalities that are related to poor prognosis. We hypothesized that CHF patients have increased respiratory drive and abnormal breathing pattern during exercise in relation to disease severity. Materials and methods: The study population consisted of 219 stable CHF patients and 30 healthy control subjects. All subjects underwent a symptom-limited cardiopulmonary exercise testing (CPET), pulmonary function tests, measurement of the maximal inspiratory pressure (PImax) and respiratory drive (P0.1).Measurements included peak oxygen uptake (VO2 peak, ml/kg/min). Respiratory drive was measured by mouth occlusion pressure P0.1 and P0.1/PImax ratio at rest, and by mean inspiratory flow (VT/TI) at rest and during exercise. CHF patients were divided into 3 groups according to VO2 peak (Group A: >20, Group B: 20-16 and Group C: <16ml/kg/min). Results: CHF patients presented higher P0.1/PImax (4.1±3.6 vs 3.0±1.5, p=0.007) and VT/TI at rest (0.48±0.14 vs 0.41±0.10, L/s respectively, p=0.004) and lower VT/TI at peak exercise (2.17±0.66 vs 2.56±0.73, L/s, p=0.009) compared to controls. P0.1/PImax was higher in CHF Group C vs B vs A (4.9±2.9 vs 3.6±1.8 vs 3.1±1.8, respectively, p<0.001), while VT/TI at peak exercise was lower (1.71±0.43 vs 2.15±0.52 vs 2.65±0.64, L/s, respectively, p<0.001). Conclusions: CHF patients present increased respiratory drive at rest and abnormal breathing pattern during exercise in relation to CHF severity. © 2013 Elsevier B.V