Metabolic responses to the acute ingestion of two commercially available carbonated beverages: A pilot study

<p>Abstract</p> <p>Background</p> <p>The purpose of this placebo-controlled, double-blind cross-over study was to compare the effects of two commercially available soft drinks on metabolic rate.</p> <p>Methods</p> <p>After giving informed consent, twenty healthy men and women were randomly assigned to ingest 12 ounces of Celsius™ and, on a separate day, 12 ounces of Diet Coke®. All subjects completed both trials using a randomized, counterbalanced design. Metabolic rate (via indirect calorimetry) and substrate oxidation (via respiratory exchange ratio) were measured at baseline (pre-ingestion) and at the end of each hour for 3 hours post-ingestion.</p> <p>Results</p> <p>Two-way ANOVA revealed a significant interaction (p < 0.001) between trials in metabolic rate. Scheffe post-hoc testing indicated that metabolic rate increased by 13.8% (+ 0.6 L/min, p < 0.001) 1 hr post, 14.4% (+0.63 L/min, p < 0.001) 2 hr post, and 8.5% (+0.37 L/min, p < 0.004) 3 hr post Celsius™ ingestion. In contrast, small (~4–6%) but statistically insignificant increases in metabolic rate were noted following Diet Coke^®ingestion. No differences in respiratory exchange ratio were noted between trials.</p> <p>Conclusion</p> <p>These preliminary findings indicate Celsius™ has thermogenic properties when ingested acutely. The effects of repeated, chronic ingestion of Celsius™ on body composition are unknown at this time.</p

Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings

Background and objectives: Steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) is a leading cause of end-stage kidney disease in children. Recurrence of primary disease following transplantation is a major cause of allograft loss. The clinical determinants of disease recurrence are not completely known. Our objectives were to determine risk factors for recurrence of FSGS/MCD following kidney transplantation and factors that predict response to immunosuppression following recurrence. Methods: Multicenter study of pediatric patients with kidney transplants performed for ESKD due to SRNS between 1/2006 and 12/2015. Demographics, clinical course, and biopsy data were collected. Patients with primary-SRNS (PSRNS) were defined as those initially resistant to corticosteroid therapy at diagnosis, and patients with late-SRNS (LSRNS) as those initially responsive to steroids who subsequently developed steroid resistance. We performed logistic regression to determine risk factors associated with nephrotic syndrome (NS) recurrence. Results: We analyzed 158 patients; 64 (41%) had recurrence of NS in their renal allograft. Disease recurrence occurred in 78% of patients with LSRNS compared to 39% of those with PSRNS. Patients with MCD on initial native kidney biopsy had a 76% recurrence rate compared with a 40% recurrence rate in those with FSGS. Multivariable analysis showed that MCD histology (OR; 95% CI 5.6; 1.3–23.7) compared to FSGS predicted disease recurrence. Conclusions: Pediatric patients with MCD and LSRNS are at higher risk of disease recurrence following kidney transplantation. These findings may be useful for designing studies to test strategies for preventing recurrence

Heart rate recovery predicts sudden cardiac death in heart failure

The purpose of this investigation was to examine the ability of heart rate recovery (HRR) to predict mortality secondary to pump failure or sudden cardiac death (SCD) in patients with heart failure (HF). Kaplan\u2013Meier analysis revealed a significant difference in survival for both SCD (100% vs. 73.9%, log-rank: 50.5, p < 0.001) and pump failure (96.1% vs. survival = 78.4%, log-rank: 24.4, p < 0.001) endpoints according to a </ 65 17 bpm HRR threshold. The results of the present study indicate HRR is a significant predictor of both SCD and pump failure mortality in patients with HF although its ability to predict SCD was superior

Large oscillatory ventilation amplitude at low intensity exercise indicates poor prognosis in heart failure

Introduction: Exercise oscillatory ventilation (EOV) occurs in a subgroup of patients with increased heart failure (HF) severity and poorer prognosis. The purpose of the present investigation is to examine the prognostic value of the timing of the largest ventilatory oscillation in HF patients during exercise testing. Methods: One hundred and forty eight subjects (88 male/60 female, 91 ischemic/57 non-ischemic, mean age: 49.5 ± 12.2 years, mean ejection fraction: 30.0 ± 14.1%) diagnosed with HF underwent cardiopulmonary exercise testing

Heart rate increase from rest to maximal exercise is prognostically significant in beta-blocked heart failure patients

Introduction: Previous research has found the increase in heart rate (HR) during exercise holds prognostic value, although heart failure (HF) patients prescribed a beta-blocking agent have not been exclusively examined. Methods: Three hundred and twenty one HF patients (72% male/28% female, 40% ischemic/ 60% non-ischemic, age: 52.7 \ub1 14.4 years, ejection fraction: 29.3 \ub1 16.7%) underwent cardiopulmonary exercise testing to determine peak oxygen consumption (VO2), the minute ventilation/carbon dioxide production (VE/VCO2) slope, peak respiratory exchange ratio and the change in HR from rest to maximal exercise (\u394HR)

Maximal dyspnea on exertion during cardiopulmonary exercise testing is related to poor prognosis and echocardiography with tissue Doppler imaging in heart failure

This study tested the hypothesis that increasing levels of maximal dyspnea on exertion (DOE) during cardiopulmonary exercise testing (CPX) is associated with heart failure (HF) disease severity and worsening prognosis. Three hundred seventy-six HF patients underwent CPX where ventilatory efficiency (minute ventilation/carbon dioxide production; VE/VCO2 slope), peak oxygen consumption (VO2), and maximal DOE were determined. A subgroup of 243 patients underwent echocardiography with tissue Doppler imaging to measure the ratio between mitral early (E) to mitral annular (E\u2032) velocity as well as other variables. Maximal DOE was significantly correlated with E/E\u2032 (rs=.49; P<.001). In the multivariate Cox regression, the VE/VCO2 slope was the strongest prognostic marker obtained from CPX (Multivariate chi-square, 48.0; P<.001) while maximal DOE (residual chi-square, 17.4; P<.001) and peak VO2 (residual chi-square, 7.5; P=.006) added predictive value. These results suggest that increasing DOE reflects the degree of disease severity and adds prognostic value to established CPX variables

The prognostic value of the initial heart rate increase during progressive exercise testing in heart failure

The increase in heart rate during the first minute of a progressive exercise test (HR1) has been shown to be prognostically significant in a large cohort at risk for or diagnosed with cardiovascular disease. This issue, however, has not been specifically investigated in patients diagnosed with heart failure (HF). We assessed the hypothesis that HR1 would possess prognostic value in a large HF cohort. Three-hundred and ninety two subjects diagnosed with HF (207 ischemic/185 non-ischemic, 279 male/113 female, age: 57.2 \ub113.2 years, ejection fraction: 33.4 \ub112.5) underwent cardiopulmonary exercise testing. Two-hundred and thirty three subjects were prescribed a beta-blocking agent at the time of testing. The difference between resting HR and HR after the first minute of exercise was defined as HR1. Ventilatory efficiency (VE/VCO2 slope), the presence of oscillatory ventilation (EOV) and peak oxygen consumption (VO2) were also determined. Subjects were tracked for major cardiac events following exercise testing. There were 93 major cardiac events (82 deaths, 8 heart transplants, 3 left ventricular assist device implantations) during the 24.5 \ub121.2 month tracking period (annual event rate: 10.5%). A HR1 threshold of >13 beats per minute was a significant univariate predictor of adverse events in the overall group (Hazard ratio: 6.5, 95% CI: 3.6\u201311.4, p13, chi-square: 53.5, p14 mlO2\ub7kg\u20131\ub7min\u20131, residual chi-square: 0.42, p=0.52) was not. Others have postulated that a greater HR1 reflects a more rapid withdrawal of parasympathetic stimulus during exercise and a higher vagal tone at rest. These results demonstrate HR1 during a progressive exercise test is prognostically valuable in patients with HF. Consideration of HR1 for prognostic purposes may therefore be warranted in patients with HF during both submaximal and maximal exercise testing

Cardiopulmonary exercise testing variables reflect the degree of diastolic dysfunction in patients with heart failure-normal ejection fraction

PURPOSE: Previous investigations have reported a relationship between variables obtained from echocardiography with tissue Doppler imaging (TDI) and cardiopulmonary exercise testing (CPX) in systolic heart failure (HF) cohorts. The purpose of the present investigation was to perform a comparative analysis between echocardiography with TDI and CPX in patients with HF and normal ejection fraction (NEF). METHODS: Patients with HF-NEF (N = 32) underwent echocardiography with TDI and CPX to determine the following variables: (1) the ratio between mitral early velocity (E) and mitral annular velocity (E'), (2) ejection fraction, (3) left ventricular (LV) mass, (4) left ventricular end systolic volume, (5) peak oxygen uptake ((V) over dotO(2)), (6) ventilatory efficiency, (7) the partial pressure of end-tidal carbon dioxide (P(ET)CO(2)) at rest and peak exercise, and (8) heart rate recovery at 1 minute (HRR(1)). RESULTS: Pearson correlation revealed that E/E' was significantly correlated with peak oxygen uptake (r = -0.55, P = .001), the ventilatory efficiency slope (r = 0.60, P 10 (positive likelihood ratio: 13:2). DISCUSSION: E/E' provides an accurate reflection of LV filling pressure and thus, insight into diastolic function. The results of the present investigation indicate CPX provides insight into cardiac dysfunction in patients with HF-NEF and thus, may eventually prove to be a valuable and accepted clinical assessment

Exercise oscillatory breathing in diastolic heart failure: prevalence and prognostic insights

Aims: Exercise intolerance occurs in both systolic and diastolic heart failure (HF). Exercise oscillatory breathing (EOB) is a powerful predictor of survival in patients with systolic HF. In diastolic HF, EOB prevalence and prognostic impact are unknown. Methods and results: A total of 556 HF patients (405 with systolic HF and 151 with diastolic HF) underwent cardiopulmonary exercise testing (CPET). Diastolic HF was defined as signs and symptoms of HF, a left ventricular ejection fraction 6550%, and a Doppler early (E) mitral to early mitral annulus ratio (E\u2032) 658. CPET responses, EOB prevalence and its ability to predict cardiac-related events were examined. EOB prevalence in systolic and diastolic HF was similar (35 vs. 31%). Compared with the patients without EOB, patients with EOB and either systolic or diastolic HF had a higher New York Heart Association class, lower peak VO2 and higher E/E\u2032 ratio (all P < 0.01). Univariate Cox regression analysis demonstrated that peak VO2, VE/VCO2 slope and EOB all were significant predictors of cardiac events in both systolic and diastolic HF. Multivariable analysis revealed that EOB was retained as a prognostic marker in systolic HF and was the strongest predictor of cardiac events in diastolic HF. Conclusion: EOB occurrence is similar in diastolic and systolic HF and provides relevant clues for the identification of diastolic HF patients at increased risk of adverse events