No abstract

Resistance exercise reduces fatigue and improves quality of life and muscular fitness in men with prostate cancer receiving androgen deprivation therapy. This form of exercise can be an important component of supportive care for these patients.

In the short term, both resistance and aerobic exercise mitigated fatigue in men with PCa receiving radiotherapy. Resistance exercise generated longer-term improvements and additional benefits for QOL, strength, triglycerides, and body fat.

Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in approximately 1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.

Quantitative grading of mitral regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation. Patients with an effective regurgitant orifice of at least 40 mm2 should promptly be considered for cardiac surgery.

Objectives Evaluate the outcomes of preclinical diastolic dysfunction in diabetic patients Background Studies have reported a high prevalence of preclinical diastolic dysfunction among patients with diabetes mellitus. Methods We identified all diabetic patients with a tissue Doppler assessment of diastolic function in Olmsted County, MN from 2001 to 2007. Diastolic dysfunction was defined as a Doppler mitral E/e′ ratio >15. The main outcome was the development of heart failure (HF). Secondary outcomes were the development of atrial fibrillation and death. Results Overall, 1,760 diabetic patients with a tissue Doppler echocardiographic assessment of diastolic function were identified; 411 patients (23%) had diastolic dysfunction. Using multivariable Cox's proportional hazard modeling, we determined that for every 1 unit increase in the mitral E/e′ ratio, the hazard of HF increased by 3% (HR=1.03, 95% CI=1.01-1.06; p=0.006) and that diastolic dysfunction was associated with the subsequent development of HF after adjustment for age, sex, body mass index, hypertension, coronary disease and echocardiographic parameters (HR=1.61, 95% CI=1.17-2.20; p=0.003). The cumulative probability of the development of HF at 5 years for diabetic patients with diastolic dysfunction was 36.9% compared to 16.8% for patients without diastolic dysfunction (P<0.001). Furthermore, diabetic patients with diastolic dysfunction had a significantly higher mortality compared to those without diastolic dysfunction. Conclusion We demonstrated that an increase in the E/e′ ratio in diabetic patients is associated with the subsequent development of HF and increased mortality independent of hypertension, coronary disease or other echocardiographic parameters.

In patients with degenerative MR in sinus rhythm at diagnosis, the incidence of AF occurring under conservative management is high and similar whether the cause of MR is flail leaflet or simple MVP. After onset of AF, an increased cardiac mortality and morbidity are both observed under conservative management. The risk of AF increases with advancing age and larger LA dimension. These data suggest that the clinical management of MR should take into account the high incidence, excess risk, and predictors of AF.

Background Among patients with severe aortic stenosis (AS) and preserved ejection fraction (EF), those with low-gradient and reduced stroke volume may have an adverse prognosis. We investigated the prognostic impact of stroke volume using the recently proposed flow-gradient classification. Methods and Results We examined 1,704 consecutive patients with severe AS (aortic valve area <1.0 cm2) and preserved EF (≥50%) using 2-D and Doppler echocardiography. Patients were stratified by stroke volume index (<35 ml/m2 (LF) vs. ≥35 ml/m2 (NF)) and aortic gradient (<40 mmHg (LG) vs. ≥40 mmHg or (HG)) into 4 groups (NF/HG, NF/LG, LF/HG, LF/LG). NF/LG (n=352, 21%), was associated with favorable survival with medical management (2 year estimate 82% vs. 67% in NF/HG, p<0.0001). LF/LG severe AS (n=53, 3%), was characterized by lower EF, more prevalent atrial fibrillation and heart failure, reduced arterial compliance, and reduced survival (2 year estimate 60% vs. 82% in NF/HG, p<0.001). By multivariable analysis, LF/LG pattern was the strongest predictor of mortality (HR 3.26 (1.71, 6.22) p<0.001 vs. NF/LG). Aortic valve replacement (AVR) was associated with a 69% mortality reduction (HR 0.31 (0.25, 0.39) p<0.0001) in LF/LG and NF/HG, with no survival benefit associated with AVR in NF/LG and LF/HG. Conclusions NF/LG severe AS with preserved EF exhibits favorable survival with medical management and impact of AVR on survival was neutral. LF/LG severe AS is characterized by a high prevalence of atrial fibrillation, heart failure and reduced survival, and AVR was associated with improved survival. These findings have implications for evaluation of AS severity and subsequent management.