P ulmonary hypertension is a chronic cardiopulmonary disorder characterized by progressive increasing pulmonary vascular resistance, leading to right ventricular heart failure. 1 Prevalence of pulmonary hypertension is estimated to be 10 to 15 cases per million with a mortality rate of 15% per year. 2 Over the past 2 decades, targeted pharmacological therapies have been effective in reducing disease progression and improving the survival rate among patients with pulmonary hypertension.3,4 However, most patients remain symptomatic with significant exercise intolerance and reduced quality of life despite being on optimal medical therapy. 5,6 Thus, there is an unmet need for adjunctive therapeutic strategies to improve exercise tolerance and quality of life among these patients. Clinical Perspective on p 1043Exercise intolerance in patients with pulmonary hypertension is associated with a reduced maximal oxygen uptake and early onset of anaerobic threshold, similar to patients with severe heart failure. 7 The decrease in pulmonary vasculature distensibility associated with pulmonary hypertension leads to marked increases in pulmonary arterial mean pressure during exercise. This results in reduced pulmonary blood flow and low cardiac output insufficient to meet the metabolic demands of exercise. [7][8][9] Furthermore, pulmonary hypertension patients have significant skeletal muscle abnormalities leading to impaired peripheral oxygen utilization. These central and peripheral abnormalities contribute significantly to the exercise intolerance and functional limitation in patients with pulmonary hypertension. 10,11 Exercise training has been shown to improve cardiorespiratory fitness, functional status, and clinical outcomes in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease (COPD). 12,13 Considering the overlap in the pathophysiological derangements Original Article© 2015 American Heart Association, Inc.Circ Heart Fail is available at http://circheartfailure.ahajournals.org DOI: 10.1161/CIRCHEARTFAILURE.115.002130Background-Exercise training has been shown to improve cardiorespiratory fitness, physical capacity, and quality of life in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease. However, its role in management of pulmonary hypertension is not well defined. In this study, we aim to evaluate the efficacy and safety of exercise training in patients with pulmonary hypertension. Methods and Results-We included all prospective intervention studies that evaluated the efficacy and safety of exercise training in patients with pulmonary hypertension. Primary outcome of this meta-analysis was a change in 6-minute walk distance. We also assessed the effect of exercise on peak oxygen uptake, resting pulmonary arterial systolic pressure, peak exercise heart rate, and quality of life. A total of 469 exercise-training participants enrolled in 16 separate training studies were included. In the pooled ana...

Background The adult mammalian heart is incapable of meaningful regeneration after substantial cardiomyocyte loss, primarily due to the inability of adult cardiomyocytes to divide. Our group recently showed that mitochondria-mediated oxidative DNA damage is an important regulator of postnatal cardiomyocyte cell cycle arrest. However, it is not known whether mechanical load also plays a role in this process. We reasoned that the postnatal physiological increase in mechanical load contributes to the increase in mitochondrial content, with subsequent activation of DNA damage response (DDR) and permanent cell cycle arrest of cardiomyocytes. Objectives The purpose of this study was to test the effect of mechanical unloading on mitochondrial mass, DDR, and cardiomyocyte proliferation. Methods We examined the effect of human ventricular unloading after implantation of left ventricular assist devices (LVADs) on mitochondrial content, DDR, and cardiomyocyte proliferation in 10 matched left ventricular samples collected at the time of LVAD implantation (pre-LVAD) and at the time of explantation (post-LVAD). Results We found that post-LVAD hearts showed up to a 60% decrease in mitochondrial content and up to a 45% decrease in cardiomyocyte size compared with pre-LVAD hearts. Moreover, we quantified cardiomyocyte nuclear foci of phosphorylated ataxia telangiectasia mutated protein, an upstream regulator of the DDR pathway, and we found a significant decrease in the number of nuclear phosphorylated ataxia telangiectasia mutated foci in the post-LVAD hearts. Finally, we examined cardiomyocyte mitosis and cytokinesis and found a statistically significant increase in both phosphorylated histone H3-positive, and Aurora B-positive cardiomyocytes in the post-LVAD hearts. Importantly, these results were driven by statistical significance in hearts exposed to longer durations of mechanical unloading. Conclusions Prolonged mechanical unloading induces adult human cardiomyocyte proliferation, possibly through prevention of mitochondria-mediated activation of DDR.

More than a third of patients referred for primary PCI from the emergency department did not have a STEMI. Multiple patient-level characteristics were significantly associated with an increased odds of false-positive STEMI activation.

Context:Tutor assessment is sometimes also considered as an exercise of power by the assessor over assesses. Student self-assessment is the process by which the students gather information about and reflect on their own learning and is considered to be a very important component of learning.Aim:The primary objective of this study was to analyze the impact of self-assessment by undergraduate medical students on their subsequent academic performance. The secondary objective was to obtain the perception of students and faculty about self-assessment as a tool for enhanced learning.Materials and Methods:The study was based on the evaluation of two theory tests consisting of both essay type and short answer questions, administered to students of the 1st year MBBS (n = 89). They self-assessed their performance after 3 days of the first test followed by marking of faculty and feedback. Then, a nonidentical theory test on the same topic with the same difficulty level was conducted after 7 days and assessed by the teachers. The feedback about the perception of students and faculty about this intervention was obtained.Results:Significant improvement in the academic performance after the process of self-assessment was observed (P < 0.001). There was a significantly positive correlation between student and teacher marking (r = 0.79). Both students and faculty perceived it to be helpful for developing self-directed learning skills.Conclusions:Self-assessment can increase the interest and motivation level of students for the subjects leading to enhanced learning and better academic performance, helping them in development of critical skills for analysis of their own work.

Objectives This study was performed to determine whether a 4-tiered classification of left ventricular hypertrophy (LVH) defines subgroups in the general population which are at variable risk of adverse cardiovascular outcomes. Background We recently proposed a 4-tiered classification of LVH where eccentric LVH is subdivided into “indeterminate hypertrophy” and “dilated hypertrophy” and concentric LVH into “thick hypertrophy” and “both thick and dilated hypertrophy,” based on the presence of increased left ventricular end-diastolic volume. Methods Participants from the Dallas Heart study who underwent cardiac magnetic resonance imaging and did not have LV dysfunction or history of heart failure (HF) (n = 2,458) were followed for a median of 9 years for the primary outcome of HF or cardiovascular (CV) death. Multivariable Cox proportional hazard models were used to adjust for age, sex, African-American race, hypertension, diabetes, and history of cardiovascular disease (CVD). Results In the cohort, 70% had no LVH, 404 (16%) had indeterminate hypertrophy, 30 (1%) had dilated hypertrophy, 289 (12%) had thick hypertrophy, and 7 (0.2%) had both thick and dilated hypertrophy. The cumulative incidence of HF or CV death was 2% with no LVH, 1.7% with indeterminate, 16.7% with dilated, 11.1% with thick, and 42.9% with both thick and dilated hypertrophy (log rank p< 0.0001). Compared with participants without LVH, those with dilated (HR 7.3, 95% CI 2.8–18.8), thick (HR 2.4, 95% CI 1.4–4.0), and both thick and dilated (HR 5.8, 95% CI 1.7–19.5) hypertrophy remained at increased risk for HF or CV death after multivariable adjustment, whereas the group with indeterminate hypertrophy was not (HR 0.9, 95% CI 0.4–2.2). Conclusion In the general population, the 4-tiered classification system for LVH stratified LVH into subgroups with differential risk of adverse CV outcomes. Unstructured Abstract: Participants from the Dallas Heart Study were stratified using a 4-tiered classification of left ventricular hypertrophy (LVH) where eccentric LVH is subdivided into “indeterminate hypertrophy” and “dilated hypertrophy” and concentric LVH into “thick hypertrophy” and “both thick and dilated hypertrophy.” Compared with participants without LVH, those with dilated, thick, and both thick and dilated hypertrophy were at increased risk for heart failure or CV death after multivariable adjustment, whereas the group with indeterminate hypertrophy was not. In the general population, the 4-tiered classification system for LVH stratified LVH into subgroups with differential risk of adverse CV outcomes.