@article{HeldMittnachtKolbetal.2014,
  author    = {Held, Matthias and Mittnacht, Maria and Kolb, Martin and Karl, Sabine and Jany, Berthold},
  title     = {Pulmonary and Cardiac Function in Asymptomatic Obese Subjects and Changes following a Structured Weight Reduction Program: A Prospective Observational Study},
  series = {PLOS ONE},
  volume    = {9},
  journal   = {PLOS ONE},
  number    = {9},
  doi       = {10.1371/journal.pone.0107480},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119239},
  pages     = {e107480},
  year      = {2014},
  abstract  = {Background The prevalence of obesity is rising. Obesity can lead to cardiovascular and ventilatory complications through multiple mechanisms. Cardiac and pulmonary function in asymptomatic subjects and the effect of structured dietary programs on cardiac and pulmonary function is unclear. Objective To determine lung and cardiac function in asymptomatic obese adults and to evaluate whether weight loss positively affects functional parameters. Methods We prospectively evaluated bodyplethysmographic and echocardiographic data in asymptomatic subjects undergoing a structured one-year weight reduction program. Results 74 subjects (32 male, 42 female; mean age 42±12 years) with an average BMI 42.5±7.9, body weight 123.7±24.9 kg were enrolled. Body weight correlated negatively with vital capacity (R = -0.42, p<0.001), FEV1 (R = -0.497, p<0.001) and positively with P 0.1 (R = 0.32, p = 0.02) and myocardial mass (R = 0.419, p = 0.002). After 4 months the study subjects had significantly reduced their body weight (-26.0±11.8 kg) and BMI (-8.9±3.8) associated with a significant improvement of lung function (absolute changes: vital capacity +5.5±7.5\% pred., p<0.001; FEV1+9.8±8.3\% pred., p<0.001, ITGV+16.4±16.0\% pred., p<0.001, SR tot -17.4±41.5\% pred., p<0.01). Moreover, P0.1/Pimax decreased to 47.7\% (p<0.01) indicating a decreased respiratory load. The change of FEV1 correlated significantly with the change of body weight (R = -0.31, p = 0.03). Echocardiography demonstrated reduced myocardial wall thickness (-0.08±0.2 cm, p = 0.02) and improved left ventricular myocardial performance index (-0.16±0.35, p = 0.02). Mitral annular plane systolic excursion (+0.14, p = 0.03) and pulmonary outflow acceleration time (AT +26.65±41.3 ms, p = 0.001) increased. Conclusion Even in asymptomatic individuals obesity is associated with abnormalities in pulmonary and cardiac function and increased myocardial mass. All the abnormalities can be reversed by a weight reduction program.},
  language  = {en}
}
@article{HeldHesseGoettetal.2014,
  author    = {Held, Matthias and Hesse, Alexander and G{\"o}tt, Franziska and Holl, Regina and H{\"u}bner, Gudrun and Kolb, Philipp and Langen, Heinz Jakob and Romen, Tobias and Walter, Franziska and Sch{\"a}fers, Hans Joachim and Wilkens, Heinrike and Jany, Berthold},
  title     = {A symptom-related monitoring program following pulmonary embolism for the early detection of CTEPH: a prospective observational registry study},
  series = {BMC Pulmonary Medicine},
  volume    = {14},
  journal   = {BMC Pulmonary Medicine},
  doi       = {10.1186/1471-2466-14-141},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119281},
  pages     = {141},
  year      = {2014},
  abstract  = {Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication following an acute pulmonary embolism (PE). It is frequently diagnosed at advanced stages which is concerning as delayed treatment has important implications for favourable clinical outcome. Performing a follow-up examination of patients diagnosed with acute PE regardless of persisting symptoms and using all available technical procedures would be both cost-intensive and possibly ineffective. Focusing diagnostic procedures therefore on only symptomatic patients may be a practical approach for detecting relevant CTEPH. This study aimed to evaluate if a follow-up program for patients with acute PE based on telephone monitoring of symptoms and further examination of only symptomatic patients could detect CTEPH. In addition, we investigated the role of cardiopulmonary exercise testing (CPET) as a diagnostic tool. Methods In a prospective cohort study all consecutive patients with newly diagnosed PE (n=170, 76 males, 94 females within 26 months) were recruited according to the inclusion and exclusion criteria. Patients were contacted via telephone and asked to answer standardized questions relating to symptoms. At the time of the final analysis 130 patients had been contacted. Symptomatic patients underwent a structured evaluation with echocardiography, CPET and complete work-up for CTEPH. Results 37.7\%, 25.5\% and 29.3\% of the patients reported symptoms after three, six, and twelve months respectively. Subsequent clinical evaluation of these symptomatic patients saw 20.4\%, 11.5\% and 18.8\% of patients at the respective three, six and twelve months time points having an echocardiography suggesting pulmonary hypertension (PH). CTEPH with pathological imaging and a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg at rest was confirmed in eight subjects. Three subjects with mismatch perfusion defects showed an exercise induced increase of PAP without increasing pulmonary artery occlusion pressure (PAOP). Two subjects with pulmonary hypertension at rest and one with an exercise induced increase of mPAP with normal PAOP showed perfusion defects without echocardiographic signs of PH but a suspicious CPET. Conclusion A follow-up program based on telephone monitoring of symptoms and further structured evaluation of symptomatic subjects can detect patients with CTEPH. CPET may serve as a complementary diagnostic tool.},
  language  = {en}
}