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Casillas JM, Gudjoncik A, Gremeaux V, Aulagne J, Besson D, Laroche D. Assessment tools for personalizing training intensity during cardiac rehabilitation: Literature review and practical proposals. Ann Phys Rehabil Med 2017; 60:43-49. [DOI: 10.1016/j.rehab.2016.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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Habigt M, Ketelhut M, Gesenhues J, Schrödel F, Hein M, Mechelinck M, Schmitz-Rode T, Abel D, Rossaint R. Comparison of novel physiological load-adaptive control strategies for ventricular assist devices. ACTA ACUST UNITED AC 2017; 62:149-160. [DOI: 10.1515/bmt-2016-0073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/29/2016] [Indexed: 12/29/2022]
Abstract
AbstractTerminal heart failure (HF) is the most prevalent cause of death in the Western world and the implantation of a left ventricular assist device (LVAD) has become the gold standard therapy today. Most of the actually implanted devices are driven at a constant speed (CS) regardless of the patient’s physiological demand. A new physiological controller [power ratio (PR) controller], which keeps a constant ratio between LVAD power and left ventricular power, a previous concept [preload responsive speed (PRS) controller], which adds a variable LVAD power to reach a defined stroke work, and a CS controller were compared with an unimpaired ventricle in a full heart computer simulation model. The effects of changes in preload, afterload and left ventricular contractility are displayed by global hemodynamics and ventricular pressure-volume loops. Both physiological controllers demonstrated the desired load dependency, whereas the PR controller exceeded the PRS controller in response to an increased load and contractility. Response was inferior when preload or contractility was decreased. Thus, the PR controller might lead to an increased exercise tolerance of the patient. Additional studies are required to evaluate the controllers
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Quadri F, Boni E, Pini L, Bottone D, Venturoli N, Corda L, Tantucci C. Exercise tolerance in obstructive sleep apnea-hypopnea (OSAH), before and after CPAP treatment: Effects of autonomic dysfunction improvement. Respir Physiol Neurobiol 2016; 236:51-56. [PMID: 27840271 DOI: 10.1016/j.resp.2016.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obstructive sleep apnea hypopnea (OSAH) is associated with decreased exercise tolerance and autonomic abnormalities and represents a risk for cardiovascular diseases. The aim of the study was to evaluate the effects of CPAP on cardiovascular autonomic abnormalities and exercise performance in patients with OSAH without changes in lifestyle and body weight during treatment. METHODS Twelve overweight subjects with OSAH underwent anthropometric measures, autonomic cardiovascular and incremental symptom-limited cardio-respiratory exercise tests before and after two months of treatment with CPAP. RESULTS Lower frequency component of power spectrum of heart rate variability (59.5±24.2 msec2 vs 43.2±25.9 msec2; p<0.05) and improvements of maximal workload (99.3±13.5 vs 108.3±16.8%pred.; p<0.05) and peak oxygen consumption (95.3±7.6 vs 105.5±7.9%pred.; p<0.05) were observed in these patients after CPAP, being their BMI unchanged. CONCLUSIONS CPAP-induced decrease of sympathetic hyperactivity is associated with better tolerance to the effort in OSAH patients that did not change their BMI and lifestyle, suggesting that OSAH limits per se the exercise capacity.
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Affiliation(s)
- F Quadri
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - E Boni
- Division of Internal Medicine, Spedali Civili of Brescia, P.zza Spedali Civili, 1, Brescia, Italy.
| | - L Pini
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - D Bottone
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - N Venturoli
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - L Corda
- Division of Internal Medicine, Spedali Civili of Brescia, P.zza Spedali Civili, 1, Brescia, Italy.
| | - C Tantucci
- Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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Snyder EM, Van Iterson EH, Olson TP. Clinical Classification of Heart Failure Patients Using Cardiac Function during Exercise. Exerc Sport Sci Rev 2016. [PMID: 26196869 DOI: 10.1249/jes.0000000000000061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An effective approach for determining the clinical classification of heart failure (HF) patients is to estimate cardiac hemodynamics during exercise. This approach is strengthened further when measurements including cardiac power are used to describe cardiac hemodynamics. We hypothesize that cardiac power quantifies the hemodynamic and pressure-generating capability of the heart, relating with exercise tolerance better than traditional measurements in HF.
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Affiliation(s)
- Eric M Snyder
- 1School of Kinesiology, University of Minnesota, Minneapolis, MN; 2Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, PA; and 3Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Van Iterson EH, Wheatley CM, Baker SE, Morgan WJ, Snyder EM. The relationship between cardiac hemodynamics and exercise tolerance in cystic fibrosis. Heart Lung 2016; 45:283-90. [PMID: 27045901 PMCID: PMC4860124 DOI: 10.1016/j.hrtlng.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/22/2016] [Accepted: 03/03/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) have reduced pulmonary function and exercise tolerance. Additionally, these individuals may develop abnormal cardiac function. The implications of abnormal cardiac function on exercise tolerance are unclear in CF. OBJECTIVE Study relationships between exercise cardiac hemodynamics and exercise tolerance in CF. METHODS 17 CF and 25 controls participated in cardiopulmonary exercise testing to measure exercise duration and peak workload (PW). Cardiac index (QI) was measured using acetylene rebreathe and oxygen uptake (VO2) breath-by-breath. Forced expiratory volume in 1-second (FEV1) was performed at rest. RESULTS Peak QI was 6.7 ± 0.5 vs. 9.1 ± 0.3 mL/min/m(2), CF vs. controls, respectively (P < 0.05). Linear regressions between QI (R(2) = 0.63 and 0.51) and exercise duration or PW were stronger than VO2 (R(2) = 0.35 and 0.37) or FEV1 (R(2) = 0.34 and 0.36) in CF, respectively (P < 0.05). CONCLUSION These data are clinically relevant suggesting attenuated cardiac function in addition to low airway function relate to exercise tolerance in CF.
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Affiliation(s)
- Erik H. Van Iterson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE. Minneapolis, MN 55455
| | - Courtney M. Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721
| | - Sarah E. Baker
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Wayne J. Morgan
- Department of Pediatrics, University of Arizona, 1501 N. Campbell Avenue, Room 3301, Tucson, AZ 85724
| | - Eric M. Snyder
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE. Minneapolis, MN 55455
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721
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Murata M, Adachi H, Oshima S, Kurabayashi M. Influence of stroke volume and exercise tolerance on peak oxygen pulse in patients with and without beta-adrenergic receptor blockers in patients with heart disease. J Cardiol 2016; 69:176-181. [PMID: 27021429 DOI: 10.1016/j.jjcc.2016.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/10/2016] [Accepted: 02/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND In a given individual, a consistent relationship exists between oxygen uptake (V˙O2) and heart rate (HR) during exercise. The quotient of V˙O2 and HR (V˙O2/HR) is called the oxygen pulse (O2 pulse), and its value is dependent on stroke volume (SV). However, it is difficult to believe that the O2 pulse would indicate the SV when HR has been modified as with the use of beta-adrenergic receptor blockers (BB). Until now, the effect of BB on peak O2 pulse has not been precisely studied. We tried to clarify the effect of BB on the relationship between O2 pulse and SV. METHODS Of 699 consecutive heart disease subjects who performed cardiopulmonary exercise tests (CPX) from 2012 to 2014, we enrolled 430 subjects who had sinus rhythm and could perform CPX until exhaustion. One hundred and fifty-seven subjects were taking BB. SV was evaluated during CPX using impedance cardiography, and we compared the peak O2 pulse with peak SV between patients without BB (Group A) and with BB (Group B). RESULTS The HRs at rest and peak exercise in Group A were greater than those in Group B (74.4±13.0/min vs. 71.8±11.3/min, p<0.01, 134.9±21.7/min vs. 124.9±23.6/min, p<0.01, respectively). The regression line of the peak O2 pulse against the peak SV was steeper in Group B than in Group A. When we divided the patients into two groups according to the average values of the peak SV and peak V˙O2, O2 pulse/SV ratio in Group B above the average was greater than that in Group A, whereas it was similar in the two groups that were below average. CONCLUSION We found that the increase in the O2 pulse was disproportionately greater than the SV that was measured by impedance cardiography when a BB was used in patients with preserved SV and exercise tolerance.
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Affiliation(s)
- Makoto Murata
- Department of Medicine and Biological Science, Graduate School of Medicine, Gunma University School of Medicine, Maebashi, Gunma, Japan
| | - Hitoshi Adachi
- Gunma Prefectural Cardiovascular Center, Department of Cardiology, Maebashi, Gunma, Japan.
| | - Shigeru Oshima
- Gunma Prefectural Cardiovascular Center, Department of Cardiology, Maebashi, Gunma, Japan
| | - Masahiko Kurabayashi
- Department of Medicine and Biological Science, Graduate School of Medicine, Gunma University School of Medicine, Maebashi, Gunma, Japan
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Hollingsworth A, Danjoux G, Howell S. Cardiopulmonary exercise testing before abdominal aortic aneurysm surgery: a validated risk prediction tool? Br J Anaesth 2015; 115:494-7. [DOI: 10.1093/bja/aev150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Twisk FNM. Accurate diagnosis of myalgic encephalomyelitis and chronic fatigue syndrome based upon objective test methods for characteristic symptoms. World J Methodol 2015; 5:68-87. [PMID: 26140274 PMCID: PMC4482824 DOI: 10.5662/wjm.v5.i2.68] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/10/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
Although myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are considered to be synonymous, the definitional criteria for ME and CFS define two distinct, partially overlapping, clinical entities. ME, whether defined by the original criteria or by the recently proposed criteria, is not equivalent to CFS, let alone a severe variant of incapacitating chronic fatigue. Distinctive features of ME are: muscle weakness and easy muscle fatigability, cognitive impairment, circulatory deficits, a marked variability of the symptoms in presence and severity, but above all, post-exertional “malaise”: a (delayed) prolonged aggravation of symptoms after a minor exertion. In contrast, CFS is primarily defined by (unexplained) chronic fatigue, which should be accompanied by four out of a list of 8 symptoms, e.g., headaches. Due to the subjective nature of several symptoms of ME and CFS, researchers and clinicians have questioned the physiological origin of these symptoms and qualified ME and CFS as functional somatic syndromes. However, various characteristic symptoms, e.g., post-exertional “malaise” and muscle weakness, can be assessed objectively using well-accepted methods, e.g., cardiopulmonary exercise tests and cognitive tests. The objective measures acquired by these methods should be used to accurately diagnose patients, to evaluate the severity and impact of the illness objectively and to assess the positive and negative effects of proposed therapies impartially.
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Asrar Ul Haq M, Goh CY, Levinger I, Wong C, Hare DL. Clinical utility of exercise training in heart failure with reduced and preserved ejection fraction. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:1-9. [PMID: 25698883 PMCID: PMC4324467 DOI: 10.4137/cmc.s21372] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/29/2014] [Accepted: 01/04/2015] [Indexed: 12/13/2022]
Abstract
Reduced exercise tolerance is an independent predictor of hospital readmission and mortality in patients with heart failure (HF). Exercise training for HF patients is well established as an adjunct therapy, and there is sufficient evidence to support the favorable role of exercise training programs for HF patients over and above the optimal medical therapy. Some of the documented benefits include improved functional capacity, quality of life (QoL), fatigue, and dyspnea. Major trials to assess exercise training in HF have, however, focused on heart failure with reduced ejection fraction (HFREF). At least half of the patients presenting with HF have heart failure with preserved ejection fraction (HFPEF) and experience similar symptoms of exercise intolerance, dyspnea, and early fatigue, and similar mortality risk and rehospitalization rates. The role of exercise training in the management of HFPEF remains less clear. This article provides a brief overview of pathophysiology of reduced exercise tolerance in HFREF and heart failure with preserved ejection fraction (HFPEF), and summarizes the evidence and mechanisms by which exercise training can improve symptoms and HF. Clinical and practical aspects of exercise training prescription are also discussed.
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Affiliation(s)
- Muhammad Asrar Ul Haq
- Northern Heart, The Northern Hospital, Melbourne, Vic, Australia
- Austin Health, Melbourne, Vic, Australia
- University of Melbourne, Melbourne, Vic, Australia
| | - Cheng Yee Goh
- Northern Heart, The Northern Hospital, Melbourne, Vic, Australia
| | - Itamar Levinger
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - Chiew Wong
- Northern Heart, The Northern Hospital, Melbourne, Vic, Australia
- University of Melbourne, Melbourne, Vic, Australia
| | - David L Hare
- Austin Health, Melbourne, Vic, Australia
- University of Melbourne, Melbourne, Vic, Australia
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60
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Hemodynamic causes of exercise intolerance in Fontan patients. Int J Cardiol 2014; 175:478-83. [DOI: 10.1016/j.ijcard.2014.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 06/11/2014] [Accepted: 06/20/2014] [Indexed: 11/18/2022]
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Taguchi T, Adachi H, Hoshizaki H, Oshima S, Kurabayashi M. Effect of physical training on ventilatory patterns during exercise in patients with heart disease. J Cardiol 2014; 65:343-8. [PMID: 25012061 DOI: 10.1016/j.jjcc.2014.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 06/03/2014] [Accepted: 06/05/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exercise training is known to improve the shortness of breath experienced by patients with heart disease when the ventilatory pattern becomes abnormal during exercise. However, the precise relationship between breathing patterns and the effect of exercise training has not been elucidated to date. We evaluated the relationship between the effect of exercise training on exercise tolerance and the amelioration of the ventilatory response during exercise in such patients. METHODS AND RESULTS Patients with heart disease (n=170) underwent cardiopulmonary exercise testing twice (pre- and postexercise training for 3-6 months). They were divided into the exercise training group (Group E, n=123) and control group (Group C, n=47). Regression line relating tidal volume to respiratory rate (TV-RR slope) during a ramp protocol below the inflection point was regarded as an indicator of rapid ventilation. Tidal volume after the inflection point was regarded as an indicator of shallow ventilation (TV at plateau). The TV-RR slope and TV at plateau improved after exercise training from 94.8±45.9 to 129.9±69.5 (p<0.001) and from 1473.6±321.9mL to 1673.2±355.1mL (p<0.001), respectively, in Group E. In contrast, no improvement was evident in Group C. In total, %anaerobic threshold (%AT) [AT improving ratio=(post-AT-pre-AT)/pre-AT×100] was positively correlated with both %TV-RR slope [TV-RR slope improving ratio=(post-TV-RR slope-pre-TV-RR slope)/pre-TV-RR slope×100] (r=0.60) and %TV at plateau [TV at plateau improving ratio=(post-TV at plateau-pre-TV at plateau)/pre-TV at plateau×100] (r=0.51). CONCLUSION Exercise training improved the rapidness and depth of breathing during exercise. Therefore, improvement of abnormal ventilatory patterns is correlated with exercise tolerance.
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Affiliation(s)
- Tetsuya Taguchi
- Department of Medicine and Biological Science, Graduate School of Medicine, Gunma University, Gunma, Japan.
| | | | | | | | - Masahiko Kurabayashi
- Department of Medicine and Biological Science, Graduate School of Medicine, Gunma University, Gunma, Japan
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Hong SJ, Youn JC, Oh J, Hong N, Lee HS, Park S, Lee SH, Choi D, Kang SM. Red cell distribution width as an independent predictor of exercise intolerance and ventilatory inefficiency in patients with chronic heart failure. Yonsei Med J 2014; 55:635-43. [PMID: 24719129 PMCID: PMC3990060 DOI: 10.3349/ymj.2014.55.3.635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/02/2013] [Accepted: 10/08/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Peak oxygen uptake (peak VO₂) and ventilatory inefficiency (VE/VCO₂ slope) have proven to be strong prognostic markers in patients with chronic heart failure (CHF). Recently increased red cell distribution width (RDW) has emerged as an additional predictor of poor outcome in CHF. We sought to evaluate the relationship between RDW and cardiopulmonary exercise test (CPET) parameters in CHF patients and healthy controls. MATERIALS AND METHODS 85 ambulatory CHF patients (68 men, 54±10 years) and 107 healthy controls, who underwent a symptom-limited CPET on a treadmill according to the modified Bruce ramp protocol, were enrolled. CHF patients and healthy controls were divided into RDW tertile groups and laboratory, echocardiographic, and CPET results were analyzed. RESULTS For patients with CHF, compared with patients in the lowest RDW tertile, those in the highest tertile had lower peak VO₂ (22 mL/kg/min vs. 28 mL/kg/min, p<0.001) and higher VE/VCO₂ slope (31 vs. 25, p=0.004). Multivariate regression analysis revealed RDW to be an independent predictor for peak VO₂ (β=-0.247, p=0.035) and VE/VCO₂ slope (β=0.366, p=0.004). The optimal cutoff value of RDW for predicting peak VO₂ ≤20 mL/kg/min and VE/VCO₂ slope ≥34 was 13.6% (sensitivity 53%, specificity 89%) and 13.4% (sensitivity 75%, specificity 82%), respectively. In contrast, for healthy controls, RDW was not related to both peak VO₂ and VE/VCO₂ slope. CONCLUSION Higher RDW is independently related to peak VO₂ and VE/VCO₂ slope only in patients with CHF. RDW assessment, an inexpensive and simple method, might help predict functional capacity and ventilatory efficiency in these patients.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewon Oh
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Namki Hong
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hak Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Keller BA, Pryor JL, Giloteaux L. Inability of myalgic encephalomyelitis/chronic fatigue syndrome patients to reproduce VO₂peak indicates functional impairment. J Transl Med 2014; 12:104. [PMID: 24755065 PMCID: PMC4004422 DOI: 10.1186/1479-5876-12-104] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/11/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multi-system illness characterized, in part, by increased fatigue following minimal exertion, cognitive impairment, poor recovery to physical and other stressors, in addition to other symptoms. Unlike healthy subjects and other diseased populations who reproduce objective physiological measures during repeat cardiopulmonary exercise tests (CPETs), ME/CFS patients have been reported to fail to reproduce results in a second CPET performed one day after an initial CPET. If confirmed, a disparity between a first and second CPET could serve to identify individuals with ME/CFS, would be able to document their extent of disability, and could also provide a physiological basis for prescribing physical activity as well as a metric of functional impairment. METHODS 22 subjects diagnosed with ME/CFS completed two repeat CPETs separated by 24 h. Measures of oxygen consumption (VO₂), heart rate (HR), minute ventilation (Ve), workload (Work), and respiratory exchange ratio (RER) were made at maximal (peak) and ventilatory threshold (VT) intensities. Data were analyzed using ANOVA and Wilcoxon's Signed-Rank Test (for RER). RESULTS ME/CFS patients showed significant decreases from CPET1 to CPET2 in VO₂peak (13.8%), HRpeak (9 bpm), Ve peak (14.7%), and Work@peak (12.5%). Decreases in VT measures included VO₂@VT (15.8%), Ve@VT (7.4%), and Work@VT (21.3%). Peak RER was high (≥1.1) and did not differ between tests, indicating maximum effort by participants during both CPETs. If data from only a single CPET test is used, a standard classification of functional impairment based on VO₂peak or VO₂@VT results in over-estimation of functional ability for 50% of ME/CFS participants in this study. CONCLUSION ME/CFS participants were unable to reproduce most physiological measures at both maximal and ventilatory threshold intensities during a CPET performed 24 hours after a prior maximal exercise test. Our work confirms that repeated CPETs warrant consideration as a clinical indicator for diagnosing ME/CFS. Furthermore, if based on only one CPET, functional impairment classification will be mis-identified in many ME/CFS participants.
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Affiliation(s)
- Betsy A Keller
- Department of Exercise & Sport Sciences, Ithaca College, School of Health Sciences & Human Performance, 318 Center for Health Sciences, Ithaca, NY 14850, USA.
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Destination Therapy With Left Ventricular Assist Devices: For Whom and When? Can J Cardiol 2014; 30:296-303. [DOI: 10.1016/j.cjca.2013.12.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 11/17/2022] Open
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Behrens K, Hottenrott K, Weippert M, Montanus H, Kreuzfeld S, Rieger A, Lübke J, Werdan K, Stoll R. [Individualization of exercise load control for inpatient cardiac rehabilitation. Development and evaluation of a HRV-based intervention program for patients with ischemic heart failure]. Herz 2014; 40 Suppl 1:61-9. [PMID: 24441395 DOI: 10.1007/s00059-013-4037-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 10/30/2013] [Accepted: 12/08/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The effective use of rehabilitation programs is of primary importance in order to improve the physical performance of cardiac disease patients. A modular program has been developed which is intended to structure and individualize conventional, exercise-based rehabilitation programs according to the individual needs and physical condition of each patient. The individualization of the program is based on detailed diagnostics before patients enter the program and daily measurements of heart rate variability (HRV) during cardiac rehabilitation. METHODS A total of 30 patients with ischemic heart disease were randomly assigned either to the intervention group (IG), completing the modular individualized rehabilitation program [n=15, mean age 54.4±4.2 years and mean left ventricular ejection fraction (LVEF) 28.53±6.25%) or to the control group (CG) taking part in the conventional rehabilitation program (n=15, mean age 56.4±4.4 years and mean LVEF 27.63±5.62). Before and after the intervention, cardiorespiratory fitness was assessed by measurement of maximal oxygen consumption (relative VO2max) during bicycle ergometry and the 6-minute walk test (6-MWT). Pre-post comparisons of cardiorespiratory fitness indicators were used to evaluate the effectiveness of the rehabilitation program. In addition to the results of the basic clinical investigations and the cardiorespiratory testing, results of standardized HRV measurements of 10 min at morning rest served as criteria for program individualization. RESULTS The relative VO2max increased significantly (p<0.05) in the IG whereas no change was found in the CG. Similar results were found for maximum power output during bicycle ergometry (p<0.01) and for 6-MWT distance (p<0.001). Although patients in the IG completed less aerobic exercise sessions than those in the CG (p<0.001) the physical performance of the IG improved significantly. DISCUSSION The results prove the effectiveness and efficacy of the modular individualized rehabilitation program. They further suggest the need for an individual program matrix instead of a maximum performance matrix in cardiac rehabilitation. Individualization should be based on clinical and performance diagnostics before and accompanying assessments of training condition, e.g. by HRV measurements, during rehabilitation programs. Each patient should only perform those intervention programs which match the results of the basic clinical investigation and additional analyses during rehabilitation.
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Affiliation(s)
- K Behrens
- Institut für Präventivmedizin, Universitätsmedizin Rostock, St.-Georg-Str. 108, 18055, Rostock, Deutschland,
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Groepenhoff H, Westerhof N, Jacobs W, Boonstra A, Postmus PE, Vonk-Noordegraaf A. Exercise stroke volume and heart rate response differ in right and left heart failure. Eur J Heart Fail 2014; 12:716-20. [DOI: 10.1093/eurjhf/hfq062] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Herman Groepenhoff
- Department of Pulmonology; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center; PO Box 7057 Amsterdam 1007 MB The Netherlands
| | - Nico Westerhof
- Department of Pulmonology; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center; PO Box 7057 Amsterdam 1007 MB The Netherlands
- Department of Physiology; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center; Amsterdam The Netherlands
| | - Wouter Jacobs
- Department of Pulmonology; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center; PO Box 7057 Amsterdam 1007 MB The Netherlands
| | - Anco Boonstra
- Department of Pulmonology; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center; PO Box 7057 Amsterdam 1007 MB The Netherlands
| | - Piet E. Postmus
- Department of Pulmonology; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center; PO Box 7057 Amsterdam 1007 MB The Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology; Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center; PO Box 7057 Amsterdam 1007 MB The Netherlands
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67
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Guazzi M. Abnormalities in Cardiopulmonary Exercise Testing Ventilatory Parameters in Heart Failure: Pathophysiology and Clinical Usefulness. Curr Heart Fail Rep 2014; 11:80-7. [DOI: 10.1007/s11897-013-0183-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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68
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Stringer WW. Cardiopulmonary exercise testing: current applications. Expert Rev Respir Med 2014; 4:179-88. [DOI: 10.1586/ers.10.8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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69
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Bernal W, Martin-Mateos R, Lipcsey M, Tallis C, Woodsford K, McPhail MJ, Willars C, Auzinger G, Sizer E, Heneghan M, Cottam S, Heaton N, Wendon J. Aerobic capacity during cardiopulmonary exercise testing and survival with and without liver transplantation for patients with chronic liver disease. Liver Transpl 2014; 20:54-62. [PMID: 24136710 DOI: 10.1002/lt.23766] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/30/2013] [Indexed: 12/13/2022]
Abstract
Chronic liver disease (CLD) is associated with muscle wasting, reduced exercise tolerance and aerobic capacity (AC). Measures of AC determined with cardiopulmonary exercise testing (CPET) may predict survival after liver transplantation (LT), but the relationship with nontransplant outcomes is uncertain. In patients assessed for LT, we examined the relationship of CPET AC parameters with the severity of liver disease, nutritional state, and survival with and without LT. Patients assessed for elective first LT who underwent CPET and an anthropometric assessment at a single center were studied. CPET-derived measures of AC that were evaluated included the peak oxygen consumption (VO2 peak) and the anaerobic threshold (AT). Three hundred ninety-nine patients underwent CPET, and 223 underwent LT; 45% of the patients had a VO2 peak < 50% of the predicted value, and 31% had an AT < 9 mL/kg/minute. The VO2 peak and AT values correlated with the Model for End-Stage Liver Disease score, but they more closely correlated with serum sodium and albumin levels. The handgrip strength correlated strongly with the VO2 peak. Patients with impaired AC had prolonged hospitalization after LT, and nonsurvivors had lower AT values than survivors 1 year after transplantation (P < 0.05); this was significant in a multivariate analysis. One hundred seventy-six patients did not undergo LT; the 1-year mortality rate was 34.6%. The AT (P < 0.05) and VO2 peak values (P < 0.001) were lower for nonsurvivors. In a multivariate analysis, AT was independently associated with nonsurvival. In conclusion, AC was markedly impaired in many patients with CLD. In patients who did not undergo transplantation, impaired AT was predictive of mortality, and in patients undergoing LT, it was related to postoperative hospitalization and survival. AC should be evaluated as a modifiable factor for improving patient survival whether or not LT is anticipated.
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Affiliation(s)
- William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, King's College London, London, United Kingdom
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70
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Irisawa H, Takeuchi K, Inui N, Miyakawa S, Morishima Y, Mizushima T, Watanabe H. Incremental Shuttle Walk Test as a Valuable Assessment of Exercise Performance in Patients With Pulmonary Arterial Hypertension. Circ J 2014; 78:215-21. [DOI: 10.1253/circj.cj-13-0238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Irisawa
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine
| | - Kazuhiko Takeuchi
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine
| | - Naoki Inui
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine
| | - Sachiko Miyakawa
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine
| | - Yutaka Morishima
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine
| | - Takashi Mizushima
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine
| | - Hiroshi Watanabe
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine
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71
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Junejo MA, Siriwardena AK, Parker MJ. Peripheral oxygen extraction in patients with malignant obstructive jaundice. Anaesthesia 2013; 69:32-6. [DOI: 10.1111/anae.12478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2013] [Indexed: 01/08/2023]
Affiliation(s)
- M. A. Junejo
- Hepatobiliary Surgery Unit; Manchester Royal Infirmary; Manchester UK
| | - A. K. Siriwardena
- Hepatobiliary Surgery Unit; Manchester Royal Infirmary; Manchester UK
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72
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Hebert A, Jensen AS, Idorn L, Sørensen KE, Søndergaard L. The effect of bosentan on exercise capacity in Fontan patients; rationale and design for the TEMPO study. BMC Cardiovasc Disord 2013; 13:36. [PMID: 23663658 PMCID: PMC3658877 DOI: 10.1186/1471-2261-13-36] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 05/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative treatment with the Fontan procedure has greatly improved survival for children with functionally univentricular heart. Since Fontan performed the first successful operation, the procedure has evolved and is now performed as Total Cavo-Pulmonary Connection (TCPC).An increasing prevalence and longer life expectancy of TCPC patients have raised new challenges. The survivors are often suffering complications such as arrhythmias, myocardial dysfunction, thromboembolic events, neuropsychological deficit, protein-losing enteropathy and reduced exercise capacity. Several causes for the reduced exercise capacity may be present e.g. impaired function of the single ventricle, valve dysfunction and chronotropic impairment, and perhaps also increased pulmonary vascular resistance. Thus, plasma endothelin-1 has been shown to correlate with increased pulmonary vascular resistance and the risk of failing Fontan circulation. This has raised the question of the role for pulmonary vasodilation therapy, especially endothelin receptor antagonist in the management of TCPC patients. METHODS/DESIGN The TEMPO trial aims to investigate whether Bosentan, an endothelin receptor antagonist, can be administered safely and improve exercise capacity in TCPC patients. The trial design is randomized, double-blind and placebo-controlled. Bosentan/placebo is administered for 14 weeks with control visits every four weeks. The primary endpoint is change in maximal oxygen consumption as assessed on bicycle ergometer test. Secondary endpoints include changes in pulmonary blood flow during exercise test, pro brain natriuretic peptide and quality of life. DISCUSSION We hypothesize that treatment with Bosentan, an endothelin receptor antagonist, can be administered safely and improve exercise capacity in TCPC patients.
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Affiliation(s)
- Anders Hebert
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
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73
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Radojevic J, Inuzuka R, Alonso-Gonzalez R, Borgia F, Giannakoulas G, Prapa M, Liodakis E, Li W, Swan L, Diller GP, Dimopoulos K, Gatzoulis MA. Peak oxygen uptake correlates with disease severity and predicts outcome in adult patients with Ebstein's anomaly of the tricuspid valve. Int J Cardiol 2013; 163:305-308. [DOI: 10.1016/j.ijcard.2011.06.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/06/2011] [Indexed: 10/18/2022]
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74
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Older P. Anaerobic threshold, is it a magic number to determine fitness for surgery? Perioper Med (Lond) 2013; 2:2. [PMID: 24472514 PMCID: PMC3964343 DOI: 10.1186/2047-0525-2-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 01/24/2013] [Indexed: 10/28/2022] Open
Abstract
The use of cardiopulmonary exercise testing (CPET) to evaluate cardiac and respiratory function was pioneered as part of preoperative assessment in the mid 1990s. Surgical procedures have changed since then. The patient population may have aged; however, the physiology has remained the same. The use of an accurate physiological evaluation remains as germane today as it was then. Certainly no 'magic' is involved. The author recognizes that not everyone accepts the classical theories of the anaerobic threshold (AT) and that there is some discussion around lactate and exercise. The article looks at aerobic capacity as an important predictor of perioperative mortality and also looks at some aspects of CPET relative to surgical risk evaluation.
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Affiliation(s)
- Paul Older
- Department of Anaesthetics, Western Hospital, Melbourne, Australia.
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75
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Chan KMJ, Punjabi PP, Flather M, Wage R, Symmonds K, Roussin I, Rahman-Haley S, Pennell DJ, Kilner PJ, Dreyfus GD, Pepper JR. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) trial. Circulation 2012; 126:2502-10. [PMID: 23136163 DOI: 10.1161/circulationaha.112.143818] [Citation(s) in RCA: 264] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The role of mitral valve repair (MVR) during coronary artery bypass grafting (CABG) in patients with moderate ischemic mitral regurgitation (MR) is uncertain. We conducted a randomized, controlled trial to determine whether repairing the mitral valve during CABG may improve functional capacity and left ventricular reverse remodeling compared with CABG alone. METHODS AND RESULTS Seventy-three patients referred for CABG with moderate ischemic MR and an ejection fraction >30% were randomized to receive CABG plus MVR (34 patients) or CABG only (39 patients). The study was stopped early after review of interim data. At 1 year, there was a greater improvement in the primary end point of peak oxygen consumption in the CABG plus MVR group compared with the CABG group (3.3 mL/kg/min versus 0.8 mL/kg/min; P<0.001). There was also a greater improvement in the secondary end points in the CABG plus MVR group compared with the CABG group: left ventricular end-systolic volume index, MR volume, and plasma B-type natriuretic peptide reduction of 22.2 mL/m(2), 28.2 mL/beat, and 557.4 pg/mL, respectively versus 4.4 mL/m(2) (P=0.002), 9.2 mL/beat (P=0.001), and 394.7 pg/mL (P=0.003), respectively. Operation duration, blood transfusion, intubation duration, and hospital stay duration were greater in the CABG plus MVR group. Deaths at 30 days and 1 year were similar in both groups: 3% and 9%, respectively in the CABG plus MVR group, versus 3% (P=1.00) and 5% (P=0.66), respectively in the CABG group. CONCLUSIONS Adding mitral annuloplasty to CABG in patients with moderate ischemic MR may improve functional capacity, left ventricular reverse remodeling, MR severity, and B-type natriuretic peptide levels, compared with CABG alone. The impact of these benefits on longer term clinical outcomes remains to be defined.
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Affiliation(s)
- K M John Chan
- Department of Cardiothoracic Surgery, Imperial College London, Royal Brompton Hospital, Sydney Street, London, United Kingdom.
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76
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Prentis JM, Trenell MI, Jones DJ, Lees T, Clarke M, Snowden CP. Submaximal exercise testing predicts perioperative hospitalization after aortic aneurysm repair. J Vasc Surg 2012; 56:1564-70. [PMID: 22858436 DOI: 10.1016/j.jvs.2012.05.097] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/21/2012] [Accepted: 05/28/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aortic aneurysm repair is a high-risk surgical procedure. Patients are often elderly, with multiple comorbidities that predispose them to perioperative morbidity. Use of endovascular aneurysm repair (EVAR) has increased due to reduced early perioperative risk. This study assessed whether preoperative cardiopulmonary exercise testing (CPET) could be used to predict morbidity and hospital length of stay (LOS) after aortic aneurysm repair. METHODS A total of 185 patients underwent surgical repair (84 open repairs, 101 EVAR) and had adequate determination of a submaximal CPET parameter (anaerobic threshold). RESULTS Patient comorbidities and cardiorespiratory fitness, derived from CPET, were similar between surgical procedures. Patients undergoing EVAR had fewer complications (10% vs 32%; P<.0001) and shorter mean (standard deviation [SD]) hospital LOS of 5.7 (9.3) days vs 14.4 (10.9) days compared with open repair (P<.0001). The hospital LOS was significantly increased in patients with one or more complications in both groups compared with those with no complications. In the open repair group, the level of fitness, as defined by anaerobic threshold, was an independent predictor of postoperative morbidity and hospital LOS. When the optimal anaerobic threshold (10 mL/min/kg) derived from receiver operator curve analysis was used as a cutoff value, unfit patients stayed significantly longer than fit patients in critical care (mean, 6.4 [SD, 6.9] days vs 2.4 [SD, 2.9] days; P=.002) and in the hospital (mean, 23.1 [SD, 14.8] days vs 11.0 [SD, 6.1] days; P<.0001). In contrast, fitness in the EVAR group was not predictive of postoperative morbidity but did have predictive value for hospital LOS. CONCLUSIONS Cardiorespiratory fitness holds significant clinical value before aortic aneurysm repair in predicting postsurgical complications and duration of critical care and hospital LOS. Preoperative measurement of fitness could then direct clinical management with regard to operative choice, postoperative resource allocation, and informed patient decision making.
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Affiliation(s)
- James M Prentis
- Department of Perioperative and Critical Care Medicine, the Freeman Hospital, and the Institute of Cellular Medicine, Biomedical Research Centre for Ageing and Age Related Diseases, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Young E, Karthikesalingam A, Huddart S, Pearse R, Hinchliffe R, Loftus I, Thompson M, Holt P. A Systematic Review of the Role of Cardiopulmonary Exercise Testing in Vascular Surgery. Eur J Vasc Endovasc Surg 2012; 44:64-71. [DOI: 10.1016/j.ejvs.2012.03.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/29/2012] [Indexed: 11/28/2022]
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78
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Lanier GM, Zheng Q, Wagman G, Tseng CH, Myers JN, Vittorio TJ. Simple prediction formula for peak oxygen consumption in patients with chronic heart failure. J Exerc Sci Fit 2012. [DOI: 10.1016/j.jesf.2012.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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79
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80
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Prentis JM, Manas DMD, Trenell MI, Hudson M, Jones DJ, Snowden CP. Submaximal cardiopulmonary exercise testing predicts 90-day survival after liver transplantation. Liver Transpl 2012; 18:152-9. [PMID: 21898768 DOI: 10.1002/lt.22426] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver transplantation has a significant early postoperative mortality rate. An accurate preoperative assessment is essential for minimizing mortality and optimizing limited donor organ resources. This study assessed the feasibility of preoperative submaximal cardiopulmonary exercise testing (CPET) for determining the cardiopulmonary reserve in patients being assessed for liver transplantation and its potential for predicting 90-day posttransplant survival. One hundred eighty-two patients underwent CPET as part of their preoperative assessment for elective liver transplantation. The 90-day mortality rate, critical care length of stay, and hospital length of stay were determined during the prospective posttransplant follow-up. One hundred sixty-five of the 182 patients (91%) successfully completed CPET; this was defined as the ability to determine a submaximal exercise parameter: the anaerobic threshold (AT). Sixty of the 182 patients (33%) underwent liver transplantation, and the mortality rate was 10.0% (6/60). The mean AT value was significantly higher for survivors versus nonsurvivors (12.0 ± 2.4 versus 8.4 ± 1.3 mL/minute/kg, P < 0.001). Logistic regression revealed that AT, donor age, blood transfusions, and fresh frozen plasma transfusions were significant univariate predictors of outcomes. In a multivariate analysis, only AT was retained as a significant predictor of mortality. A receiver operating characteristic curve analysis demonstrated sensitivity and specificity of 90.7% and 83.3%, respectively, with good model accuracy (area under the receiver operating characteristic curve = 0.92, 95% confidence interval = 0.82-0.97, P = 0.001). The optimal AT level for survival was defined to be >9.0 mL/minute/kg. The predictive value was improved when the ideal weight was substituted for the actual body weight of a patient with refractory ascites, even after a correction for the donor's age. In conclusion, the preoperative cardiorespiratory reserve (as defined by CPET) is a sensitive and specific predictor of early survival after liver transplantation. The predictive value of CPET requires further evaluation.
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Affiliation(s)
- James M Prentis
- Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle upon Tyne, UK.
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81
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West M, Jack S, Grocott MPW. Perioperative cardiopulmonary exercise testing in the elderly. Best Pract Res Clin Anaesthesiol 2011; 25:427-37. [PMID: 21925407 DOI: 10.1016/j.bpa.2011.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/12/2011] [Indexed: 10/17/2022]
Abstract
The elderly constitute an increasingly large segment of the population and of the patients requiring medical attention. Major surgery is associated with a substantial burden of postoperative morbidity and mortality. Advancing age is a particular risk factor for these outcomes. This article reviews the current literature on the value and practical applications of cardiopulmonary exercise testing (CPET) as a tool to evaluate risk and thereby improve the management of the elderly patient undergoing major surgery. There is a consistent association between CPET-derived variables and outcome following major surgery. Furthermore, CPET-derived variables have utility in perioperative risk prediction and identification of patients at high risk of adverse outcome following major surgery. This optimal predictor appears to differ between various surgery types and the incremental benefit of combining CPET with alternative methods of perioperative risk prediction remains poorly defined.
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Affiliation(s)
- M West
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
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82
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Hemodynamic Effects of Exercise Training in Heart Failure. J Card Fail 2011; 17:916-22. [DOI: 10.1016/j.cardfail.2011.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/30/2011] [Accepted: 07/28/2011] [Indexed: 01/11/2023]
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83
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Nilsson KR, Duscha BD, Hranitzky PM, Kraus WE. Chronic heart failure and exercise intolerance: the hemodynamic paradox. Curr Cardiol Rev 2011; 4:92-100. [PMID: 19936283 PMCID: PMC2779357 DOI: 10.2174/157340308784245757] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 11/23/2007] [Accepted: 12/03/2007] [Indexed: 01/14/2023] Open
Abstract
Heart failure represents a major source of morbidity and mortality in industrialized nations. As the leading hospital discharge diagnosis in the United States in patients over the age of 65, it is also associated with substantial economic costs. While the acute symptoms of volume overload frequently precipitate inpatient admission, it is the symptoms of chronic heart failure, including fatigue, exercise intolerance and exertional dyspnea, that impact quality of life. Over the last two decades, research into the enzymatic, histologic and neurohumoral alterations seen with heart failure have revealed that hemodynamic derangements do not necessarily correlate with symptoms. This “hemodynamic paradox” is explained by alterations in the skeletal musculature that occur in response to hemodynamic derangements. Importantly, gender specific effects appear to modify both disease pathophysiology and response to therapy. The following review will discuss our current understanding of the systemic effects of heart failure before examining how exercise training and cardiac resynchronization therapy may impact disease course.
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Affiliation(s)
- Kent R Nilsson
- Department of Medicine, Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina, USA
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84
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Plasma adenosine concentration during and after dynamic exercise in patients with chronic heart failure. Int J Angiol 2011. [DOI: 10.1007/bf02042918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cattadori G, Salvioni E, Gondoni E, Agostoni P. Evaluation of noninvasive exercise cardiac output determination in chronic heart failure patients: a proposal of a new diagnostic and prognostic method. J Cardiovasc Med (Hagerstown) 2011; 12:19-27. [DOI: 10.2459/jcm.0b013e3283405c4c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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86
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Miyatake N, Shikata K, Makino H, Numata T. Comparison of ventilatory threshold between subjects with and without proteinuria in Japanese. Health (London) 2011. [DOI: 10.4236/health.2011.36066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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87
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Rooks CR, Thom NJ, McCully KK, Dishman RK. Effects of incremental exercise on cerebral oxygenation measured by near-infrared spectroscopy: A systematic review. Prog Neurobiol 2010; 92:134-50. [DOI: 10.1016/j.pneurobio.2010.06.002] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 05/22/2010] [Accepted: 06/04/2010] [Indexed: 11/25/2022]
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88
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Miyatake N, Numata T, Nishii K, Sakano N, Suzue T, Hirao T, Miyachi M, Tabata I. Relation between cigarette smoking and ventilatory threshold in the Japanese. Environ Health Prev Med 2010; 16:185-90. [PMID: 21431801 DOI: 10.1007/s12199-010-0178-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 08/12/2010] [Indexed: 11/29/2022] Open
Abstract
The link between cigarette smoking and ventilatory threshold (VT) was investigated. We used data for 407 men and 418 women not taking medication. Habits of cigarette smoking were obtained through interviews by well-trained staff. The influence of cigarette smoking on oxygen uptake, work rate, and heart rate at VT was evaluated. Oxygen uptake at VT in women and work rate at VT in men with cigarette smoking were significantly lower than in subjects without cigarette smoking after adjusting for age. The differences of parameters at VT did not reach significant levels after adjusting for age and exercise habits in both sexes. However, in women without exercise habits, there was significant difference of oxygen uptake at VT between women with and without cigarette smoking after adjusting for age [cigarette smoking (+): 11.5 ± 1.8 ml/kg/min, cigarette smoking (-): 12.4 ± 2.1 ml/kg/min, p = 0.0006]. The number of cigarettes smoked per day and the Brinkman Index were not clearly correlated with oxygen uptake at VT. A combination of promoting exercise habits and prohibiting cigarette smoking might be recommended for improving the aerobic exercise level, especially in women.
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Affiliation(s)
- Nobuyuki Miyatake
- Department of Hygiene, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan.
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89
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Cuomo G, Santoriello C, Polverino F, Ruocco L, Valentini G, Polverino M. Impaired exercise performance in systemic sclerosis and its clinical correlations. Scand J Rheumatol 2010; 39:330-5. [PMID: 20476863 DOI: 10.3109/03009740903555358] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate the prevalence of impaired exercise performance as assessed by a standardized cardiopulmonary exercise test (CPET) in systemic sclerosis (SSc) and to identify the associated disease features. METHODS Forty-six SSc patients were enrolled and evaluated for clinical and serological SSc subset, extent of skin and internal organ involvement, and disease activity and severity. Exercise performance was subsequently evaluated in these patients and in 23 healthy individuals matched for sex and age, using a standardized CPET. RESULTS Exercise performance, measured by maximum oxygen uptake (VO2 max < 80% of predicted value), was found to be impaired in 43/46 patients. Stepwise regression analysis showed that VO2 max adjusted for body weight VO2 max/kg) was independently correlated with the severity of heart (p = 0.001) and lung (p = 0.013) involvement, left ventricular diastolic dysfunction (p = 0.009), and the Health Assessment Questionnaire Disability Index (HAQ-DI) score (p = 0.016). CONCLUSIONS This study demonstrates that physical disability contributes significantly to the development of impaired exercise performance in SSc patients. Cardiopulmonary exercise testing may be included among the battery of tests used to determine the severity of SSc.
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Affiliation(s)
- G Cuomo
- Department of Internal Medicine, Second University of Naples, ASL SA1, Naples, Italy
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90
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Laveneziana P, Agostoni P, Mignatti A, Mushtaq S, Colombo P, Sims D, Uriel N, Jorde UP. Effect of Acute β-blocker Withholding on Ventilatory Efficiency in Patients With Advanced Chronic Heart Failure. J Card Fail 2010; 16:548-55. [DOI: 10.1016/j.cardfail.2010.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 02/08/2010] [Accepted: 02/10/2010] [Indexed: 11/30/2022]
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91
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Unverdorben M, von Holt K, Winkelmann BR. Smoking and atherosclerotic cardiovascular disease: part III: functional biomarkers influenced by smoking. Biomark Med 2010; 3:807-23. [PMID: 20477716 DOI: 10.2217/bmm.09.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Smoking cigarettes induces rapidly occurring and reversible functional changes in the cardiovascular system, which precede morphologic changes. These functional changes are also related to atherosclerotic disease development and thus may qualify as prognostic parameters in chronic smokers. As opposed to smoking-induced morphologic changes functional alterations occur and revert within minutes, thus, allowing for the detection of smoking-induced effects on the cardiovascular system within minutes following exposure to mainstream smoke. Some alterations represent 'direct' changes (e.g., endothelial function), others reflect changes in a different organ system (e.g., the autonomous nervous system influencing heart rate variability), while some represent the sum of alterations in many organs and systems (e.g., exercise performance influenced by the autonomous nervous and by endothelial and cardiac function). Since a specific functional parameter usually changes with at least one or several others, caution should be exercised when trying to establish a direct cause relationship between the alteration of a single parameter and a clinical outcome.
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Affiliation(s)
- Martin Unverdorben
- Clinical Research Institute, Center for Cardiovascular Diseases, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.
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92
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Miyatake N, Miyachi M, Tabata I, Sakano N, Suzue T, Hirao T, Numata T. Evaluation of ventilatory threshold and its relation to exercise habits among Japanese. Environ Health Prev Med 2010; 15:374-80. [PMID: 21432569 DOI: 10.1007/s12199-010-0147-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 04/06/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate aerobic exercise levels, expressed in terms of ventilatory threshold (VT), in a Japanese population and explore the relationship between VT and exercise habits in this population. METHODS This was a cross-sectional study in which data collected from 547 men and 524 women aged 20-69 years and not on medications, were used to assess exercise habits and parameters at VT, namely, oxygen uptake, work rate, and heart rate. RESULTS Age-related changes in parameters at VT were noted. Of the participants, 205 men (37.5%) and 142 women (27.1%) had exercise habits. Oxygen uptake and work rate at VT in subjects with exercise habits were significantly higher than those without exercise habits after age had been adjusted for in both sexes. Anthropometric parameters were significantly correlated with oxygen uptake at VT, and the highest correlation coefficient rate was found between oxygen uptake at VT and body fat percentage (men r = -0.589, women r = -0.631). CONCLUSION The mean values determined here may provide a useful database for evaluating VT in Japanese adult subjects.
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Affiliation(s)
- Nobuyuki Miyatake
- Department of Hygiene, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan,
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93
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Elmariah S, Goldberg LR, Allen MT, Kao A. The Effects of Race on Peak Oxygen Consumption and Survival in Patients With Systolic Dysfunction. J Card Fail 2010; 16:332-9. [DOI: 10.1016/j.cardfail.2009.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/11/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
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94
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Submaximal Cardiopulmonary Exercise Testing Predicts Complications and Hospital Length of Stay in Patients Undergoing Major Elective Surgery. Ann Surg 2010; 251:535-41. [DOI: 10.1097/sla.0b013e3181cf811d] [Citation(s) in RCA: 271] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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95
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Goda A, Lang CC, Williams P, Jones M, Farr MJ, Mancini DM. Usefulness of non-invasive measurement of cardiac output during sub-maximal exercise to predict outcome in patients with chronic heart failure. Am J Cardiol 2009; 104:1556-60. [PMID: 19932792 DOI: 10.1016/j.amjcard.2009.07.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 07/10/2009] [Accepted: 07/10/2009] [Indexed: 11/26/2022]
Abstract
Peak oxygen consumption (Vo(2)) is a powerful prognostic predictor of survival in patients with chronic heart failure (CHF) because it provides an indirect assessment of a patient's ability to increase cardiac output (CO). However, many patients with CHF who undergo cardiopulmonary exercise testing are unable to perform maximal exercise. New metabolic carts coupled with the inert gas rebreathing technique provide a noninvasive measurement of CO. Whether the noninvasive measurement of CO at a fixed submaximal workload can predict outcome is unknown. This study's population comprised 259 patients (mean age 54 +/- 14 years, mean left ventricular ejection fraction 27 +/- 14%) with CHF who underwent symptom-limited incremental cardiopulmonary exercise testing. Vo(2) and CO were measured at rest, at 25 W, and at peak exercise. Submaximal exercise was defined as <80% peak Vo(2). Among 259 patients, 145 had Vo(2) at 25 W <80% of peak. Vo(2) at 25 W averaged 9.3 +/- 1.8 ml/kg/min. This Vo(2) represented 62 +/- 11% of peak Vo(2), which averaged 15.4 +/- 4.4 ml/kg/min. Prospective follow-up averaged 521 +/- 337 days. In this cohort, there were 15 outcome events (death, urgent heart transplantation, or implantation of a left ventricular assist device as a bridge to transplantation). On univariate Cox hazard analysis, CO at 25 W (hazard ratio 0.64, 95% confidence interval 0.48 to 0.84, p = 0.002) was found to be significant predictor of events of outcome. In conclusion, CO at 25 W measured noninvasively during submaximal exercise may have potential value as a predictor of outcomes in patients with CHF.
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96
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Maurer MM, Burkhoff D, Maybaum S, Franco V, Vittorio TJ, Williams P, White L, Kamalakkannan G, Myers J, Mancini DM. A Multicenter Study of Noninvasive Cardiac Output by Bioreactance During Symptom-limited Exercise. J Card Fail 2009; 15:689-99. [DOI: 10.1016/j.cardfail.2009.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Revised: 04/15/2009] [Accepted: 04/20/2009] [Indexed: 10/20/2022]
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97
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Bombardini T, Gemignani V, Bianchini E, Pasanisi E, Pratali L, Pianelli M, Faita F, Giannoni M, Arpesella G, Sicari R, Picano E. Post-exercise contractility, diastolic function, and pressure: operator-independent sensor-based intelligent monitoring for heart failure telemedicine. Cardiovasc Ultrasound 2009; 7:21. [PMID: 19442285 PMCID: PMC2689191 DOI: 10.1186/1476-7120-7-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 05/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New sensors for intelligent remote monitoring of the heart should be developed. Recently, a cutaneous force-frequency relation recording system has been validated based on heart sound amplitude and timing variations at increasing heart rates. AIM To assess sensor-based post-exercise contractility, diastolic function and pressure in normal and diseased hearts as a model of a wireless telemedicine system. METHODS We enrolled 150 patients and 22 controls referred for exercise-stress echocardiography, age 55 +/- 18 years. The sensor was attached in the precordial region by an ECG electrode. Stress and recovery contractility were derived by first heart sound amplitude vibration changes; diastolic times were acquired continuously. Systemic pressure changes were quantitatively documented by second heart sound recording. RESULTS Interpretable sensor recordings were obtained in all patients (feasibility = 100%). Post-exercise contractility overshoot (defined as increase > 10% of recovery contractility vs exercise value) was more frequent in patients than controls (27% vs 8%, p < 0.05). At 100 bpm stress heart rate, systolic/diastolic time ratio (normal, < 1) was > 1 in 20 patients and in none of the controls (p < 0.01); at recovery systolic/diastolic ratio was > 1 in only 3 patients (p < 0.01 vs stress). Post-exercise reduced arterial pressure was sensed. CONCLUSION Post-exercise contractility, diastolic time and pressure changes can be continuously measured by a cutaneous sensor. Heart disease affects not only exercise systolic performance, but also post-exercise recovery, diastolic time intervals and blood pressure changes--in our study, all of these were monitored by a non-invasive wearable sensor.
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Affiliation(s)
- Tonino Bombardini
- Department of Echocardiography Lab, Institute of Clinical Physiology, National Council of Research, Pisa, Italy.
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98
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Magrì D, Brioschi M, Banfi C, Schmid JP, Palermo P, Contini M, Apostolo A, Bussotti M, Tremoli E, Sciomer S, Cattadori G, Fiorentini C, Agostoni P. Circulating Plasma Surfactant Protein Type B as Biological Marker of Alveolar-Capillary Barrier Damage in Chronic Heart Failure. Circ Heart Fail 2009; 2:175-80. [DOI: 10.1161/circheartfailure.108.819607] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Damiano Magrì
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Maura Brioschi
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Cristina Banfi
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Jean Paul Schmid
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Pietro Palermo
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Mauro Contini
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Anna Apostolo
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Maurizio Bussotti
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Elena Tremoli
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Susanna Sciomer
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Gaia Cattadori
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Cesare Fiorentini
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Piergiuseppe Agostoni
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
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Abstract
Noninvasive cardiopulmonary exercise (CPX) testing has proven useful in the assessment of heart and lung disease, including cardiac and ventilatory reserves. CPX includes the monitoring of respiratory gas exchange, O2 uptake the CO2 production, together with minute ventilation and its components--tidal volume and respiratory rate--together with surveillance of electrocardiography and blood pressure during supervised, incremental exercise. Exercise responses in anaerobic threshold and/or maximal O2 uptake are used to grade functional capacity objectively and to predict cardiac reserve (exercise cardiac output), which grades the severity of chronic cardiac or circulatory failure. CPX also serves to distinguish primary cardiac from ventilatory-based exertional dyspnea.
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Affiliation(s)
- K T Weber
- Department of Internal Medicine, University of Missouri Health Sciences Center, Columbia, USA
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100
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Goda A, Koike A, Iwamoto MH, Nagayama O, Yamaguchi K, Tajima A, Sawada H, Itoh H, Isobe M, Aizawa T. Prognostic Value of Heart Rate Profiles During Cardiopulmonary Exercise Testing in Patients With Cardiac Disease. Int Heart J 2009; 50:59-71. [DOI: 10.1536/ihj.50.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ayumi Goda
- The Cardiovascular Institute, Tokyo Medical and Dental University
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Akira Koike
- The Cardiovascular Institute, Tokyo Medical and Dental University
| | - Masayo Hoshimoto- Iwamoto
- The Cardiovascular Institute, Tokyo Medical and Dental University
- School of Health and Sports Science, Juntendo University
| | - Osamu Nagayama
- The Cardiovascular Institute, Tokyo Medical and Dental University
| | - Kaori Yamaguchi
- The Cardiovascular Institute, Tokyo Medical and Dental University
| | - Akihiko Tajima
- The Cardiovascular Institute, Tokyo Medical and Dental University
| | - Hitoshi Sawada
- The Cardiovascular Institute, Tokyo Medical and Dental University
| | | | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tadanori Aizawa
- The Cardiovascular Institute, Tokyo Medical and Dental University
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