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Molinger J, Kittipibul V, Gray JM, Rao VN, Barth S, Swavely A, Coyne B, Coburn A, Bakker J, Wischmeyer PE, Green CL, MacLeod D, Patel M, Fudim M. Feasibility of a Novel Augmented 6-Minute Incremental Step Test: A Simplified Cardiorespiratory Fitness Assessment Tool. JACC. ADVANCES 2024; 3:101079. [PMID: 39099774 PMCID: PMC11294698 DOI: 10.1016/j.jacadv.2024.101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 08/06/2024]
Abstract
Background The cardiopulmonary exercise test (CPET) is considered a gold standard in assessing cardiorespiratory fitness (CRF) but has limited accessibility due to competency requirements and cost. Incorporating portable sensor devices into a simple bedside test of CRF could improve diagnostic and prognostic value. Objectives The authors sought to evaluate the association of an augmented 6-minute incremental step test (6MIST) with standard CPET. Methods We enrolled patients undergoing clinically indicated supine cycle ergometry CPET with invasive hemodynamics (iCPET) for the same-day 6MIST. CRF-related variables were simultaneously recorded using a signal morphology-based impedance cardiograph (PhysioFlow Enduro) and a portable metabolic analyzer (VO2 Master Pro) during incremental pace stationary stepping. The correlation between CPET and hemodynamic parameters from both tests was assessed using the intraclass correlation coefficient (ICC). Results Fifteen patients (mean age 60 ± 14 years, 40% female, 27% Black) were included. All patients who agreed to undergo 6MIST completed the study without any test-related adverse events. We observed good to excellent correlation between iCPET- and 6MIST-measured CPET parameters: peak heart rate (ICC = 0.60; 95% CI: 0.15-0.85), absolute peak O2 consumption (VO2) (ICC = 0.77; 95% CI: 0.44-0.92), relative peak VO2 (ICC = 0.64; 95% CI: 0.20-0.86), maximum ventilation (ICC = 0.59; 95% CI: 0.13-0.84), O2 pulse (ICC = 0.71; 95% CI: 0.33-0.89), and cardiorespiratory optimal point (ICC = 0.82; 95% CI: 0.52-0.94). No significant correlation was determined between iCPET and 6MIST in measuring cardiac index at rest (ICC = 0.19; 95% CI: -0.34 to 0.63) or at peak exercise (ICC = 0.36; 95% CI: -0.17 to 0.73). Conclusions We demonstrate the feasibility of a novel augmented 6MIST with wearable devices for simultaneous CPET and hemodynamic assessment. 6MIST-measured CPET parameters were strongly correlated with the iCPET-derived measurements. Additional studies are needed to confirm the validity of the 6MIST compared to standard upright CPET.
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Affiliation(s)
- Jeroen Molinger
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
- Division of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Veraprapas Kittipibul
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - J. Matthew Gray
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vishal N. Rao
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Stratton Barth
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ashley Swavely
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian Coyne
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Aubrie Coburn
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jan Bakker
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Paul E. Wischmeyer
- Division of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia L. Green
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - David MacLeod
- Human Pharmacology & Physiology Lab, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
- Division of Critical Care, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Manesh Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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Piaggi G, Paneroni M, Maestri R, Salvioni E, Corrà U, Caporotondi A, Scalvini S, Agostoni P, La Rovere MT. Estimating maximum work rate during cardiopulmonary exercise testing from the six-minute walk distance in patients with heart failure. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200247. [PMID: 38496329 PMCID: PMC10943044 DOI: 10.1016/j.ijcrp.2024.200247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
Background Exercise is recommended for patients with chronic heart failure (CHF) and its intensity is usually set as a percentage of the maximal work rate (MWR) during cardiopulmonary exercise testing (CPX) or a symptom-limited incremental test (SLIT). As these tests are not always available in cardiac rehabilitation due to logistic/cost constraints, we aimed to develop a predictive model to estimate MWR at CPX (estMWR@CPX) in CHF patients using anthropometric and clinical measures and the 6-min walk test (6 MWT), the most widely used exercise field test. Methods This is a multicentre cross-sectional retrospective study in a cardiac rehabilitation setting. Six hundred patients with HF in New York Heart Association (NYHA) functional class I-III underwent both CPX and 6 MWT and, through multivariable linear regression analysis, we defined several predictive models to define estMWR@CPX. Results The best model included 6 MWT, sex, age, weight, NYHA class, left ventricular ejection fraction (LVEF), smoking status and chronic obstructive pulmonary disease COPD (adjusted R2 = 0.55; 95% LoA -39 to 33 W). When LVEF was excluded as a predictor, the resulting model performed only slightly worse (adjusted R2 = 0.54; 95% LoA -42 to 34 W). Only in 34% of cases was the percentage difference between estMWR@CPX and real MWR@CPX <10% in absolute value. EstMWR@CPX tended to overestimate low values and underestimate high values of true MWR@CPX. Conclusions Our results showed a lack of accuracy in the predictive model evaluated; therefore, for an accurate prescription of cycle-ergometer exercise training, it is necessary to assess MWR by CPX or SLIT.
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Affiliation(s)
- Giancarlo Piaggi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory and Cardiac Rehabilitation of the Institute of Montescano, Pavia, Italy
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Cardio-Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Roberto Maestri
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Biomedical Engineering of the Institute of Montescano, Pavia, Italy
| | | | - Ugo Corrà
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Cardiac Rehabilitation of the Institute of Veruno, Novara, Italy
| | - Angelo Caporotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Montescano, Pavia, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Montescano, Pavia, Italy
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Mapelli M, Salvioni E, Bonomi A, Paneroni M, Raimondo R, Gugliandolo P, Mattavelli I, Bidoglio J, Mirza KK, La Rovere MT, Gustafsson F, Agostoni P. Taking a walk on the heart failure side: comparison of metabolic variables during walking and maximal exertion. ESC Heart Fail 2024; 11:1269-1274. [PMID: 38287881 DOI: 10.1002/ehf2.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/20/2023] [Accepted: 11/17/2023] [Indexed: 01/31/2024] Open
Abstract
AIMS Although cardiopulmonary exercise testing (CPET) is the gold standard to assess exercise capacity, simpler tests (i.e., 6-min walk test, 6MWT) are also commonly used. The aim of this study was to evaluate the relationship between cardiorespiratory parameters during CPET and 6MWT in a large, multicentre, heterogeneous population. METHODS We included athletes, healthy subjects, and heart failure (HF) patients of different severity, including left ventricular assist device (LVAD) carriers, who underwent both CPET and 6MWT with oxygen consumption measurement. RESULTS We enrolled 186 subjects (16 athletes, 40 healthy, 115 non-LVAD HF patients, and 15 LVAD carriers). CPET-peakV̇O2 was 41.0 [35.0-45.8], 26.2 [23.1-31.0], 12.8 [11.1-15.3], and 15.2 [13.6-15.6] ml/Kg/min in athletes, healthy, HF patients, and LVAD carriers, respectively (P < 0.001). During 6MWT they used 63.5 [56.3-76.8], 72.0 [57.8-81.0], 95.5 [80.3-109], and 95.0 [92.0-99.0] % of their peakV̇O2, respectively. None of the athletes, 1 healthy (2.5%), 30 HF patients (26.1%), and 1 LVAD carrier (6.7%), reached a 6MWT-V̇O2 higher than their CPET-peakV̇O2. Both 6MWT-V̇O2 and walked distance were significantly associated with CPET-peakV̇O2 in the whole population (R2 = 0.637 and R2 = 0.533, P ≤ 0.001) but not in the sub-groups. This was confirmed after adjustment for groups. CONCLUSIONS The 6MWT can be a maximal effort especially in most severe HF patients and suggest that, in absence of prognostic studies related to 6MWT metabolic values, CPET should remain the first method of choice in the functional assessment of patients with HF as well as in sport medicine.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | - Mara Paneroni
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Italy
| | - Rosa Raimondo
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | | | | | | | - Kiran K Mirza
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Denmark
| | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Italy
| | - Finn Gustafsson
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Scrutinio D, Guida P, La Rovere MT, Vecchia LAD, Forni G, Raimondo R, Scalvini S, Passantino A. Incremental prognostic value of functional impairment assessed by 6-min walking test for the prediction of mortality in heart failure. Sci Rep 2024; 14:3089. [PMID: 38321196 PMCID: PMC10847418 DOI: 10.1038/s41598-024-53817-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/05/2024] [Indexed: 02/08/2024] Open
Abstract
Natriuretic peptides (NP) are recognized as the most powerful predictors of adverse outcomes in heart failure (HF). We hypothesized that a measure of functional limitation, as assessed by 6-min walking test (6MWT), would improve the accuracy of a prognostic model incorporating a NP. This was a multicenter observational retrospective study. We studied the prognostic value of severe functional impairment (SFI), defined as the inability to perform a 6MWT or a distance walked during a 6MWT < 300 m, in 1696 patients with HF admitted to cardiac rehabilitation. The primary outcome was 1-year all-cause mortality. After adjusting for the baseline multivariable risk model-including age, sex, systolic blood pressure, anemia, renal dysfunction, sodium level, and NT-proBNP-or for the MAGGIC score, SFI had an odds ratio of 2.58 (95% CI 1.72-3.88; p < 0.001) and 3.12 (95% CI 2.16-4.52; p < 0.001), respectively. Adding SFI to the baseline risk model or the MAGGIC score yielded a significant improvement in discrimination and risk classification. Our data suggest that a simple, 6MWT-derived measure of SFI is a strong predictor of death and provide incremental prognostic information over well-established risk markers in HF, including NP, and the MAGGIC score.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy.
| | - Pietro Guida
- Regional General Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | | | | | - Giovanni Forni
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Pavia, Pavia, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate, Varese, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy
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Mapelli M, Salvioni E, Mattavelli I, Gugliandolo P, Bonomi A, Palermo P, Rossi M, Stolfo D, Gustafsson F, Piepoli M, Agostoni P. Activities of daily living in heart failure patients and healthy subjects: when the cardiopulmonary assessment goes beyond traditional exercise test protocols. Eur J Prev Cardiol 2023; 30:ii47-ii53. [PMID: 37819228 DOI: 10.1093/eurjpc/zwad155] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 10/13/2023]
Abstract
Heart failure (HF) patients traditionally report dyspnoea as their main symptom. Although the cardiopulmonary exercise test (CPET) and 6 min walking test are the standardized tools in assessing functional capacity, neither cycle ergometers nor treadmill maximal efforts do fully represent the actual HF patients' everyday activities [activities of daily living (ADLs)] (i.e. climbing the stairs). New-generation portable metabolimeters allow the clinician to measure task-related oxygen intake (VO2) in different scenarios and exercise protocols. In the last years, we have made considerable progress in understanding the ventilatory and metabolic behaviours of HF patients and healthy subjects during tasks aimed to reproduce ADLs. In this paper, we describe the most recent findings in the field, with special attention to the relationship between the metabolic variables obtained during ADLs and CPET parameters (i.e. peak VO2), demonstrating, for example, how exercises traditionally thought to be undemanding, such as a walk, instead represent supramaximal efforts, particularly for subjects with advanced HF and/or artificial heart (left ventricular assist devices) wearers.
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Affiliation(s)
- Massimo Mapelli
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Festa del Perdono 7 - 20122 Milano, Italy
| | | | - Irene Mattavelli
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
| | - Paola Gugliandolo
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
| | - Alice Bonomi
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
| | - Pietro Palermo
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
| | - Maddalena Rossi
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Finn Gustafsson
- Department of Cardiology and Clinical Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Piepoli
- Clinical Cardiology, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
- Department of Preventive Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Piergiuseppe Agostoni
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Festa del Perdono 7 - 20122 Milano, Italy
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Nederend M, Kiès P, Regeer MV, Vliegen HW, Mertens BJ, Robbers-Visser D, Bouma BJ, Tops LF, Schalij MJ, Jongbloed MRM, Egorova AD. Tolerability and beneficial effects of sacubitril/valsartan on systemic right ventricular failure. Heart 2023; 109:1525-1532. [PMID: 37169551 DOI: 10.1136/heartjnl-2022-322332] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/12/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Patients with a systemic right ventricle (sRV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are prone to sRV dysfunction. Pharmacological options for sRV failure remain poorly defined. This study aims to investigate the tolerability and effects of sacubitril/valsartan on sRV failure in adult patients with sRV. METHODS In this two-centre, prospective cohort study, all consecutive adult patients with symptomatic heart failure and at least moderately reduced sRV systolic function were initiated on sacubitril/valsartan and underwent structured follow-up. RESULTS Data of 40 patients were included (40% female, 30% ccTGA, median age 48 (44-53) years). Five patients discontinued therapy during titration. Median follow-up was 24 (12-36) months. The maximal dose was tolerated by 49% of patients. No episodes of hyperkalaemia or renal function decline occurred. Six-minute walking distance increased significantly after 6 months of treatment (569±16 to 597±16 m, p=0.016). Serum N-terminal-prohormone brain natriuretic peptide (NT-proBNP) levels decreased significantly after 3 months (567 (374-1134) to 404 (226-633) ng/L, p<0.001). Small, yet consistent echocardiographic improvements in sRV function were observed after 6 months (sRV global longitudinal strain: -11.1±0.5% to -12.6±0.7%, p<0.001, and fractional area change: 20% (16%-24%) to 26% (19%-30%), p<0.001). The linear mixed-effects model illustrated that after first follow-up moment, no time effect was present for the parameters. CONCLUSIONS Treatment with sacubitril/valsartan was associated with a low rate of adverse effects in this adult sRV cohort. Persisting improvement in 6-minute walking test distance, NT-proBNP levels and echocardiographic parameters of sRV function was observed in an on-treatment analysis and showed no differential response based on sex or anatomy.
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Affiliation(s)
- Marieke Nederend
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippine Kiès
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Madelien V Regeer
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert W Vliegen
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart Ja Mertens
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniëlle Robbers-Visser
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Berto J Bouma
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurens F Tops
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anastasia D Egorova
- Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands
- Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Scrutinio D, Guida P, Passantino A. Prognostic Value of 6-Minute Walk Test in Advanced Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2023; 199:37-43. [PMID: 37245248 DOI: 10.1016/j.amjcard.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 05/30/2023]
Abstract
There is limited evidence regarding the prognostic value of the 6-minute walk test for patients with advanced heart failure (HF). Accordingly, we studied 260 patients presenting to inpatient cardiac rehabilitation (CR) with advanced HF. The primary outcome was 3-year all-cause mortality after discharge from CR. The association between 6-minute walk distance (6MWD) and the primary outcome was determined using the multivariable Cox regression analysis. To avoid collinearity, 6MWD at admission (6MWDadm) to CR and 6MWD at discharge (6MWDdisch) from CR were analyzed separately. At multivariable analysis, 4 baseline characteristics (age, ejection fraction, systolic blood pressure, and blood urea nitrogen) were identified as prognostic of the primary outcome (baseline risk model). After adjusting for the baseline risk model, the hazard ratios of 6MWDadm and 6MWDdisch modeled as per 50-m increase for the primary outcome were 0.92 (95% confidence interval [CI] 0.85 to 0.99, p = 0.035) and 0.93 (95% CI 0.88 to 0.99, p = -017), respectively. After adjusting for the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score, the corresponding hazard ratios were 0.91 (95% CI 0.84 to 0.98, p = 0.017) and 0.93 (95% CI 0.88 to 0.99, p = 0.016). The addition of either 6MWDadm or 6MWDdisch to the baseline risk model or the MAGGIC score yielded a statistically significant increase in global chi-square and in the net proportion of survivors reclassified downward. In conclusion, our data suggest that the distance covered during a 6-minute walk test predicts survival and provides incremental prognostic information on the top of well-established prognostic factors and the MAGGIC risk score in advanced HF.
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Affiliation(s)
- Domenico Scrutinio
- Scientific Clinical Institutes Maugeri, Institutes of Care and Research, Institute of Bari, Bari, Italy.
| | - Pietro Guida
- Regional General Hospital "F. Miulli," Acquaviva delle Fonti, Bari, Italy
| | - Andrea Passantino
- Scientific Clinical Institutes Maugeri, Institutes of Care and Research, Institute of Bari, Bari, Italy
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Mapelli M, Salvioni E, Mattavelli I, Vignati C, Galotta A, Magrì D, Apostolo A, Sciomer S, Campodonico J, Agostoni P. Cardiopulmonary exercise testing and heart failure: a tale born from oxygen uptake. Eur Heart J Suppl 2023; 25:C319-C325. [PMID: 37125287 PMCID: PMC10132578 DOI: 10.1093/eurheartjsupp/suad057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Since 50 years, cardiopulmonary exercise testing (CPET) plays a central role in heart failure (HF) assessment. Oxygen uptake (VO2) is one of the main HF prognostic indicators, then paralleled by ventilation to carbon dioxide (VE/VCO2) relationship slope. Also anaerobic threshold retains a strong prognostic power in severe HF, especially if expressed as a percent of maximal VO2 predicted value. Moving beyond its absolute value, a modern approach is to consider the percentage of predicted value for peak VO2 and VE/VCO2 slope, thus allowing a better comparison between genders, ages, and races. Several VO2 equations have been adopted to predict peak VO2, built considering different populations. A step forward was made possible by the introduction of reliable non-invasive methods able to calculate cardiac output during exercise: the inert gas rebreathing method and the thoracic electrical bioimpedance. These techniques made possible to calculate the artero-venous oxygen content differences (ΔC(a-v)O2), a value related to haemoglobin concentration, pO2, muscle perfusion, and oxygen extraction. The role of haemoglobin, frequently neglected, is however essential being anaemia a frequent HF comorbidity. Finally, peak VO2 is traditionally obtained in a laboratory setting while performing a standardized physical effort. Recently, different wearable ergo-spirometers have been developed to allow an accurate metabolic data collection during different activities that better reproduce HF patients' everyday life. The evaluation of exercise performance is now part of the holistic approach to the HF syndrome, with the inclusion of CPET data into multiparametric prognostic scores, such as the MECKI score.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, University of Milan Via Parea, 4, 20138 Milano, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Elisabetta Salvioni
- Centro Cardiologico Monzino, IRCCS, University of Milan Via Parea, 4, 20138 Milano, Italy
| | - Irene Mattavelli
- Centro Cardiologico Monzino, IRCCS, University of Milan Via Parea, 4, 20138 Milano, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, University of Milan Via Parea, 4, 20138 Milano, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Arianna Galotta
- Centro Cardiologico Monzino, IRCCS, University of Milan Via Parea, 4, 20138 Milano, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant’Andrea, ‘Sapienza’ Università degli Studi di Roma, Via di Grottarossa, 1035/1039, 00189 Rome, Italy
| | - Anna Apostolo
- Centro Cardiologico Monzino, IRCCS, University of Milan Via Parea, 4, 20138 Milano, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, ‘Sapienza’, Rome University, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino, IRCCS, University of Milan Via Parea, 4, 20138 Milano, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
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Johansson MC, Rosengren A, Fu M. Echocardiographic diagnosis of heart failure with preserved ejection fraction in elderly patients with hypertension. SCAND CARDIOVASC J 2022; 56:368-377. [PMID: 36266943 DOI: 10.1080/14017431.2022.2129777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Objectives. The aim of this study is to evaluate the diagnostic performance of echocardiography for the diagnosis of heart failure with preserved ejection fraction (HFpEF) in the elderly and to validate the Heart Failure Association diagnostic algorithm (HFA-PEFF). Design. A case-control study was conducted in patients with hypertension with or without HFpEF who were matched for age (n = 33; 78.4 ± 5.3 years) and sex. Participants underwent echocardiography including assessment of left atrial (LA) volume index (LAVI), early mitral filling to early diastolic mitral annulus velocity ratio (E/e'), LA reservoir strain (LASr), tissue Doppler LA contraction (a'), right ventricular isovolumic relaxation time (RVIVRT), and a 6-minute walk test (6-MWT). The filling pressure algorithm from the European association of cardiovascular imaging (EACVI) 2021 was applied. The HFA-PEFF score was also applied, using echocardiography parameters and the value of NT pro-BNP, without considering symptomatic status. Results. Echocardiographic parameters identified patients with HFpEF with an area under the curve (AUC) >0.9 for E/e', RVIVRT, LASr, a', and the ratio of LAVI/a'. LASr correlated with 6-MWT (r = 0.59, p = .0003). The EACVI algorithm classified all controls with normal filling pressure and 94% of patients with HFpEF with increased filling pressure. When the HFA-PEFF diagnostic algorithm was validated, a high score (≥5 points) had 100% sensitivity for HFpEF, while 88% of controls had intermediate scores (2-4 points). Conclusion. The EACVI filling pressure algorithm, RVIVRT, LASr, and the ratio LAVI/a' were accurate for diagnosing HFpEF in elderly patients with hypertension. The HFA-PEFF score had high sensitivity but limited ability to exclude HFpEF.
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Affiliation(s)
- Magnus C Johansson
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Martijn S, Cindel B, Maarten F, Dominique H, Deeman M, Toshiki K, Linqi X, Elaine J, Lotte S, Hanne K, Karin C, Paul D. Smartphone-based 6-minute walking test while walking in the park: bringing physical fitness monitoring to the patient's hands. Eur J Prev Cardiol 2022; 29:e350-e352. [PMID: 35899314 DOI: 10.1093/eurjpc/zwac157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Scherrenberg Martijn
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, 3590 Diepenbeek, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, 2000 Antwerp, Belgium
| | - Bonneux Cindel
- UHasselt, Faculty of Sciences, HCI and eHealth, 3590 Diepenbeek, Belgium
| | - Falter Maarten
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, 3590 Diepenbeek, Belgium
- Faculty of Medicine, Department of Cardiology, KULeuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hansen Dominique
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- REVAL/BIOMED, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Mahmood Deeman
- UHasselt, Faculty of Sciences, HCI and eHealth, 3590 Diepenbeek, Belgium
| | - Kaihara Toshiki
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, 3590 Diepenbeek, Belgium
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 210 Kawasaki, Japan
| | - Xu Linqi
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, 3590 Diepenbeek, Belgium
| | - Jaeken Elaine
- Faculty of Medicine and Life Sciences, UHasselt, 3590 Diepenbeek, Belgium
| | - Schols Lotte
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Kindermans Hanne
- Faculty of Medicine and Life Sciences, UHasselt, 3590 Diepenbeek, Belgium
| | - Coninx Karin
- UHasselt, Faculty of Sciences, HCI and eHealth, 3590 Diepenbeek, Belgium
| | - Dendale Paul
- Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, 3590 Diepenbeek, Belgium
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