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Patti A, Blumberg Y, Hedman K, Neunhäuserer D, Haddad F, Wheeler M, Ashley E, Moneghetti KJ, Myers J, Christle JW. Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise. Clinics (Sao Paulo) 2023; 78:100225. [PMID: 37356413 PMCID: PMC10310477 DOI: 10.1016/j.clinsp.2023.100225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 03/20/2023] [Accepted: 04/12/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Cardiopulmonary Exercise Testing (CPX) is essential for the assessment of exercise capacity for patients with Chronic Heart Failure (CHF). Respiratory gas and hemodynamic parameters such as Ventilatory Efficiency (VE/VCO2 slope), peak oxygen uptake (peak VO2), and heart rate recovery are established diagnostic and prognostic markers for clinical populations. Previous studies have suggested the clinical value of metrics related to respiratory gas collected during recovery from peak exercise, particularly recovery time to 50% (T1/2) of peak VO2. The current study explores these metrics in detail during recovery from peak exercise in CHF. METHODS Patients with CHF who were referred for CPX and healthy individuals without formal diagnoses were assessed for inclusion. All subjects performed CPX on cycle ergometers to volitional exhaustion and were monitored for at least five minutes of recovery. CPX data were analyzed for overshoot of respiratory exchange ratio (RER=VCO2/VO2), ventilatory equivalent for oxygen (VE/VO2), end-tidal partial pressure of oxygen (PETO2), and T1/2 of peak VO2 and VCO2. RESULTS Thirty-two patients with CHF and 30 controls were included. Peak VO2 differed significantly between patients and controls (13.5 ± 3.8 vs. 32.5 ± 9.8 mL/Kg*min-1, p < 0.001). Mean Left Ventricular Ejection Fraction (LVEF) was 35.9 ± 9.8% for patients with CHF compared to 61.1 ± 8.2% in the control group. The T1/2 of VO2, VCO2 and VE was significantly higher in patients (111.3 ± 51.0, 132.0 ± 38.8 and 155.6 ± 45.5s) than in controls (58.08 ± 13.2, 74.3 ± 21.1, 96.7 ± 36.8s; p < 0.001) while the overshoot of PETO2, VE/VO2 and RER was significantly lower in patients (7.2 ± 3.3, 41.9 ± 29.1 and 25.0 ± 13.6%) than in controls (10.1 ± 4.6, 62.1 ± 17.7 and 38.7 ± 15.1%; all p < 0.01). Most of the recovery metrics were significantly correlated with peak VO2 in CHF patients, but not with LVEF. CONCLUSIONS Patients with CHF have a significantly blunted recovery from peak exercise. This is reflected in delays of VO2, VCO2, VE, PETO2, RER and VE/VO2, reflecting a greater energy required to return to baseline. Abnormal respiratory gas kinetics in CHF was negatively correlated with peak VO2 but not baseline LVEF.
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Affiliation(s)
- Alessandro Patti
- Division of Cardiovascular Medicine, Department of Medicine, Stanford, California, USA; Division of Sports and Exercise Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Yair Blumberg
- Division of Cardiovascular Medicine, Department of Medicine, Stanford, California, USA; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Kristofer Hedman
- Department of Clinical Physiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Daniel Neunhäuserer
- Division of Sports and Exercise Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Francois Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford, California, USA; Stanford Sports Cardiology, Stanford University, Stanford, California, USA
| | - Matthew Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford, California, USA; Stanford Sports Cardiology, Stanford University, Stanford, California, USA
| | - Euan Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford, California, USA; Stanford Sports Cardiology, Stanford University, Stanford, California, USA
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Department of Medicine, Stanford, California, USA; Stanford Sports Cardiology, Stanford University, Stanford, California, USA; Baker Department of Cardiometabolic Health, University of Melbourne, Australia; National Centre for Sports Cardiology, St Vincent's Hospital, Melbourne, Australia
| | - Jonathan Myers
- Division of Cardiovascular Medicine, Department of Medicine, Stanford, California, USA; Stanford Sports Cardiology, Stanford University, Stanford, California, USA; Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jeffrey W Christle
- Division of Cardiovascular Medicine, Department of Medicine, Stanford, California, USA; Stanford Sports Cardiology, Stanford University, Stanford, California, USA.
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Pella E, Alexandrou ME, Boutou A, Theodorakopoulou M, Dipla K, Zafeiridis A, Sarafidis P. Effect of kidney transplantation on indices of cardiorespiratory fitness assessed with cardiopulmonary exercise testing: a systematic review and meta-analysis. Expert Rev Respir Med 2023; 17:171-179. [PMID: 36803358 DOI: 10.1080/17476348.2023.2182772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Patients with kidney failure often present with reduced cardiovascular reserve. Kidney transplantation (KT) is the optimal treatment for patients with end-stage kidney disease as it is associated with longer survival and improved quality of life compared to dialysis. METHODS This is a systematic review and meta-analysis of studies using cardiopulmonary-exercise-testing to examine the cardiorespiratory fitness of patients with kidney failure before and after KT. The primary outcome was difference in pre- and post-transplantation values of peak oxygen uptake (VO2peak). Literature search involved three databases (PubMed-Web of Science-Scopus), manual search, and grey literature. RESULTS From 379 records initially retrieved, six studies were included in final meta-analysis. A marginal, but not significant, improvement was observed in VO2peak after KT compared to pre-transplantation values (SMD: 0.32, 95%CI -0.02; 0.67). Oxygen consumption at anaerobic threshold was significantly improved after KT (WMD: 2.30 ml/kg/min, 95%CI 0.50; 4.09). Consistent results were shown between preemptive and after-dialysis-initiation transplantation and a trend for improvement in VO2peak was observed at least 3 months post-transplantation, but not earlier. CONCLUSION Several major indices of cardiorespiratory fitness tend to improve after KT. This finding may represent another modifiable factor contributing to better survival rates of kidney transplant recipients compared to patients undergoing dialysis.
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Affiliation(s)
- Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Department of Sports Science At Serres, Exercise Physiology and Biochemistry Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Department of Sports Science At Serres, Exercise Physiology and Biochemistry Laboratory, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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The Effect of Endurance Training on Pulmonary V˙O 2 Kinetics in Solid Organs Transplanted Recipients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159097. [PMID: 35897466 PMCID: PMC9331393 DOI: 10.3390/ijerph19159097] [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: 06/07/2022] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Abstract
Background: We investigated the effects of single (SL-ET) and double leg (DL-ET) high-intensity interval training on O2 deficit (O2Def) and mean response time (MRT) during square-wave moderate-intensity exercise (DL-MOD), and on the amplitude of V˙O2p slow component (SCamp), during heavy intensity exercise (DL-HVY), on 33 patients (heart transplant = 13, kidney transplanted = 11 and liver transplanted = 9). Methods: Patients performed DL incremental step exercise to exhaustion, two DL-MOD tests, and a DL-HVY trial before and after 24 sessions of SL-ET (n = 17) or DL-ET (n = 16). Results: After SL-ET, O2Def, MRT and SCamp decreased by 16.4% ± 13.7 (p = 0.008), by 15.6% ± 13.7 (p = 0.004) and by 35% ± 31 (p = 0.002), respectively. After DL-ET, they dropped by 24.9% ± 16.2 (p < 0.0001), by 25.9% ± 13.6 (p < 0.0001) and by 38% ± 52 (p = 0.0003), respectively. The magnitude of improvement of O2Def, MRT, and SCamp was not significantly different between SL-ET and DL-ET after training. Conclusions: We conclude that SL-ET is as effective as DL-ET if we aim to improve V˙O2p kinetics in transplanted patients and suggest that the slower, V˙O2p kinetics is mainly caused by the impairment of peripherals exchanges likely due to the immunosuppressive medications and disuse.
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Hoffmann U, Faber F, Drescher U, Koschate J. Cardiorespiratory kinetics in exercise physiology: estimates and predictions using randomized changes in work rate. Eur J Appl Physiol 2021; 122:717-726. [PMID: 34962595 PMCID: PMC8854137 DOI: 10.1007/s00421-021-04878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022]
Abstract
Purpose Kinetics of cardiorespiratory parameters (CRP) in response to work rate (WR) changes are evaluated by pseudo-random binary sequences (PRBS testing). In this study, two algorithms were applied to convert responses from PRBS testing into appropriate impulse responses to predict steady states values and responses to incremental increases in exercise intensity. Methods 13 individuals (age: 41 ± 9 years, BMI: 23.8 ± 3.7 kg m−2), completing an exercise test protocol, comprising a section of randomized changes of 30 W and 80 W (PRBS), two phases of constant WR at 30 W and 80 W and incremental WR until subjective fatigue, were included in the analysis. Ventilation (\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}_{{\text{E}}}$$\end{document}V˙E), O2 uptake (\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}{\text{O}}_{2}$$\end{document}V˙O2), CO2 output (\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}{\text{CO}}_{2}$$\end{document}V˙CO2) and heart rate (HR) were monitored. Impulse responses were calculated in the time domain and in the frequency domain from the cross-correlations of WR and the respective CRP. Results The algorithm in the time domain allows better prediction for \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}{\text{O}}_{2}$$\end{document}V˙O2 and \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}{\text{CO}}_{2}$$\end{document}V˙CO2, whereas for \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}_{{\text{E}}}$$\end{document}V˙E and HR the results were similar for both algorithms. Best predictions were found for \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}{\text{O}}_{2}$$\end{document}V˙O2 and HR with higher (3–4%) 30 W steady states and lower (1–4%) values for 80 W. Tendencies were found in the residuals between predicted and measured data. Conclusion The CRP kinetics, resulting from PRBS testing, are qualified to assess steady states within the applied WR range. Below the ventilatory threshold, \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}{\text{O}}_{2}$$\end{document}V˙O2 and HR responses to incrementally increasing exercise intensities can be sufficiently predicted.
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Affiliation(s)
- Uwe Hoffmann
- Department of Exercise Physiology, Institute of Exercise Training and Sport Informatics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - Felix Faber
- Department of Exercise Physiology, Institute of Exercise Training and Sport Informatics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Uwe Drescher
- Department of Exercise Physiology, Institute of Exercise Training and Sport Informatics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Jessica Koschate
- Geriatric Medicine, Department for Health Services Research, School of Medicine and Health Sciences, Carl Von Ossietzky University Oldenburg, Ammerlaender Heerstr.140, 26129, Oldenburg, Germany
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Overshoot of the Respiratory Exchange Ratio during Recovery from Maximal Exercise Testing in Kidney Transplant Recipients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179236. [PMID: 34501820 PMCID: PMC8431158 DOI: 10.3390/ijerph18179236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
The overshoot of the respiratory exchange ratio (RER) during recovery from exercise has been found to be reduced in magnitude among patients with heart failure. The aim of this study is to investigate whether this phenomenon could also be present in patients with peripheral, and not cardiac, limitations to exercise such as kidney transplant recipients (KTRs). In this retrospective cross-sectional study, KTRs were evaluated with maximal cardiopulmonary exercise testing (CPET) assessing the RER overshoot parameters during recovery: the RER at peak exercise, the maximum RER value reached during recovery, the magnitude of the RER overshoot (RER mag = (RER max-peak RER)/peak RER%) and the linear slope of the RER increase after the end of exercise. A total of 57 KTRs were included in the study (16 females), all of them showing a significant RER overshoot (RER mag: 28.4 ± 12.7%). Moreover, the RER mag showed significant correlations with the fitness of patients (peak VO2: ρ = 0.57, p < 0.01) and cardiorespiratory efficiency (VE/VCO2 slope: r = −0.32, p < 0.05; oxygen uptake efficiency slope (OUES): r = 0.48, p < 0.01). Indeed, the RER mag was significantly different between the subgroups stratified by Weber’s fitness class or a ventilatory efficiency class. Our study is the first to investigate recovery of the RER in a population of KTRs, which correlates well with known prognostic CPET markers of cardiorespiratory fitness, determining the RER mag as the most meaningful RER overshoot parameter. Thus, the RER recovery might be included in CPET evaluations to further improve prognostic risk stratifications in KTRs and other chronic diseases.
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