1
|
Garcia Brás P, Gonçalves AV, Reis JF, Moreira RI, Pereira-da-Silva T, Rio P, Timóteo AT, Silva S, Soares RM, Ferreira RC. Age Differences in Cardiopulmonary Exercise Testing Parameters in Heart Failure with Reduced Ejection Fraction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1685. [PMID: 37763804 PMCID: PMC10535443 DOI: 10.3390/medicina59091685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Cardiopulmonary exercise testing (CPET) is a cornerstone of risk stratification in heart failure with reduced ejection fraction (HFrEF). However, there is a paucity of evidence on its predictive power in older patients. The aim of this study was to evaluate the prognostic power of current heart transplantation (HTx) listing criteria in HFrEF stratified according to age groups. Materials and Methods: Consecutive patients with HFrEF undergoing CPET between 2009 and 2018 were followed-up for cardiac death and urgent HTx. Results: CPET was performed in 458 patients with HFrEF. The composite endpoint occurred in 16.8% of patients ≤50 years vs. 14.1% of patients ≥50 years in a 36-month follow-up. Peak VO2 (pVO2), VE/VCO2 slope and percentage of predicted pVO2 were strong independent predictors of outcomes. The International Society for Heart and Lung Transplantation thresholds of pVO2 ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers), VE/VCO2 slope > 35 and percentage of predicted pVO2 ≤ 50% presented a higher overall diagnostic effectiveness in younger patients (≤50 years). Specific thresholds for each age subgroup outperformed the traditional cut-offs. Conclusions: Personalized age-specific thresholds may contribute to an accurate risk stratification in HFrEF. Further studies are needed to address the gap in evidence between younger and older patients.
Collapse
Affiliation(s)
- Pedro Garcia Brás
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
| | - António Valentim Gonçalves
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
| | - João Ferreira Reis
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
| | - Rita Ilhão Moreira
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
| | - Tiago Pereira-da-Silva
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
| | - Pedro Rio
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
| | - Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), 1169-056 Lisbon, Portugal
| | - Sofia Silva
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
| | - Rui M. Soares
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
| | - Rui Cruz Ferreira
- Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, 1169-024 Lisbon, Portugal
| |
Collapse
|
2
|
Van Iterson EH, Cho L, Tonelli A, Finet JE, Laffin LJ. All-cause mortality predicted by peak oxygen uptake differs depending on spirometry pattern in patients with heart failure and reduced ejection fraction. ESC Heart Fail 2021; 8:2731-2740. [PMID: 33932128 PMCID: PMC8318425 DOI: 10.1002/ehf2.13342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/09/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022] Open
Abstract
Aims In patients with heart failure and reduced ejection fraction (HFrEF), it remains unclear how exacerbated impairments in peak exercise oxygen uptake (V̇O2peak) caused by coexistent obstructive or restrictive ventilatory defects affect mortality risk. We evaluated in patients with HFrEF, whether demonstrating either an obstructive or restrictive‐patterned ventilatory defect on spirometry affects V̇O2peak to yield all‐cause mortality risk predicted by V̇O2peak that is spirometry pattern specific. Methods and results We retrospectively analysed resting spirometry and treadmill cardiopulmonary exercise testing data of patients with HFrEF (left ventricular ejection fraction ≤ 40%). The study sample (N = 329) was grouped by spirometry pattern: normal [Group 1: N = 101; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥ 0.70; FVC ≥ 80% predicted], restrictive without airflow obstruction (Group 2: N = 104; FEV1/FVC ≥ 0.70; FVC < 80% predicted), or obstructive (Group 3: N = 124; FEV1/FVC < 0.70). Patients were followed up to 1 year for the endpoint of all‐cause mortality. V̇O2peak was higher in Group 1 versus Groups 2 and 3 (13.4 ± 4.0 vs. 12.1 ± 3.7 and 12.2 ± 3.3 mL/kg/min, respectively; P = 0.014). Over the 1 year follow‐up, n = 9, n = 16, and n = 12 deaths occurred in Groups 1–3, respectively, with corresponding crude survival rates of 88%, 81%, and 92%, respectively (log‐rank; P = 0.352). V̇O2peak was associated with all‐cause mortality (crude hazard ratio = 0.77; P < 0.001). In multivariate analyses, a significant V̇O2peak‐by‐spirometry group interaction yielded 1.99 (95% confidence interval, 1.14–3.46) and 2.43 (95% confidence interval, 1.44–4.11) higher mortality risk associated with V̇O2peak in Group 2 versus Groups 1 and 3, respectively. Conclusions Demonstrating a restrictive pattern on spirometry yields the severest mortality risk associated with V̇O2peak. Using spirometry to screen patients with HFrEF for ventilatory defects has a potential role in improving risk stratification based on V̇O2peak.
Collapse
Affiliation(s)
- Erik H Van Iterson
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH, 44195, USA
| | - Leslie Cho
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH, 44195, USA
| | | | - J Emanuel Finet
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luke J Laffin
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk JB-1, Cleveland, OH, 44195, USA
| |
Collapse
|
3
|
Ogura A, Izawa KP, Tawa H, Kureha F, Wada M, Harada N, Ikeda Y, Kimura K, Kondo N, Kanai M, Kubo I, Yoshikawa R, Matsuda Y. Impact of the COVID-19 pandemic on phase 2 cardiac rehabilitation patients in Japan. Heart Vessels 2021; 36:1184-1189. [PMID: 33512598 PMCID: PMC7844103 DOI: 10.1007/s00380-021-01783-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022]
Abstract
This study aimed to clarify the effects of the interruption of cardiac rehabilitation (CR) and refraining from going outside due to the COVID-19 pandemic on hemodynamic response and rating of perceived exertion (RPE) during exercise including differences by age in phase 2 CR outpatients. Among 76 outpatients participating in consecutive phase 2 CR in both periods from March to April and June to July 2020, which were before and after CR interruption, respectively, at Sanda City Hospital were enrolled. The inclusion criterion was outpatients whose CR was interrupted due to COVID-19. We compared the data of hemodynamic response and RPE during exercise on the last day before interruption and the first day after interruption when aerobic exercise was performed at the same exercise intensity in the < 75 years group and ≥ 75 years group. Fifty-three patients were enrolled in the final analysis. Post-CR interruption, peak heart rate increased significantly (p = 0.009) in the < 75 years group, whereas in the ≥ 75 years group, weight and body mass index decreased significantly (p = 0.009, 0.011, respectively) and Borg scale scores for both dyspnea and lower extremities fatigue worsened significantly (both, p < 0.001). CR interruption and refraining from going outside due to the COVID-19 pandemic affected the hemodynamic response, RPE during exercise and body weight in phase 2 CR outpatients. In particular, patients aged ≥ 75 years appeared to be placed at an increased risk of frailty.
Collapse
Affiliation(s)
- Asami Ogura
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan.,Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome Suma, Kobe, 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome Suma, Kobe, 654-0142, Japan. .,Cardiovascular Stroke Renal Project (CRP), Kobe, Japan.
| | - Hideto Tawa
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Fumie Kureha
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Masaaki Wada
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan
| | - Nobuko Harada
- Department of Nursing, Sanda City Hospital, Sanda, Japan
| | - Yuki Ikeda
- Department of Nursing, Sanda City Hospital, Sanda, Japan
| | - Kaemi Kimura
- Department of Nursing, Sanda City Hospital, Sanda, Japan
| | - Naomi Kondo
- Department of Nursing, Sanda City Hospital, Sanda, Japan
| | - Masashi Kanai
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome Suma, Kobe, 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
| | - Ikko Kubo
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome Suma, Kobe, 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
| | | | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| |
Collapse
|
4
|
Turski M, Kocierz-Woźnowska M, Wybraniec M, Grabka M, Wita M, Berger-Kucza A, Wita K, Mizia-Stec K. Factors determining exercise capacity evaluated during cardiopulmonary exercise testing in 6-month follow-up after ST elevation myocardial infarction. Clin Physiol Funct Imaging 2018; 39:209-214. [PMID: 30589484 DOI: 10.1111/cpf.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/17/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION ST elevation myocardial infarction (STEMI) is one of the main causes of congestive heart failure (CHF). The main symptom of CHF is exercise tolerance impairment. The aim of the study was to evaluate the prevalence and risk factors for impaired exercise tolerance in patients after STEMI. METHODS AND RESULTS A total of 84 patients with STEMI were analysed in the study. Cardiopulmonary exercise test (CPET) was performed 6 months after STEMI. Impaired exercise tolerance defined as peak VO2 < 84% predicted for age and sex was present in 49 (58%) patients and was connected with lack of abciximab administration (91.4 versus 69%, P = 0·02) and the presence of mitral regurgitation (47 versus 23%, P = 0·02). In univariate analysis, the troponin I level at admission (OR 1·89, P = 0·047), the use of abciximab (OR 0·21, P = 0·03), the presence of mitral regurgitation (OR 2·98, P = 0·03) and NT-proBNP concentration (OR 2·17, P = 0·021) were related to impaired exercise tolerance. The best multivariate model for predicting impaired exercise tolerance included mitral regurgitation and lack of abciximab administration. CONCLUSIONS Impaired exercise tolerance after STEMI is common. Mitral regurgitation and lack of abciximab administration are the best predicting factors of impaired exercise tolerance after STEMI.
Collapse
Affiliation(s)
- Maciej Turski
- 1st Department of Cardiology, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland.,Department of Outpatient Cardiac Rehabilitation, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland
| | - Magdalena Kocierz-Woźnowska
- 1st Department of Cardiology, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland.,Department of Outpatient Cardiac Rehabilitation, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland
| | - Maciej Wybraniec
- 1st Department of Cardiology, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland
| | - Marek Grabka
- 1st Department of Cardiology, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland
| | - Marcin Wita
- 1st Department of Cardiology, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland
| | - Adrianna Berger-Kucza
- 1st Department of Cardiology, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland
| | - Krystian Wita
- 1st Department of Cardiology, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
5
|
Ozemek C, Laddu DR, Lavie CJ, Claeys H, Kaminsky LA, Ross R, Wisloff U, Arena R, Blair SN. An Update on the Role of Cardiorespiratory Fitness, Structured Exercise and Lifestyle Physical Activity in Preventing Cardiovascular Disease and Health Risk. Prog Cardiovasc Dis 2018; 61:484-490. [PMID: 30445160 DOI: 10.1016/j.pcad.2018.11.005] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 12/19/2022]
Abstract
The cardiovascular disease (CVD) pandemic has placed considerable strain on healthcare systems, quality of life, and physical function, while remaining the leading cause of death globally. Decades of scientific investigations have fortified the protective effects of cardiorespiratory fitness (CRF), exercise training, and physical activity (PA) against the development of CVD. This review will summarize recent efforts that have made significant strides in; 1) the application of novel analytic techniques to increase the predictive utility of CRF; 2) understanding the protective effects of long-term compliance to PA recommendations through large cohort studies with multiple points of assessment; 3) and understanding the potential harms associated with extreme volumes of PA.
Collapse
Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Deepika R Laddu
- Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA, USA
| | - Hannah Claeys
- Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN, USA
| | - Robert Ross
- Schoold of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada; School of Medicine, Department of Endocrinology and Metabolism, Queen's University, Kingston, Ontario, Canada
| | - Ulrik Wisloff
- K. G. Jebsen Center of Exercise in Medicine at the Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; School of Human Movement & Nutrition Sciences, University of Queensland, St. Lucia, QLD, Australia
| | - Ross Arena
- Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
6
|
Kakutani N, Fukushima A, Yokota T, Katayama T, Nambu H, Shirakawa R, Maekawa S, Abe T, Takada S, Furihata T, Ono K, Okita K, Kinugawa S, Anzai T. Impact of High Respiratory Exchange Ratio During Submaximal Exercise on Adverse Clinical Outcome in Heart Failure. Circ J 2018; 82:2753-2760. [DOI: 10.1253/circj.cj-18-0103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoya Kakutani
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Arata Fukushima
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Takashi Yokota
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Takashi Katayama
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Hideo Nambu
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Ryosuke Shirakawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Satoshi Maekawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Shingo Takada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Takaaki Furihata
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Kota Ono
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital
| | - Koichi Okita
- Graduate School of Lifelong Sport, Hokusho University
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| |
Collapse
|
7
|
Corrà U, Agostoni PG, Anker SD, Coats AJS, Crespo Leiro MG, de Boer RA, Harjola VP, Hill L, Lainscak M, Lund LH, Metra M, Ponikowski P, Riley J, Seferović PM, Piepoli MF. Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2017; 20:3-15. [PMID: 28925073 DOI: 10.1002/ejhf.979] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 12/20/2022] Open
Abstract
Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle-aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co-morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom-limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed.
Collapse
Affiliation(s)
- Ugo Corrà
- Cardiology Division, Istituti Clinici Scientifici Maugeri, Centro Medico di Riabilitazione di Veruno, Veruno, Novara, Italy
| | - Pier Giuseppe Agostoni
- Cardiology Center of Monzino, IRCCS, Milan, Italy; and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Berlin; Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | | | - Maria G Crespo Leiro
- Heart Failure and Heart Transplant Unit, Complejo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, La Coruña, Spain
| | | | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana; and Center for Heart Failure, General Hospital Murska Sobota, Slovenia
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet; and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Jillian Riley
- National Heart and Lung Institute, Imperial College, London, UK
| | - Petar M Seferović
- Internal Medicine, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| |
Collapse
|
8
|
Ribeiro-Samora GA, Montemezzo D, Pereira DAG, Tagliaferri TL, Vieira OA, Britto RR. Could peak oxygen uptake be estimated from proposed equations based on the six-minute walk test in chronic heart failure subjects? Braz J Phys Ther 2017; 21:100-106. [PMID: 28460707 PMCID: PMC5537474 DOI: 10.1016/j.bjpt.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/17/2016] [Accepted: 05/27/2016] [Indexed: 12/19/2022] Open
Abstract
Measured and estimated VO2peak in CHF patients showed a moderate association. With the exception of equation 1, all equations underestimated VO2peak by up to 51%. The agreement evaluated using Bland–Altman was not consistent.
Objectives To evaluate the agreement between the measured peak oxygen uptake (VO2peak) and the VO2peak estimated by four prediction equations based on the six-minute walk test (6MWT) in chronic heart failure patients. Method Thirty-six chronic heart failure patients underwent cardiopulmonary exercise testing and the 6MWT to assess their VO2peak. Four previously published equations that include the variable six-minute walk distance were used to estimate the VO2peak: Cahalin, 1996a (1); Cahalin, 1996b (2); Ross, 2010 (3); and Adedoyin, 2010 (4). The agreement between the VO2peak in the cardiopulmonary exercise testing and the estimated values was assessed using the Bland–Altman method. A p-value of <0.05 was considered statistically significant. Results All estimated VO2peak values presented moderate correlation (ranging from 0.55 to 0.70; p < 0.001) with measured VO2peak values. Equations 2, 3, and 4 underestimated the VO2peak by 30%, 15.2%, and 51.2%, respectively, showing significant differences from the actual VO2peak measured in the cardiopulmonary exercise testing (p < 0.0001 for all), and the limits of agreement were elevated. The VO2peak estimated by equation 1 was similar to that measured by the cardiopulmonary exercise testing, and despite the agreement, bias increased as VO2peak increased. Conclusions Only equation 1 showed estimated VO2peak similar to the measured VO2peak; however, a large limits of agreement range (∼3 METs) does not allow its use to estimate maximal VO2peak.
Collapse
Affiliation(s)
- Giane A Ribeiro-Samora
- Laboratório de Avaliação e Pesquisa em Desempenho Cardiorrespiratório, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| | - Dayane Montemezzo
- Laboratório de Avaliação e Pesquisa em Desempenho Cardiorrespiratório, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Danielle A G Pereira
- Laboratório de Avaliação e Pesquisa em Desempenho Cardiorrespiratório, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Thaysa L Tagliaferri
- Laboratório de Avaliação e Pesquisa em Desempenho Cardiorrespiratório, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Otávia A Vieira
- Laboratório de Avaliação e Pesquisa em Desempenho Cardiorrespiratório, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Raquel R Britto
- Laboratório de Avaliação e Pesquisa em Desempenho Cardiorrespiratório, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| |
Collapse
|
9
|
Hulkkonen J, Aatola H, Pälve K, Lehtimäki T, Hutri-Kähönen N, Viikari JS, Raitakari OT, Kähönen M. Determinants of exercise peak arterial blood pressure, circulatory power, and exercise cardiac power in a population based sample of Finnish male and female aged 30 to 47 years: the Cardiovascular Risk in Young Finns Study. BMC Cardiovasc Disord 2014; 14:35. [PMID: 24621399 PMCID: PMC3995605 DOI: 10.1186/1471-2261-14-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Novel parameters derived from peak maximal oxygen uptake (VO2) and exercise arterial blood pressure, such as peak circulatory power (CP) and exercise cardiac power (ECP), can be used in the risk assessment of cardiovascular disease and stroke. However, the determinants of these factors are poorly characterized in the general population. Methods We assessed peak arterial blood pressure, CP and ECP with standardized cardiopulmonary exercise test (CPET) on 281 female and 257 male participants of the Cardiovascular Risk in Young Finns Study. The subjects were aged 30–47 years. Peak VO2 as well as systolic and diastolic arterial blood pressures were measured to calculate peak mean arterial pressure, CP and ECP. These parameters were assessed for correlation with sex, age, height, weight, waist-to-hip ratio, smoking, physical activity index (PAI), fasting insulin and glucose levels as well as the use of antihypertensive treatment. Results Sex, age and weight explained 36% of the variation in peak systolic blood pressure, and these factors in combination with height and the use of antihypertensive treatment explained 13% of the variation in peak diastolic blood pressure. Sex, height, weight, waist-to-hip ratio, PAI and smoking explained 49% − 52% of the variation in peak CP. Sex, age, height, weight, waist-to-hip ratio, PAI, smoking and insulin levels explained 21% − 49% of variation in ECP. Conclusions Subject demographics and lifestyle-related factors should be taken into account when exercise blood pressure response, CP and ECP are used to evaluate patients’ cardiac function in CPET.
Collapse
Affiliation(s)
- Janne Hulkkonen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Tzanis G, Dimopoulos S, Agapitou V, Nanas S. Exercise intolerance in chronic heart failure: the role of cortisol and the catabolic state. Curr Heart Fail Rep 2014; 11:70-9. [PMID: 24293034 DOI: 10.1007/s11897-013-0177-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic heart failure (CHF) is a complex clinical syndrome leading to exercise intolerance due to muscular fatigue and dyspnea. Hemodynamics fail to explain the reduced exercise capacity, while a significant skeletal muscular pathology seems to constitute the main underlying mechanism for exercise intolerance in CHF patients. There have been proposed several metabolic, neurohormonal and immune system abnormalities leading to an anabolic/catabolic imbalance that plays a central role in the pathogenesis of the wasting process of skeletal muscle myopathy. The impairment of the anabolic axes is associated with the severity of symptoms and the poor outcome in CHF, whereas increased cortisol levels are predictive of exercise intolerance, ventilatory inefficiency and chronotropic incompetence, suggesting a significant contributing mechanism to the limited functional status. Exercise training and device therapy could have beneficial effects in preventing and treating muscle wasting in CHF. However, specific anabolic treatment needs more investigation to prove possible beneficial effects.
Collapse
Affiliation(s)
- Georgios Tzanis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio Hospital", National & Kapodestrian University of Athens, Papadiamantopoulou str., 20, Athens, 11528, Greece
| | | | | | | |
Collapse
|
11
|
Dominguez-Rodriguez A, Abreu-Gonzalez P. In the era of beta-blockers better is the VE/VCO2 slope for heart transplant selection in patients with systolic heart failure. Int J Cardiol 2014; 172:e314-5. [DOI: 10.1016/j.ijcard.2013.12.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/28/2013] [Indexed: 11/15/2022]
|
12
|
Gargiulo P, Olla S, Boiti C, Contini M, Perrone-Filardi P, Agostoni P. Predicted values of exercise capacity in heart failure: where we are, where to go. Heart Fail Rev 2013; 19:645-53. [DOI: 10.1007/s10741-013-9403-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
13
|
Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013; 128:873-934. [PMID: 23877260 DOI: 10.1161/cir.0b013e31829b5b44] [Citation(s) in RCA: 1197] [Impact Index Per Article: 108.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
14
|
Alomari MA, Shqair DM, Khabour OF, Alawneh K, Nazzal MI, Keewan EF. The clinical and nonclinical values of nonexercise estimation of cardiovascular endurance in young asymptomatic individuals. ScientificWorldJournal 2012; 2012:958752. [PMID: 22606068 PMCID: PMC3346685 DOI: 10.1100/2012/958752] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/11/2011] [Indexed: 11/20/2022] Open
Abstract
Exercise testing is associated with barriers prevent using cardiovascular (CV) endurance (CVE) measure frequently. A recent nonexercise model (NM) is alleged to estimate CVE without exercise. This study examined CVE relationships, using the NM model, with measures of obesity, physical fitness (PF), blood glucose and lipid, and circulation in 188 asymptomatic young (18–40 years) adults. Estimated CVE correlated favorably with measures of PF (r = 0.4 − 0.5) including handgrip strength, distance in 6 munities walking test, and shoulder press, and leg extension strengths, obesity (r = 0.2 − 0.7) including % body fat, body water content, fat mass, muscle mass, BMI, waist and hip circumferences and waist/hip ratio, and circulation (r = 0.2 − 0.3) including blood pressures, blood flow, vascular resistance, and blood (r = 0.2 − 0.5) profile including glucose, total cholesterol, LDL-C, HDL-C, and triglycerides. Additionally, differences (P < 0.05) in examined measures were found between the high, average, and low estimated CVE groups. Obviously the majority of these measures are CV disease risk factors and metabolic syndrome components. These results enhance the NM scientific value, and thus, can be further used in clinical and nonclinical settings.
Collapse
Affiliation(s)
- Mahmoud A Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | | | | | | | | | | |
Collapse
|
15
|
Pereira DAG, Rodrigues RS, Samora GAR, Lage SM, Alencar MCN, Parreira VF, Britto RR. Capacidade funcional de indivíduos com insuficiência cardíaca avaliada pelo teste de esforço cardiopulmonar e classificação da New York Heart Association. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000100010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi avaliar a capacidade discriminativa da classificação da New York Heart Association (NYHA) em indivíduos com insuficiência cardíaca (IC) classes II e III por meio de variáveis do teste de esforço cardiopulmonar (TECP). Participaram do estudo 17 pessoas com IC classe II (44,47±10,11 anos; fração de ejeção ventricular 32,11±10,37%) e 15 classe III (46,73±8,74 anos; fração de ejeção ventricular 30,46±10,23%) da NYHA que realizaram TECP máximo em esteira ergométrica. De acordo com a distribuição dos dados, houve correlação de Pearson ou Spearman e, para comparação entre classes, utilizou-se o teste t de Student. Foram encontradas correlações significativas (p<0,05) entre consumo de oxigênio (VO2) e pulso de oxigênio (r=0,76), idade (r=0,35) e índice de massa corpórea (r=0,45). Não houve correlação significativa entre fração de ejeção ventricular e as demais variáveis estudadas. Comparando as classes da NYHA, foram encontradas diferenças para VO2 e pulso de oxigênio (p<0,05). Nesta pesquisa, as correlações refletem a complexidade de se analisar e entender o processo de disfunção da IC, considerando que provavelmente há outros fatores influenciando cada uma das variáveis estudadas. A classificação da NYHA foi efetiva na diferenciação dos indivíduos nos diferentes grupos, reforçando sua utilidade na caracterização de grupos de indivíduos com IC para fins de pesquisas científicas, assim como para avaliação de terapêuticas.
Collapse
|
16
|
Understanding results of trials in heart failure with preserved ejection fraction: remembering forgotten lessons and enduring principles. J Am Coll Cardiol 2011; 57:1687-9. [PMID: 21492766 DOI: 10.1016/j.jacc.2011.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 01/04/2011] [Indexed: 11/24/2022]
|