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van Hassel G, Rivrud SCS, Timmerman FJ, van der Meer P, Hoendermis ES, Liem ET, Berger RMF, van Melle JP. Iron deficiency in patients with a Fontan circulation and its impact on exercise capacity. Open Heart 2024; 11:e002693. [PMID: 38839367 PMCID: PMC11163596 DOI: 10.1136/openhrt-2024-002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Iron deficiency (ID) has been reported in patients with congenital heart disease. There is, however, a scarcity of data on its prevalence in patients with a Fontan circulation. The aim of this study is to investigate the prevalence of ID in Fontan patients and to investigate the association between ID and exercise capacity in this population. METHODS AND RESULTS Blood count and haematological parameters were determined in plasma of 61 Fontan patients (51% female, mean age 29±9 years). ID was defined as transferrin saturation (TSAT) ≤19.8%. The prevalence of ID was 36% (22/61 patients). Especially among women, the diagnosis of ID was highly prevalent (52%) despite normal haemoglobin levels (153.7±18.4 g/L). Mean ferritin levels were 98±80 µg/L and mean TSAT levels were 22%±12%. Cardiopulmonary exercise testing was performed in 46 patients (75%). Patients with ID had a lower peak oxygen uptake (V̇O2peak) (1397±477 vs 1692±530 mL/min; p=0.039), although this relationship was confounded by sex. The presence of ID increased the likelihood of not achieving a respiratory exchange ratio (RER) ≥1.1 by 5-fold (p=0.035). CONCLUSION ID is highly prevalent among patients with a Fontan circulation. V̇O2peak is lower in patients with ID. Fontan patients with ID are less likely to achieve an RER≥1.1 during cardiopulmonary exercise testing.
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Affiliation(s)
- Gaston van Hassel
- Center for Congential Heart Diseases, Department of Paediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sean C S Rivrud
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank J Timmerman
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Elke S Hoendermis
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Eryn T Liem
- Center for Congential Heart Diseases, Department of Paediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Rolf M F Berger
- Center for Congential Heart Diseases, Department of Paediatric Cardiology, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost P van Melle
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Flucher C, Windhaber J, Gasparella P, Castellani C, Tschauner S, Mittl B, Wolfschluckner V, Singer G, Till H. Long-term motor activity, cardiopulmonary performance and quality of life in abdominal wall defect patients. Pediatr Res 2024; 95:1101-1109. [PMID: 38052863 PMCID: PMC10920181 DOI: 10.1038/s41390-023-02900-y] [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: 05/31/2023] [Revised: 09/17/2023] [Accepted: 11/05/2023] [Indexed: 12/07/2023]
Abstract
AIM To assess whether patients born with an abdominal wall defect (AWD) have impaired cardiorespiratory performance capacity, motor skills, core stability or quality of life in a long-term follow up. METHODS Patients diagnosed with AWD between 2002 and 2013 were invited to participate in the study, which included clinical examination, spirometry, cardiopulmonary exercise performance testing, assessment of motor activity, ultrasound, electromyography of the abdominal wall and assessment of the Gastrointestinal Quality of Life Index (GIQLI). The results were compared to a healthy control group matched for age, sex, BMI, and physical activity levels. RESULTS In total, 18 AWD patients (mean age 12.6 ± 3.5 years) were included and there were no significant differences in anthopometric data compared to the control group (n = 18). AWD patients had a significantly lower GIQLI score (AWD mean 137.2 ± 6.8 vs. control mean 141.4 ± 4.9; p = 0.038) and were affected by decreased motor abilities with significantly higher Dordel-Koch-Test values (AWD median 3.54/IQR 1 vs. control median 2.8/IQR 1; p = 0.005). CONCLUSION Follow-up examinations of AWD patients revealed decreased motor abilities and GIQLI scores while cardiopulmonary function was not different compared to healthy controls. The clinical impact of these findings remains to be elucidated. IMPACT Clinical examination, assessment of the gastrointestinal quality of life, sport medical testing, electromyography and abdominal wall ultrasound were performed in patients with congenital abdominal wall defect and compared to an age and sex matched healthy control group. Results of spirometry and spiroergometry, ultrasound or electromyography did not significantly differ between the groups. Significantly decreased locomotor function and gastrointestinal quality of life were found in patients with abdominal wall defect. However, the clinical impact of these findings remains to be elucidated.
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Affiliation(s)
- Christina Flucher
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Jana Windhaber
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Paolo Gasparella
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Christoph Castellani
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Barbara Mittl
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Vanessa Wolfschluckner
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
| | - Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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Garcia Brás P, Gonçalves AV, Reis JF, Moreira RI, Pereira-da-Silva T, Rio P, Timóteo AT, Silva S, Soares RM, Ferreira RC. Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool? Biomedicines 2023; 11:2208. [PMID: 37626705 PMCID: PMC10452308 DOI: 10.3390/biomedicines11082208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B). METHODS Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT. RESULTS CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO2 (pVO2) and VE/VCO2 slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO2 ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers) and VE/VCO2 slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO2 ≤ 10 mL/kg/min and VE/VCO2 slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results. CONCLUSION ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification.
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Affiliation(s)
- Pedro Garcia Brás
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - António Valentim Gonçalves
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - João Ferreira Reis
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Rita Ilhão Moreira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Tiago Pereira-da-Silva
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Pedro Rio
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Ana Teresa Timóteo
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), 1169-056 Lisbon, Portugal
| | - Sofia Silva
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Rui M. Soares
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Rui Cruz Ferreira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
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Das BB. A Systematic Approach for the Interpretation of Cardiopulmonary Exercise Testing in Children with Focus on Cardiovascular Diseases. J Cardiovasc Dev Dis 2023; 10:jcdd10040178. [PMID: 37103057 PMCID: PMC10143216 DOI: 10.3390/jcdd10040178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Abstract
Cardiopulmonary exercise testing (CPET) is the clinical standard for children with congenital heart disease (CHD), heart failure (HF) being assessed for transplantation candidacy, and subjects with unexplained dyspnea on exertion. Heart, lung, skeletal muscle, peripheral vasculature, and cellular metabolism impairment frequently lead to circulatory, ventilatory, and gas exchange abnormalities during exercise. An integrated analysis of the multi-system response to exercise can be beneficial for differential diagnosis of exercise intolerance. The CPET combines standard graded cardiovascular stress testing with simultaneous ventilatory respired gas analysis. This review addresses the interpretation and clinical significance of CPET results with specific reference to cardiovascular diseases. The diagnostic values of commonly obtained CPET variables are discussed using an easy-to-use algorithm for physicians and trained nonphysician personnel in clinical practice.
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Affiliation(s)
- Bibhuti B Das
- Division of Pediatric Cardiology, Department of Pediatrics, McLane Children's Baylor Scott and White Medical Center, Baylor College of Medicine-Temple, Temple, TX 76502, USA
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Siddiqi TJ, Rashid AM, Javaid SS, Siddiqi AK, Usman MS, Hervir O, Kamimura D, Lavie CJ, Mentz RJ, Butler J, Hall ME. High-Intensity Interval Training Versus Moderate Continuous Training in Patients With Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2023; 48:101720. [PMID: 36967072 DOI: 10.1016/j.cpcardiol.2023.101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 04/28/2023]
Abstract
High-intensity interval training (HIIT) is a novel training approach that improves cardiopulmonary fitness and functional capacity in numerous chronic conditions, however its impact in patients with heart failure (HF) with preserved ejection fraction (HFpEF) is uncertain. We evaluated data from prior studies reporting the effects of HIIT versus moderate continuous training (MCT), on cardiopulmonary exercise outcomes in patients with HFpEF. PubMed and SCOPUS were queried from inception till February 1st, 2022 for all randomized controlled trials (RCT) comparing the effect of HIIT versus MCT in patients with HFpEF on peak oxygen consumption (peak VO2), left atrial volume index (LAVI), respiratory exchange ratio (RER), and ventilatory efficiency (VE/CO2 slope). A random-effects model was applied, and the weighted mean difference (WMD) of each outcome was reported with 95% confidence intervals (CI). Three RCTs (total N = 150 patients with HFpEF), with a follow-up of 4 to 52 weeks were included in our analysis. Our pooled analysis demonstrated that HIIT significantly improved peak VO2 (WMD = 1.46 mL/kg/min (0.88, 2.05); P < 0.00001; I2 = 0%), as compared to MCT. However, no statistically significant change was demonstrated for LAVI (WMD = -1.71 mL/m2 (-5.58, 2.17); P = 0.39; I2 = 22%), RER (WMD = -0.10 (-0.32, 0.12); P = 0.38; I2 = 0%), and VE/CO2 slope (WMD = 0.62 (-1.99, 3.24); P = 0.64; I2 = 67%) in patients with HFpEF. Across current RCT data, HIIT, compared to MCT, had a significant impact on improving peak VO2. Conversely, there was no significant change in LAVI, RER, and VE/CO2 slope between HFpEF patients undertaking HIIT as opposed to MCT.
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Affiliation(s)
- Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
| | | | - Syed Sarmad Javaid
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Oliver Hervir
- School of Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Daisuke Kamimura
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS; Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA
| | - Robert J Mentz
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS; Baylor University Medical Center to Baylor Scott and White Research Institute, Dallas TX
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
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Cardiopulmonary Exercise Testing Characterizes Silent Cardiovascular Abnormalities in Asymptomatic Pediatric Cancer Survivors. Pediatr Cardiol 2023; 44:344-353. [PMID: 36076098 DOI: 10.1007/s00246-022-02995-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
Late-onset cardiovascular complications are serious concerns for pediatric cancer survivors (PCS) including those who are asymptomatic. We investigated whether cardiopulmonary exercise testing (CPET) can delineate the underlying pathophysiology of preclinical cardiovascular abnormalities in PCS. We examined CPET data via cycle ergometer in asymptomatic PCS with normal echocardiogram and age-matched controls. Peak and submaximal parameters were analyzed. Fifty-three PCS and 60 controls were studied. Peak oxygen consumption (VO2), peak work rate (WR), and ventilatory anaerobic threshold (VAT) were significantly lower in PCS than controls (1.86 ± 0.53 vs. 2.23 ± 0.61 L/min, 125 ± 45 vs. 154 ± 46 W, and 1.20 ± 0.35 vs. 1.42 ± 0.43 L/min, respectively; all p < 0.01), whereas peak heart rate (HR) and ventilatory efficiency (a slope of minute ventilation over CO2 production or ∆VE/∆VCO2) were comparable. Peak respiratory exchange ratio (RER) was significantly higher in PCS (p = 0.0006). Stroke volume (SV) reserve was decreased in PCS, indicated by simultaneous higher dependency on HR (higher ∆HR/∆WR) and lower peak oxygen pulse (OP). Twelve PCS with high peak RER (≥ 1.3) revealed lower pVO2 and VAT than the rest of PCS despite higher ventilatory efficiency (lower ∆VE/∆VCO2), suggesting fundamental deficiency in oxygen utilization in some PCS. Poor exercise performance in PCS may be mainly attributed to limited stroke volume reserve, but the underlying pathophysiology is multifactorial. Combined assessment of peak and submaximal CPET parameters provided critical information in delineating underlying exercise physiology of PCS.
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Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival. J Clin Med 2023; 12:jcm12010366. [PMID: 36615166 PMCID: PMC9821085 DOI: 10.3390/jcm12010366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Decreased peak oxygen consumption during exercise (peak Vo2) is a well-established prognostic marker for mortality in ambulatory heart failure. After heart transplantation, the utility of peak Vo2 as a marker of post-transplant survival is not well established. METHODS AND RESULTS We performed a retrospective analysis of adult heart transplant recipients at the Hospital of the University of Pennsylvania who underwent cardiopulmonary exercise testing within a year of transplant between the years 2000 to 2011. Using time-to-event models, we analyzed the hazard of mortality over nearly two decades of follow-up as a function of post-transplant percent predicted peak Vo2 (%Vo2). A total of 235 patients met inclusion criteria. The median post-transplant %Vo2 was 49% (IQR 42 to 60). Each standard deviation (±14%) increase in %Vo2 was associated with a 32% decrease in mortality in adjusted models (HR 0.68, 95% CI 0.53 to 0.87, p = 0.002). A %Vo2 below 29%, 64% and 88% predicted less than 80% survival at 5, 10, and 15 years, respectively. CONCLUSIONS Post-transplant peak Vo2 is a highly significant prognostic marker for long-term post-transplant survival. It remains to be seen whether decreased peak Vo2 post-transplant is modifiable as a target to improve post-transplant longevity.
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Corrà U, Piepoli MF, Giordano A, Doni F, Magini A, Bonomi A, Salvioni E, Lagioia R, Limongelli G, Paolillo S, Magrì D, Filardi PP, Sinagra G, Scardovi AB, Metra M, Senni M, Scrutinio D, Raimondo R, Emdin M, Cattadori G, Parati G, Re F, Cicoira M, Minà C, Correale M, Frigerio M, Perna E, Bussotti M, Battaia E, Guazzi M, Bandera F, Badagliacca R, Lenarda AD, Maggioni A, Passino C, Sciomer S, Pacileo G, Mapelli M, Vignati C, Clemenza F, Lombardi C, Agostoni P. Revisiting a Prognosticating Algorithm from Cardiopulmonary Exercise Testing in Chronic Heart Failure (from the MECKI Score Population). Am J Cardiol 2022; 180:65-71. [DOI: 10.1016/j.amjcard.2022.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/01/2022]
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Corrà U, Giordano A, Marcassa C, Gambarin FI, Gnemmi M, Pistono M. Prognostic value of 6-min walk test compared to cardiopulmonary exercise test in patients with severe heart failure. J Cardiovasc Med (Hagerstown) 2022; 23:379-386. [PMID: 35645028 DOI: 10.2459/jcm.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The 6-min walk test (6MWT) and cardiopulmonary exercise test (CPET) are both predictive in heart failure (HFrEF). Although 6MWT substitutes for CPET in HFrEF patients, as submaximal testing may be preferable, its prognostic superiority still needs to be verified, particularly in regard to beta blockers (BBs). We aimed to compare the prognostic role of CPET and 6MWT and investigate whether BB therapy influences the predictive value. METHODS This is a single-center, retrospective study. Advanced HFrEF patients were followed up for 3 years: events were cardiovascular death or urgent heart transplantation. We analyzed the predictive capacity of CPET and 6MWT in patients, and subdivided according to use of BBs. RESULTS In a group of 251 HFrEF patients, we found a correlation between meters and peak VO2 (r2 = 0.94). Over the 3-year follow-up, 74 events were recorded. Both CPET and 6MWT variables were correlated with outcome at univariate analysis (meter and VE/VCO2 slope, peak VO2, VO2 at ventilatory anaerobic threshold, percentage predicted of peak VO2), but only percentage predicted of peak VO2 (pppVO2) was an independent predictor. In 103 HFrEF patients on BBs (23 nonsurvivors), neither pppVO2 nor meter were predictive, while in 148 patients not treated with BB (51 with events) pppVO2 was selected as an independent prognostic parameter (P = 0.001). CONCLUSIONS 6MWT is a valid alternative to CPET, although the percentage of predicted of peak VO2 emerged as the strongest predictor. Nonetheless, our results suggest that both functional derived parameters are not predictive among those patients treated with BBs. Further studies are necessary to confirm these findings.
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Affiliation(s)
| | - Andrea Giordano
- Bio-engineering Department, Istituti Clinici Scientifici Maugeri, Institute of Veruno, Veruno (NO), Italy
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Leitner BP, Siebel S, Akingbesote ND, Zhang X, Perry RJ. Insulin and cancer: a tangled web. Biochem J 2022; 479:583-607. [PMID: 35244142 PMCID: PMC9022985 DOI: 10.1042/bcj20210134] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 12/13/2022]
Abstract
For a century, since the pioneering work of Otto Warburg, the interwoven relationship between metabolism and cancer has been appreciated. More recently, with obesity rates rising in the U.S. and worldwide, epidemiologic evidence has supported a link between obesity and cancer. A substantial body of work seeks to mechanistically unpack the association between obesity, altered metabolism, and cancer. Without question, these relationships are multifactorial and cannot be distilled to a single obesity- and metabolism-altering hormone, substrate, or factor. However, it is important to understand the hormone-specific associations between metabolism and cancer. Here, we review the links between obesity, metabolic dysregulation, insulin, and cancer, with an emphasis on current investigational metabolic adjuncts to standard-of-care cancer treatment.
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Affiliation(s)
- Brooks P. Leitner
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
| | - Stephan Siebel
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Pediatrics, Yale School of Medicine, New Haven, CT, U.S.A
| | - Ngozi D. Akingbesote
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
| | - Xinyi Zhang
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
| | - Rachel J. Perry
- Departments of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, U.S.A
- Departments of Internal Medicine, Yale School of Medicine, New Haven, CT, U.S.A
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Suk MH, Kwon JY. Effect of Equine-Assisted Activities and Therapies on Cardiorespiratory Fitness in Children with Cerebral Palsy: A Randomized Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:51-59. [PMID: 35085017 DOI: 10.1089/jicm.2021.0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Abstract Objectives: To determine the effects of an equine-assisted activities and therapies (EAAT) program on cardiorespiratory fitness (CRF) in children with cerebral palsy (CP). Design: An evaluator-blinded, parallel, two-arm, randomized controlled clinical trial with 1:1 randomization. Settings/Location: A tertiary university hospital and a local arena. Subjects: Forty-six children with CP (24 boys and 22 girls) classified as Gross Motor Function Classification System levels I, II, or III were included. Interventions: The EAAT program was conducted for 40 min twice a week for 16 weeks (32 lessons). Outcome measures: Clinical global impression scales, motor capacity, cardiopulmonary fitness, and habitual physical activity was measured on both groups before and after the 16-week period. Results: Changes in the Clinical Global Impression-Severity scale and Clinical Global Impression-Improvement scale scores were not different between the groups after the intervention. Analysis of covariance revealed statistically significant differences in Gross Motor Function Measure 66 (GMFM 66) (p < 0.05) and Pediatric Balance Scale (p < 0.001) in motor capacity and resting heart rate (HRrest) (p < 0.001) in CRF, between the EAAT group and the control group. Subgroup analysis using multiple linear regression analysis revealed that the GMFM 66 changes had a statistically significant effect on the HRrest changes in the EAAT group (p < 0.05). Conclusions: The present study showed decreased HRrest in children with CP after completing the 16-week EAAT program. This improvement was explained by the improvement of GMFM 66 in the EAAT group. Thus, EAAT may be among the endurance training programs that could be offered to children with CP to improve their CRF. Clinical Trial Registration number: NCT03870893.
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Affiliation(s)
- Min-Hwa Suk
- Department of Physical Education, Seoul National University of Education, Seoul, Republic of Korea
| | - Jeong-Yi Kwon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Nayor M, Shah RV, Tanguay M, Blodgett JB, Chernofsky A, Miller PE, Xanthakis V, Malhotra R, Houstis NE, Velagaleti RS, Larson MG, Vasan RS, Lewis GD. Feasibility, Methodology, and Interpretation of Broad-Scale Assessment of Cardiorespiratory Fitness in a Large Community-Based Sample. Am J Cardiol 2021; 157:56-63. [PMID: 34391575 DOI: 10.1016/j.amjcard.2021.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
Cardiorespiratory fitness (CRF) is intricately related to health status. The optimal approach for CRF quantification is through assessment of peak oxygen uptake (VO2), but such measurements have been largely confined to small referral populations. Here we describe protocols and methodological considerations for peak VO2 assessment and determination of volitional effort in a large community-based sample. Maximum incremental ramp cycle ergometry cardiopulmonary exercise testing (CPET) was performed by Framingham Heart Study participants at a routine study visit (2016 to 2019). Of 3,486 individuals presenting for a multicomponent study visit, 3,116 (89%) completed CPET. The sample was middle-aged (54 ± 9 years), with 53% women, body mass index 28.3 ± 5.6 kg/m2, 48% with hypertension, 6% smokers, and 8% with diabetes. Exercise duration was 12.0 ± 2.1 minutes (limits 3.7to20.5). No major cardiovascular events occurred. A total of 98%, 96%, 90%, 76%, and 57% of the sample reached peak respiratory exchange ratio (RER) values of ≥1.0, ≥1.05, ≥1.10, ≥1.15, and ≥1.20, respectively (mean peak RER = 1.21 ± 0.10). With rising peak RER values up to ≈1.10, steep changes were observed for percent predicted peak VO2, VO2 at the ventilatory threshold/peak VO2, heart rate response, and Borg (subjective dyspnea) scores. More shallow changes for effort dependent CPET variables were observed with higher achieved RER values. In conclusion, measurement of peak VO2 is feasible and safe in a large sample of middle-aged, community-dwelling individuals with heterogeneous cardiovascular risk profiles. Peak RER ≥1.10 was achievable by the majority of middle-aged adults and RER values beyond this threshold did not necessarily correspond to higher peak VO2 values.
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Triantafyllidi H, Birmpa D, Benas D, Trivilou P, Fambri A, Iliodromitis EK. Cardiopulmonary exercise testing: The ABC for the Clinical Cardiologist. Cardiology 2021; 147:62-71. [PMID: 34649252 DOI: 10.1159/000520024] [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: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Helen Triantafyllidi
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, ATTIKON Hospital, Athens, Greece
| | - Dionyssia Birmpa
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, ATTIKON Hospital, Athens, Greece
| | - Dimitrios Benas
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, ATTIKON Hospital, Athens, Greece
| | - Paraskevi Trivilou
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, ATTIKON Hospital, Athens, Greece
| | - Anastasia Fambri
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, ATTIKON Hospital, Athens, Greece
| | - Efstathios K Iliodromitis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, ATTIKON Hospital, Athens, Greece
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Cardiorespiratory performance and locomotor function of patients with anorectal malformations. Sci Rep 2021; 11:18919. [PMID: 34556713 PMCID: PMC8460638 DOI: 10.1038/s41598-021-98368-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/24/2021] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to assess whether adolescents following anorectal malformation repair have a decreased cardiorespiratory performance capacity and impaired motor skills. All eligible children treated for ARMs between 2000 and 2014 were invited to participate in a prospective study consisting of a clinical examination, evaluation of Bowel function and Quality of Life, spirometry, spiroergometry and assessment of the motor activity. The results were compared to a healthy age- and sex-matched control group. There was no statistically significant difference in height, weight, BMI, muscle mass or body fat percentage between the study and the control group. Nine out of 18 patients (50%) had an excellent functional outcome with a normal Bowel Function Score. Spirometry revealed no significant differences between ARM patients and controls, four patients showed a ventilation disorder. Spiroergometry revealed a significantly lower relative performance capacity and the overall rating of the motor activity test showed significantly decreased grades in ARM patients. ARM patients were affected by an impaired cardiopulmonary function and decreased motor abilities. Long-term examinations consisting of routine locomotor function evaluation and spiroergometry are advisable to detect impaired cardiopulmonary function and to prevent a progression of associated complications and related impaired quality of life.
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Li D, Chen P, Zhu J. The Effects of Interval Training and Continuous Training on Cardiopulmonary Fitness and Exercise Tolerance of Patients with Heart Failure-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6761. [PMID: 34201804 PMCID: PMC8268940 DOI: 10.3390/ijerph18136761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the effects of interval training (IT) as compared with continuous training (CT) on cardiorespiratory fitness and exercise tolerance of patients with heart failure (HF), with the aim to provide reasonable exercise prescriptions for patients with HF. METHODS Through searching electronic databases, randomized controlled studies were collected. The included studies were evaluated for methodological quality using the Cochrane risk of bias assessment tool, and statistical analyses were carried out using Review Manager 5.3 and Stata MP 15.1 software. RESULTS A total of seventeen randomized controlled trials (i.e., studies) with 617 patients were included. The meta-analysis showed that IT can improve a patient's peak oxygen uptake (VO2peak) (MD = 2.08, 95% CI 1.16 to 2.99, p < 0.00001), left ventricular ejection fraction (LVEF) (MD =1.32, 95% CI 0.60 to 2.03, p = 0.0003), and 6-minute walk distance (6MWD) (MD = 25.67, 95% CI 12.87 to 38.47, p < 0.0001) as compared with CT. However, for respiratory exchange ratio (RER) (MD = 0.00, 95% CI -0.02 to 0.03, p = 0.81), CO2 ventilation equivalent slope (VE/VCO2 slope) (SMD = 0.04, 95% CI -0.23 to 0.31, p = 0.75), and resting heart rate (HRrest) (MD = 0.15, 95% CI -3.00 to 3.29, p = 0.93) there were no statistical significance. CONCLUSIONS The evidence shows that IT is better than CT for improving the cardiorespiratory fitness and exercise tolerance of patients with HF. Moreover, an intensity of 60-80% peak heart rate of IT is the optimal choice for patients. It is hoped that, in the future, more well-designed studies would further expand the meta-analysis results.
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Affiliation(s)
| | | | - Junying Zhu
- Department of Physical Education, Ocean University of China-Laoshan Campus, Qingdao 266100, China; (D.L.); (P.C.)
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Bicycle spiroergometry: comparison of standardized examination protocols for adolescents: is it necessary to define own standard values for each protocol? Eur J Appl Physiol 2021; 121:1783-1794. [PMID: 33712869 PMCID: PMC8144119 DOI: 10.1007/s00421-021-04601-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/10/2021] [Indexed: 11/10/2022]
Abstract
Purpose To compare performance data of adolescents collected with five different bicycle spiroergometry protocols and to assess the necessity for establishing standard values for each protocol. Methods One-hundred-twenty adolescents completed two bicycle spiroergometries within 14 days. One of the two tests was performed based on our institutional weight-adapted protocol (P0). The other test was performed based on one out of four exercise protocols widely used for children and adolescents (P1, 2, 3 or 4) with 30 persons each. The two tests were performed in a random order. Routine parameters of cardiopulmonary exercise tests (CPET) such as VO2peak, maximum power, O2 pulse, OUES, VE/VCO2 slope as well as ventilatory and lactate thresholds were investigated. Agreement between protocols was evaluated by Bland–Altman analysis, coefficients of variation (CV) and intra-class correlation coefficients (ICC). Results None of the CPET parameters were significantly different between P0 and P1, 2, 3 or 4. For most of the parameters, low biases between P0 and P1–P4 were found and 95% confidence intervalls were narrow. CV and ICC values largely corresponded to well-defined analytical goals (CV < 10% and ICC > 0.9). Only maximal power (Pmax) showed differences in size and drift of the bias depending on the length of the step duration of the protocols. Conclusion Comparability between examination protocols has been shown for CPET parameters independent on step duration. Protocol-dependent standard values do not appear to be necessary. Only Pmax is dependent on the step duration, but in most cases, this has no significant influence on the fitness assessment.
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Impact of peak respiratory exchange ratio on the prognostic power of symptoms-limited exercise testing using Bruce protocol in patients with Fontan physiology. Cardiol Young 2021; 31:216-223. [PMID: 33208204 DOI: 10.1017/s1047951120003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We evaluated the impact of peak respiratory exchange ratio on the prognostic values of cardiopulmonary exercise variables during symptoms-limited incremental exercise tests in patients with Fontan physiology. METHODS Retrospective single-centre chart review study of Fontan patients who underwent exercise testing using the Bruce protocol between 2014 and 2018 and follow-up. RESULTS A total of 34 patients (age > 18 years) had a Borg score of ≥7 on the Borg 10-point scale, but only 50% of patients achieved a peak respiratory exchange ratio of ≥ 1.10 (maximal test). Peak oxygen consumption, percent-predicted peak oxygen consumption, and peak oxygen consumption at the ventilatory threshold was reduced significantly in patients with a peak respiratory exchange ratio of < 1.10. Peak oxygen consumption and percent-predicted peak oxygen consumption was positively correlated with peak respiratory exchange ratio values (r = 0.356, p = 0.039). After a median follow-up of 21 months, cardiac-related events occurred in 16 (47%) patients, with no proportional differences in patients due to their respiratory exchange ratio (odds ratio, 0.62; 95% CI: 0.18-2.58; p = 0.492). Multivariate Cox proportional hazard analysis showed percent-predicted peak oxygen consumption, peak heart rate, and the oxygen uptake efficient slope were highly related to the occurrence of events in patients only with a peak respiratory exchange ratio of ≥ 1.10. CONCLUSIONS The value of peak cardiopulmonary exercise variables is limited for the determination of prognosis and assessment of interventions in Fontan patients with sub-maximal effort. Our findings deserve further research and clinical application.
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Cardiorespiratory performance capacity and airway microbiome in patients following primary repair of esophageal atresia. Pediatr Res 2021; 90:66-73. [PMID: 33159185 PMCID: PMC8370877 DOI: 10.1038/s41390-020-01222-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/04/2020] [Accepted: 10/11/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients following repair of an esophageal atresia (EA) or tracheoesophageal fistula (TEF) carry an increased risk of long-term cardiopulmonary malaise. The role of the airway microbiome in EA/TEF patients remains unclear. METHODS All EA/TEF patients treated between 1980 and 2010 were invited to a prospective clinical examination, spirometry, and spiroergometry. The airway microbiome was determined from deep induced sputum by 16 S rRNA gene sequencing. The results were compared to a healthy age- and sex-matched control group. RESULTS Nineteen EA/TEF patients with a mean age of 24.7 ± 7 years and 19 age- and sex-matched controls were included. EA/TEF patients showed a significantly lower muscle mass, lower maximum vital capacity (VCmax), and higher rates of restrictive ventilation disorders. Spiroergometry revealed a significantly lower relative performance capacity and lower peak VO2 in EA/TEF patients. Alpha- and beta-diversity of the airway microbiome did not differ significantly between the two groups. Linear discriminant effect size analysis revealed significantly enriched species of Prevotella_uncultured, Streptococcus_anginosus, Prevotella_7_Prevotella_enoeca, and Mogibacterium_timidum. CONCLUSION EA/TEF patients frequently suffer from restrictive ventilation disorders and impaired cardiopulmonary function associated with minor alterations of the airway microbiome. Long-term examinations of EA/TEF patients seem to be necessary in order to detect impaired cardiopulmonary function. IMPACT The key messages of the present study are a significantly decreased VCmax and exercise performance, as well as airway microbiome differences in EA/TEF patients. This study is the first to present parameters of lung function and exercise performance in combination with airway microbiome analysis with a mean follow-up of 24 years in EA/TEF patients. Prospective, long-term studies are needed to unravel possible interactions between alterations of the airway microbiome and impaired pulmonary function in EA/TEF patients.
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Maximal versus sub-maximal effort during cardiopulmonary exercise testing in adults with congenital heart disease: outcome analysis of short-term cardiac-related events. Cardiol Young 2021; 31:91-96. [PMID: 33070792 DOI: 10.1017/s104795112000339x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Peak respiratory exchange ratio is an objective marker of patient effort during cardiopulmonary exercise testing. We evaluated exercise variables in 175 adult congenital heart disease patients and the impact of respiratory exchange ratio on the prognostic value of exercise variables for short-term cardiac-related events. Of 175 patients, 110 completed the exercise test with a peak respiratory exchange ratio of ≥1.10 and the remaining 65 had a peak respiratory exchange ratio of <1.10. Peak oxygen consumption, the percentage of oxygen consumption at the ventilatory threshold, peak heart rate, percentage predicted peak heart rate, double product, oxygen uptake efficiency slope, and the number of patients with exercise oscillatory ventilation were reduced significantly in patients with a respiratory exchange ratio of <1.10 compared to those with a respiratory exchange ratio of ≥1.10. After a median follow-up of 21 months, total cardiac-related events occurred in 37 (21%) patients. Multivariate Cox proportional hazard analysis showed that the percentage predicted peak oxygen consumption, and oxygen uptake efficiency slope were independent predictors of cardiac-related events only in patients with a peak respiratory exchange ratio of ≥1.10. Sub-maximal exercise performance can be preserved in adult congenital heart disease patients. The percentage predicted oxygen consumption and the oxygen uptake efficiency slope are two independent predictors for short-term cardiac-related events in adult congenital heart disease patients.
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Cardiopulmonary exercise testing in chronic heart failure patients treated with beta-blockers: Still a valid prognostic tool. Int J Cardiol 2020; 317:128-132. [DOI: 10.1016/j.ijcard.2020.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
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22
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Thomasson R, Vignier N, Peccate C, Mougenot N, Noirez P, Muchir A. Alteration of performance in a mouse model of Emery-Dreifuss muscular dystrophy caused by A-type lamins gene mutation. Hum Mol Genet 2020; 28:2237-2244. [PMID: 31220270 DOI: 10.1093/hmg/ddz056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 11/13/2022] Open
Abstract
Autosomal Emery-Dreifuss muscular dystrophy (EDMD) is caused by mutations in the lamin A/C gene (LMNA) encoding A-type nuclear lamins, intermediate filament proteins of the nuclear envelope. Classically, the disease manifests as scapulo-humero-peroneal muscle wasting and weakness, early joint contractures and dilated cardiomyopathy with conduction blocks; however, variable skeletal muscle involvement can be present. Previously, we and other demonstrated altered activity of signaling pathways in hearts and striated muscles of LmnaH222P/H222P mice, a model of autosomal EDMD. We showed that blocking their activation improved cardiac function. However, the evaluation of the benefit of these treatments on the whole organism is suffering from a better knowledge of the performance in mouse models. We show in the present study that LmnaH222P/H222P mice display a significant loss of lean mass, consistent with the dystrophic process. This is associated with altered VO2 peak and respiratory exchange ratio. These results showed for the first time that LmnaH222P/H222P mice have decreased performance and provided a new useful means for future therapeutic interventions on this model of EDMD.
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Affiliation(s)
- Rémi Thomasson
- Université Sorbonne Paris Cité, EA7329, Université Paris Descartes, Paris, France
| | - Nicolas Vignier
- Sorbonne Université, INSERM, UMRS974, Center of Research in Myology, Institut de Myologie, Paris, France
| | - Cecile Peccate
- Sorbonne Université, INSERM, UMRS974, Center of Research in Myology, Institut de Myologie, Paris, France
| | - Nathalie Mougenot
- Sorbonne Université, INSERM, UMS28, Phénotypage du Petit Animal, Paris F-75013, France
| | - Philippe Noirez
- Université Sorbonne Paris Cité, EA7329, Université Paris Descartes, Paris, France.,Institute for Research in Medicine and Epidemiology of Sport, National Institute of Sport, Expertise and Performance, Paris, France
| | - Antoine Muchir
- Sorbonne Université, INSERM, UMRS974, Center of Research in Myology, Institut de Myologie, Paris, France
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Murata M, Adachi H, Nakade T, Miyaishi Y, Kan H, Okonogi S, Kuribara J, Yamashita E, Kawaguchi R, Ezure M. Ventilatory Efficacy After Transcatheter Aortic Valve Replacement Predicts Mortality and Heart Failure Events in Elderly Patients. Circ J 2019; 83:2034-2043. [PMID: 31462606 DOI: 10.1253/circj.cj-19-0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to clarify the predictors of death or heart failure (HF) in elderly patients who undergo transcatheter aortic valve replacement (TAVR).Methods and Results:We prospectively enrolled 83 patients (age, 83±5 years) who underwent transthoracic echocardiography (TTE) and cardiopulmonary exercise testing (CPET) with impedance cardiography post-TAVR. We investigated the association of TTE and CPET parameters with death and the combined outcome of death and HF hospitalization. Over a follow-up of 19±9 months, peak oxygen uptake (V̇O2) was not associated with death or the combined outcome. The minimum ratio of minute ventilation (V̇E) to carbon dioxide production (V̇CO2) and the V̇E vs. V̇CO2slope were higher in patients with the combined outcome. After adjusting for age, sex, Society of Thoracic Surgeons score and peak V̇O2, ventilatory efficacy parameters remained independent predictors of the combined outcome (minimum V̇E/V̇O2: hazard ratio, 1.108; 95% confidence interval, 1.010-1.215; P=0.031; V̇E vs. V̇CO2slope: hazard ratio, 1.035; 95% confidence interval, 1.001-1.071; P=0.044), and had a greater area under the receiver-operating characteristic curve. The V̇E vs. V̇CO2slope ≥34.6 was associated with higher rates of the combined outcome, as well as lower cardiac output at peak work rate during CPET. CONCLUSIONS In elderly patients, lower ventilatory efficacy post-TAVR is a predictor of death and HF hospitalization, reflecting lower cardiac output at peak exercise.
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Affiliation(s)
- Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Taisuke Nakade
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Yusuke Miyaishi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hakuken Kan
- Department of Cardiology, Gunma Prefectural Cardiovascular Center.,Department of Cardiology, Shisei Clinic
| | - Shuichi Okonogi
- Department of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center
| | - Jun Kuribara
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Eiji Yamashita
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Ren Kawaguchi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Masahiko Ezure
- Department of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center
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Agostoni P, Dumitrescu D. How to perform and report a cardiopulmonary exercise test in patients with chronic heart failure. Int J Cardiol 2019; 288:107-113. [DOI: 10.1016/j.ijcard.2019.04.053] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/04/2019] [Accepted: 04/16/2019] [Indexed: 01/01/2023]
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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
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Tsuda M, Fukushima A, Matsumoto J, Takada S, Kakutani N, Nambu H, Yamanashi K, Furihata T, Yokota T, Okita K, Kinugawa S, Anzai T. Protein acetylation in skeletal muscle mitochondria is involved in impaired fatty acid oxidation and exercise intolerance in heart failure. J Cachexia Sarcopenia Muscle 2018; 9:844-859. [PMID: 30168279 PMCID: PMC6204592 DOI: 10.1002/jcsm.12322] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/04/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Exercise intolerance is a common clinical feature and is linked to poor prognosis in patients with heart failure (HF). Skeletal muscle dysfunction, including impaired energy metabolism in the skeletal muscle, is suspected to play a central role in this intolerance, but the underlying mechanisms remain elusive. Lysine acetylation, a recently identified post-translational modification, has emerged as a major contributor to the derangement of mitochondrial metabolism. We thus investigated whether mitochondrial protein acetylation is associated with impaired skeletal muscle metabolism and lowered exercise capacity in both basic and clinical settings of HF. METHODS We first conducted a global metabolomic analysis to determine whether plasma acetyl-lysine is a determinant factor for peak oxygen uptake (peak VO2 ) in HF patients. We then created a murine model of HF (n = 11) or sham-operated (n = 11) mice with or without limited exercise capacity by ligating a coronary artery, and we tested the gastrocnemius tissues by using mass spectrometry-based acetylomics. A causative relationship between acetylation and the activity of a metabolic enzyme was confirmed in in vitro studies. RESULTS The metabolomic analysis verified that acetyl-lysine was the most relevant metabolite that was negatively correlated with peak VO2 (r = -0.81, P < 0.01). At 4 weeks post-myocardial infarction HF, a treadmill test showed lowered work (distance × body weight) and peak VO2 in the HF mice compared with the sham-operated mice (11 ± 1 vs. 23 ± 1 J, P < 0.01; 143 ± 5 vs. 159 ± 3 mL/kg/min, P = 0.01; respectively). As noted, the protein acetylation of gastrocnemius mitochondria was 48% greater in the HF mice than the sham-operated mice (P = 0.047). Acetylproteomics identified the mitochondrial enzymes involved in fatty acid β-oxidation (FAO), the tricarboxylic acid cycle, and the electron transport chain as targets of acetylation. In parallel, the FAO enzyme (β-hydroxyacyl CoA dehydrogenase) activity and fatty acid-driven mitochondrial respiration were reduced in the HF mice. This alteration was associated with a decreased expression of mitochondrial deacetylase, Sirtuin 3, because silencing of Sirtuin 3 in cultured skeletal muscle cells resulted in increased mitochondrial acetylation and reduced β-hydroxyacyl CoA dehydrogenase activity. CONCLUSIONS Enhanced mitochondrial protein acetylation is associated with impaired FAO in skeletal muscle and reduced exercise capacity in HF. Our results indicate that lysine acetylation is a crucial mechanism underlying deranged skeletal muscle metabolism, suggesting that its modulation is a potential approach for exercise intolerance in HF.
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Affiliation(s)
- Masaya Tsuda
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Arata Fukushima
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Junichi Matsumoto
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shingo Takada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoya Kakutani
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideo Nambu
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Katsuma Yamanashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takaaki Furihata
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Yokota
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koichi Okita
- Graduate School of Program in Lifelong Learning Studies, Hokusho University, Ebetsu, Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Yang X, Xu W, Huang K, Zhang B, Wang H, Zhang X, Gong L, Luo Y, He X. Precision toxicology shows that troxerutin alleviates ochratoxin A-induced renal lipotoxicity. FASEB J 2018; 33:2212-2227. [PMID: 30247986 DOI: 10.1096/fj.201800742r] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Lipotoxicity is the most common cause of severe kidney disease, with few treatment options available today. Precision toxicology can improve detection of subtle intracellular changes in response to exogenous substrates; thus, it facilitates in-depth research on bioactive molecules that may interfere with the onset of certain diseases. In the current study, troxerutin significantly relieved nephrotoxicity, increased endurance, and improved systemic energy metabolism and renal inflammation in OTA-induced nephrotic mice. Lipidomics showed that troxerutin effectively reduced the levels of triglycerides, phosphatidylcholines, and phosphatidylethanolamines in nephropathy. The mechanism was partly attributable to troxerutin in alleviating the aberrantly up-regulated expression of sphingomyelinase, the cystic fibrosis transmembrane conductance regulator, and chloride channel 2. Renal tubular epithelial cells, the main site of toxin-induced accumulation of lipids in the kidney, were subjected to transcriptomic profiling, which uncovered several metabolic factors relevant to aberrant lipid and lipoprotein metabolism. Our work provides new insights into the molecular features of toxin-induced lipotoxicity in renal tubular epithelial cells in vivo and demonstrates the function of troxerutin in alleviating OTA-induced nephrosis and associated systemic energy metabolism disorders.-Yang, X., Xu, W., Huang, K., Zhang, B., Wang, H., Zhang, X., Gong, L., Luo, Y., He, X. Precision toxicology shows that troxerutin alleviates ochratoxin A-induced renal lipotoxicity.
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Affiliation(s)
- Xuan Yang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Wentao Xu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,Beijing Laboratory for Food Quality and Safety, Beijing, China
| | - Kunlun Huang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,Beijing Laboratory for Food Quality and Safety, Beijing, China
| | - Boyang Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Haomiao Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xueqin Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lijing Gong
- China Academy of Sport and Health Sciences, Beijing Sport University, Beijing, China
| | - Yunbo Luo
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,Key Laboratory of Safety Assessment of Genetically Modified Organism-Food Safety, Ministry of Agriculture, China
| | - Xiaoyun He
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,Key Laboratory of Safety Assessment of Genetically Modified Organism-Food Safety, Ministry of Agriculture, China
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Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation. Rev Port Cardiol 2018. [DOI: 10.1016/j.repc.2017.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pereira-da-Silva T, M. Soares R, Papoila AL, Pinto I, Feliciano J, Almeida-Morais L, Abreu A, Cruz Ferreira R. Optimizing risk stratification in heart failure and the selection of candidates for heart transplantation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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: 150] [Impact Index Per Article: 21.4] [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.
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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
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Nelson N, Asplund CA. Exercise Testing: Who, When, and Why? PM R 2017; 8:S16-23. [PMID: 26972264 DOI: 10.1016/j.pmrj.2015.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/11/2015] [Accepted: 10/04/2015] [Indexed: 10/25/2022]
Abstract
There are different modalities of exercise testing that can provide valuable information to physicians about patient and athlete fitness and cardiopulmonary status. Cardiopulmonary exercise testing (CPX) is a form of exercise testing that measures ventilatory and gas exchange, heart rate, electrocardiogram, and blood pressures to provide detailed information on the cardiovascular, pulmonary, and muscular systems. This testing allows an accurate quantification of functional capacity/measure of exercise tolerance, diagnosis of cardiopulmonary disease, disease-progression monitoring or response to intervention, and the prescription of exercise and training. CPX directly measures inhaled and exhaled ventilator gases to determine the maximal oxygen uptake, which reflects the body's maximal use of oxygen and defines the limits of the cardiopulmonary system. CPX is the ideal modality to evaluate causes of exertional fatigue and dyspnea, especially in complex cases in which the etiology could be cardiac, pulmonary, or deconditioning. Exercise tolerance has become an important outcome measure in patients with chronic obstructive pulmonary disease and congestive heart failure, as well as other chronic diseases, and is a well-recognized predictor of mortality. Older athletes or those with underlying medical conditions could benefit from exercise testing for risk stratification and clearance to participate, as well as to help set their training zones and determine their functional limitations.
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Affiliation(s)
- Nicole Nelson
- Department of Family Medicine, Eisenhower Army Medical Center, Fort Gordon, GA(∗)
| | - Chad A Asplund
- Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA 30458(†).
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Kim C, Choi HE, Lee KH, Kim YJ, Lee SJ. Influence of Low Peak Respiratory Exchange Ratio on Cardiac Rehabilitation in Patients With Coronary Artery Disease. Ann Rehabil Med 2016; 40:1114-1123. [PMID: 28119843 PMCID: PMC5256319 DOI: 10.5535/arm.2016.40.6.1114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/23/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare and analyze the effects of cardiac rehabilitation (CR) in two groups based on the peak respiratory exchange ratio (RERpeak) 1.1 values using the exercise tolerance test (ETT) results, and to investigate the reasons for early termination of ETT. METHODS Patients with acute coronary syndrome who participated in CR exercise training were selected and all subjects underwent 6 weeks of CR exercise training. ETT was performed on a treadmill using a Modified Bruce Protocol before and after CR exercise training. According to the result of the first ETT, the subjects were divided into two groups: those with an RERpeak≥1.1 (n=33) and those with an RERpeak<1.1 (n=22). We investigated the reasons for ETT termination and compared the effect of CR between the groups. RESULTS The reasons for the early termination of the first ETT in the RERpeak<1.1 group were subjective dyspnea, abnormal cardiovascular responses, leg fatigue and other problems. After a 6-week CR, the peak oxygen consumption (VO2peak) and ETT time increased, and the rate of perceived exertion (RPE) and RPP (rate pressure product) at stage 3 decreased in both the RERpeak<1.1 and RERpeak≥1.1 groups. CONCLUSION CR exercise training improved exercise capacity, not only in the RERpeak≥1.1 group, but also in the RERpeak<1.1 group. This means that patients with a lower exercise tolerance could also benefit from the effects of CR. Thoughtful consideration to identify the direct and indirect causes for the early termination of ETT would be necessary to improve the efficiency of CR.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hee Eun Choi
- Department of Rehabilitation Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki Hoon Lee
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Joo Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sang Jae Lee
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Liu LC, Hummel YM, van der Meer P, Berger RM, Damman K, van Veldhuisen DJ, Voors AA, Hoendermis ES. Effects of sildenafil on cardiac structure and function, cardiopulmonary exercise testing and health‐related quality of life measures in heart failure patients with preserved ejection fraction and pulmonary hypertension. Eur J Heart Fail 2016; 19:116-125. [DOI: 10.1002/ejhf.662] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Licette C.Y. Liu
- Department of Cardiology, University of Groningen University Medical Centre Groningen Hanzeplein 1 9713 GZ Groningen the Netherlands
| | - Yoran M. Hummel
- Department of Cardiology, University of Groningen University Medical Centre Groningen Hanzeplein 1 9713 GZ Groningen the Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen University Medical Centre Groningen Hanzeplein 1 9713 GZ Groningen the Netherlands
| | - Rolf M.F. Berger
- Department of Pediatric and Congenital Cardiology, University of Groningen University Medical Centre Groningen Groningen the Netherlands
| | - Kevin Damman
- Department of Cardiology, University of Groningen University Medical Centre Groningen Hanzeplein 1 9713 GZ Groningen the Netherlands
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University of Groningen University Medical Centre Groningen Hanzeplein 1 9713 GZ Groningen the Netherlands
| | - Adriaan A. Voors
- Department of Cardiology, University of Groningen University Medical Centre Groningen Hanzeplein 1 9713 GZ Groningen the Netherlands
| | - Elke S. Hoendermis
- Department of Cardiology, University of Groningen University Medical Centre Groningen Hanzeplein 1 9713 GZ Groningen the Netherlands
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Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation Part III: Interpretation of cardiopulmonary exercise testing in chronic heart failure and future applications: Task Force of the Italian Working Group on Cardiac Rehabilitation and Prevention (Gruppo Italiano di Cardiologia Riabilitativa e Prevenzione, GICR), endorsed by Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology. ACTA ACUST UNITED AC 2016; 13:485-94. [PMID: 16874136 DOI: 10.1097/01.hjr.0000201518.43837.bc] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Optimal use of cardiopulmonary exercise testing (CPET) in clinical practice and chronic heart failure (CHF) requires appropriate data presentation and a flexible interpretative strategy. The greatest potential impact on the decision-making process may rest not on the value of any individual measurement, although some are obviously more important than others, but rather on their integrative use. Such an integrative approach relies on interrelationship, trending phenomena and patterns of key gas exchange variable responses. An multiparametric approach will be discussed in different clinical applications, for exercise prescription and monitoring, functional evaluation of drug therapy or cardiac resynchronisation therapy efficacy, and risk stratification. The role of CPET in the daily clinical decision-making process will be underscored. Future indications of CPET will be addressed, suggesting and promoting an extended candidacy either to all CHF patients, including those at high risk or most vulnerable, such as female, elderly patients, and patients with implantable cardioverter defibrillator or in every clinical setting where objective definition of exercise capacity provides implications for medical, surgical, and social decision making.
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Corrà U, Mezzani A, Bosimini E, Giannuzzi P. Prognostic value of time-related changes of cardiopulmonary exercise testing indices in stable chronic heart failure: a pragmatic and operative scheme. ACTA ACUST UNITED AC 2016; 13:186-92. [PMID: 16575271 DOI: 10.1097/01.hjr.0000189807.22224.54] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although peak oxygen consumption (VO2) is an objective measurement of functional capacity linked to survival, most clinicians use clinical history to monitor changes over time of functional disability. The aim was to verify the prognostic value of time-related changes (Delta) of symptom-limited cardiopulmonary exercise testing (CPX) indices in stable chronic heart failure (CHF). DESIGN AND METHODS We studied 231 stable CHF patients (200 men) with left ventricular ejection fraction (LVEF) of 24 +/- 8% and peak VO2 of 14.3 +/- 8 ml/kg per min, who performed two symptom-limited CPX over time. RESULTS The two incremental CPX were separated by a mean interval of 258 +/- 42 days; 59 (26%) suffered cardiovascular death or underwent urgent heart transplantation during the follow-up (1167 +/- 562 days). Peak VO2, LVEF (measured at second evaluation), Deltapeak VO2 and DeltaNYHA (New York Heart Association classification) were selected as independent predictors in the total population, and LVEF, Deltapeak VO2, and NYHA in patients with peak VO2 of 14 ml/kg per min or less (106 patients); no Delta parameter was selected in patients with preserved exercise tolerance. Survival analysis was performed taking into consideration the inter-test variability of peak VO2 (6%): true fall: more than 6% decrease, decline within the measurement variability; less than 6% decrease, improvement within the measurement variability; less than 6% increase and true rise; more than 6% increase: total mortality rate was 51, 23, 19 and 14% (P < 0.0001), respectively. CONCLUSIONS Deltapeak VO2 is a useful outcome index; a combination of static (single) and time-related functional variables can enhance the prognostication process in stable CHF patients.
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Affiliation(s)
- Ugo Corrà
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy.
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36
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Die Nachsorge von Patienten nach MitraClip®-Implantation. Herz 2016; 42:176-185. [DOI: 10.1007/s00059-016-4448-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/14/2016] [Accepted: 02/14/2016] [Indexed: 01/23/2023]
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Sustained improvements in fitness and exercise tolerance in obese adolescents after a 12 week exercise intervention. Obes Res Clin Pract 2016; 10:178-88. [DOI: 10.1016/j.orcp.2015.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 12/26/2022]
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Mastenbroek MH, Van't Sant J, Versteeg H, Cramer MJ, Doevendans PA, Pedersen SS, Meine M. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy. J Card Fail 2015; 22:385-94. [PMID: 26363091 DOI: 10.1016/j.cardfail.2015.08.342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS Eighty-four patients with a 1st-time CRT-defibrillator (mean age 65 ± 11; 73% male) underwent echocardiography and cardiopulmonary exercise testing (CPX) before implantation (baseline) and 6 months after implantation. At baseline, patients also completed a set of questionnaires measuring mental and physical health. The association between echocardiographic response (left ventricular end-systolic volume decrease ≥15%) and a comprehensive set of CPX results was examined. Echocardiographic responders (54%) demonstrated higher peak oxygen consumption and better exercise performance than nonresponders at baseline and at 6-month follow-up. Furthermore, only echocardiographic responders showed improvements in ventilatory efficiency during follow-up. Multivariable repeated measures analyses revealed that, besides reverse remodeling, New York Heart Association functional class II and good patient-reported health status before implantation were the most important correlates of higher average oxygen consumption during exercise, and that nonischemic etiology and smaller pre-implantation QRS width were associated with better ventilatory efficiency over time. CONCLUSIONS During the first 6 months of CRT there was a significant positive association between reverse remodeling and cardiopulmonary exercise capacity.
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Affiliation(s)
- Mirjam H Mastenbroek
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
| | - Jetske Van't Sant
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Susanne S Pedersen
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mathias Meine
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
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Vascular hippocampal plasticity after aerobic exercise in older adults. Mol Psychiatry 2015; 20:585-93. [PMID: 25311366 DOI: 10.1038/mp.2014.114] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 08/07/2014] [Accepted: 08/21/2014] [Indexed: 01/17/2023]
Abstract
Aerobic exercise in young adults can induce vascular plasticity in the hippocampus, a critical region for recall and recognition memory. In a mechanistic proof-of-concept intervention over 3 months, we investigated whether healthy older adults (60-77 years) also show such plasticity. Regional cerebral blood flow (rCBF) and volume (rCBV) were measured with gadolinium-based perfusion imaging (3 Tesla magnetic resonance image (MRI)). Hippocampal volumes were assessed by high-resolution 7 Tesla MRI. Fitness improvement correlated with changes in hippocampal perfusion and hippocampal head volume. Perfusion tended to increase in younger, but to decrease in older individuals. The changes in fitness, hippocampal perfusion and volume were positively related to changes in recognition memory and early recall for complex spatial objects. Path analyses indicated that fitness-related changes in complex object recognition were modulated by hippocampal perfusion. These findings indicate a preserved capacity of the aging human hippocampus for functionally relevant vascular plasticity, which decreases with progressing age.
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Corrà U, Agostoni P, Piepoli MF. Metabolic exercise data combined with cardiac and kidney indexes: MECKI score. Predictive role in cardiopulmonary exercise testing with low respiratory exchange ratio in heart failure. Int J Cardiol 2015; 184:299-301. [PMID: 25731843 DOI: 10.1016/j.ijcard.2015.02.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ugo Corrà
- Cardiology Division, IRCCS Fondazione 'S. Maugeri', Centro Medico e di Riabilitazione di Veruno, Via per Revislate 13, 28010 Veruno, Novara, Italy.
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Italy
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Shafer KM, Mann N, Hehn R, Ubeda Tikkanen A, Valente AM, Geva T, Gauthier N, Rhodes J. Relationship between Exercise Parameters and Noninvasive Indices of Right Ventricular Function in Patients with Biventricular Circulation and Systemic Right Ventricle. CONGENIT HEART DIS 2015; 10:457-65. [PMID: 25597937 DOI: 10.1111/chd.12248] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In patients with systemic right ventricles (RVs) in a biventricular circulation, exercise capacity and RV function often deteriorate over time and echocardiographic assessment of systemic RV function is difficult. The purpose of this study was to examine the relationship between exercise capacity and RV function and to determine which noninvasive imaging parameters correlate most closely with exercise capacity. DESIGN Patients with a systemic RV (D-loop transposition of the great arteries [TGA] after atrial switch procedure or physiologically "corrected" TGA) who underwent cardiopulmonary exercise testing (CPX) and noninvasive imaging (cardiac magnetic resonance [CMR] and echocardiography [echo]) within 1 year of CPX were identified. Regression analysis was used to evaluate the relationship between exercise variables and noninvasive indices of ventricular function. RESULTS We identified 92 patients with 149 encounters (mean age 31.0 years, 61% men, 70% D-loop TGA) meeting inclusion criteria. Statistically significant correlations between % predicted peak oxygen uptake (%pVO2 ) and RV ejection fraction (EF) (r = 0.29, P = .0007), indexed RV end-systolic volume (r = -0.25, P = .002), and Tei index (r = -0.22, P = .03) were found. In patients without additional hemodynamically significant lesions, the correlations between %pVO2 and RV EF (r = 0.37, P = .0007) and the Tei index (r = -0.28, P = .03) strengthened and a correlation emerged between %pVO2 and dP/dtic (r = 0.31, P = .007). On multivariable analysis, Tei index was the only statistically significant correlate of %pVO2 (P = .04). CONCLUSIONS In patients with systemic RVs in a biventricular circulation, CMR-derived RVEF and echo-derived Tei index correlate with %pVO2 . On multivariable analysis, the Tei index was the strongest predictor of peak %pVO2 response.
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Affiliation(s)
- Keri M Shafer
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
| | - Nina Mann
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
| | - Rebecca Hehn
- Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
| | - Ana Ubeda Tikkanen
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
| | - Naomi Gauthier
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jonathan Rhodes
- Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
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Left atrial volume index is an independent predictor of hypertensive response to exercise in patients with hypertension. Hypertens Res 2014; 38:137-42. [DOI: 10.1038/hr.2014.146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 12/16/2022]
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43
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Ohuchi H, Negishi J, Noritake K, Hayama Y, Sakaguchi H, Miyazaki A, Kagisaki K, Yamada O. Prognostic Value of Exercise Variables in 335 Patients after the Fontan Operation: A 23-year Single-center Experience of Cardiopulmonary Exercise Testing. CONGENIT HEART DIS 2014; 10:105-16. [DOI: 10.1111/chd.12222] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Jun Negishi
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Kanae Noritake
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Yosuke Hayama
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Heima Sakaguchi
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Aya Miyazaki
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Koji Kagisaki
- Department of Thoracic Surgery; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Osamu Yamada
- Department of Pediatric Cardiology; National Cerebral and Cardiovascular Center; Osaka Japan
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Corrà U, Piepoli MF, Adamopoulos S, Agostoni P, Coats AJ, Conraads V, Lambrinou E, Pieske B, Piotrowicz E, Schmid JP, Seferović PM, Anker SD, Filippatos G, Ponikowski PP. Cardiopulmonary exercise testing in systolic heart failure in 2014: the evolving prognostic role. Eur J Heart Fail 2014; 16:929-41. [DOI: 10.1002/ejhf.156] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 06/23/2014] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ugo Corrà
- Cardiology Division, IRCCS Fondazione ‘S. Maugeri’; Centro Medico e di Riabilitazione di Veruno; Veruno Novara Italy
| | - Massimo F. Piepoli
- Heart Failure Unit, Cardiac Department; G Da Saliceto Hospital; Piacenza Italy
| | | | | | - Andrew J.S. Coats
- Monash University, Melbourne, Australia and University of Warwick; Coventry UK
| | - Viviane Conraads
- Department of Cardiology; Antwerp University Hospital; Edegem Antwerpen Belgium
| | | | - Burkert Pieske
- Department of Cardiology Medical University Graz; Austria
| | - Ewa Piotrowicz
- Telecardiology Center; Institute of Cardiology; Warsaw Poland
| | - Jean-Paul Schmid
- Department of Cardiology, Cardiovascular Prevention, Rehabilitation & Sports Medicine; Bern University Hospital and University of Bern; Switzerland
| | - Petar M. Seferović
- Polyclinic of the Clinical Centre of Serbia, and Department of Internal Medicine Belgrade University School of Medicine; Belgrade Serbia
| | - Stefan D. Anker
- Applied Cachexia Research; Department of Cardiology, Charitè, Campus Virchow Klinikum; Berlin Germany
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology; University Hospital Attikon; Athens Greece
| | - Piotr P. Ponikowski
- Department of Heart Diseases, Faculty of Health Sciences; Wroclaw Medical University Military Hospital; Wroclaw Poland
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Murninkas D, Alba AC, Delgado D, McDonald M, Billia F, Chan WS, Ross HJ. Right Ventricular Function and Prognosis in Stable Heart Failure Patients. J Card Fail 2014; 20:343-9. [DOI: 10.1016/j.cardfail.2014.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 01/08/2023]
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Ingle L, Witte KK, Cleland JG, Clark AL. Combining the ventilatory response to exercise and peak oxygen consumption is no better than peak oxygen consumption alone in predicting mortality in chronic heart failure. Eur J Heart Fail 2014; 10:85-8. [DOI: 10.1016/j.ejheart.2007.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 09/21/2007] [Accepted: 10/18/2007] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lee Ingle
- Carnegie Research Institute, Leeds Metropolitan University; Leeds UK
| | - Klaus K. Witte
- Department of Cardiology; Leeds General Infirmary; Leeds UK
| | | | - Andrew L. Clark
- Academic Department of Cardiology, University of Hull; Hull UK
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47
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Nakanishi M, Takaki H, Kumasaka R, Arakawa T, Noguchi T, Sugimachi M, Goto Y. Targeting of High Peak Respiratory Exchange Ratio Is Safe and Enhances the Prognostic Power of Peak Oxygen Uptake for Heart Failure Patients. Circ J 2014; 78:2268-75. [DOI: 10.1253/circj.cj-14-0047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michio Nakanishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Takaki
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute
| | - Reon Kumasaka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tetsuo Arakawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute
| | - Yoichi Goto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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48
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Prognostic significance of peak oxygen consumption≤10ml/kg/min in heart failure: Context vs. criteria. Int J Cardiol 2013; 168:3419-23. [DOI: 10.1016/j.ijcard.2013.04.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 04/15/2013] [Accepted: 04/19/2013] [Indexed: 11/18/2022]
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49
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Chase PJ, Kenjale A, Cahalin LP, Arena R, Davis PG, Myers J, Guazzi M, Forman DE, Ashley E, Peberdy MA, West E, Kelly CT, Bensimhon DR. Effects of respiratory exchange ratio on the prognostic value of peak oxygen consumption and ventilatory efficiency in patients with systolic heart failure. JACC-HEART FAILURE 2013; 1:427-32. [PMID: 24621975 DOI: 10.1016/j.jchf.2013.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 05/02/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (Vo2) and the minute ventilation/carbon dioxide (VE/Vco2) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with heart failure (HF). BACKGROUND For patients with HF, peak Vo2 and the VE/Vco2 slope are used for assessing prognosis. Peak Vo2 is assessed in association with peak RER ≥1.10, indicating maximal effort and prognostic sensitivity. Conversely, the VE/Vco2 slope provides effort-independent prognostic discrimination. METHODS Patients with HF scheduled to undergo cardiopulmonary exercise testing were enrolled. Patients were subclassified by peak RER (RER <1.00, RER 1.00 to 1.04, RER 1.05 to 1.09, RER ≥1.10) and followed for up to 3 years for major cardiac-related events (death, left ventricular assist device implantation, or cardiac transplantation). RESULTS Included were 1,728 patients with HF (75% males; 40% ischemic etiology; age: 55 ± 14 years; left ventricular ejection fraction: 28 ± 10%). Two hundred seventy major events occurred, with no proportional differences across the RER subgroups. Multivariate Cox regression analysis indicated that the VE/Vco2 slope and peak Vo2 remained prognostic within each subgroup; the VE/Vco2 slope remained the strongest predictor. Receiver-operating characteristic analysis demonstrated equitable prognostic cutoffs for the VE/Vco2 slope (range: 34.9 to 35.7; area under the curve [AUC] range: 0.69 to 0.75) and peak Vo2 (range: 13.8 to 14.0 ml·kg(-1)·min(-1); AUC range: 0.68 to 0.75). CONCLUSIONS Peak Vo2 provided a sensitive assessment of prognosis in patients with HF in all RER subgroups. The VE/Vco2 slope provided greater prognostic discrimination in all RER subgroups. Clinical consideration may be warranted for patients with low RER, low peak Vo2, and an elevated VE/Vco2 slope.
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Affiliation(s)
- Paul J Chase
- LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina; Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina.
| | - Aarti Kenjale
- LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina; Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Lawrence P Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois
| | - Paul G Davis
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, California
| | - Marco Guazzi
- Cardiology, IRCCS Policlinico San Donato, University of Milano, San Donato Milanese, Milan, Italy
| | - Daniel E Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Euan Ashley
- Cardiovascular Medicine, Stanford University, Palo Alto, California
| | - Mary Ann Peberdy
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Erin West
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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50
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Corrà U, Mezzani A, Giordano A, Pistono M, Gnemmi M, Caruso R, Giannuzzi P. Peak oxygen consumption and prognosis in heart failure. Int J Cardiol 2013; 167:157-61. [DOI: 10.1016/j.ijcard.2011.12.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 11/18/2011] [Accepted: 12/17/2011] [Indexed: 10/14/2022]
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