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Ganesananthan S, Rajkumar CA, Foley M, Thompson D, Nowbar AN, Seligman H, Petraco R, Sen S, Nijjer S, Thom SA, Wensel R, Davies J, Francis D, Shun-Shin M, Howard J, Al-Lamee R. Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: a substudy of the ORBITA trial. Eur Heart J 2022; 43:3132-3145. [PMID: 35639660 PMCID: PMC9433310 DOI: 10.1093/eurheartj/ehac260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/10/2022] [Accepted: 05/06/2022] [Indexed: 01/10/2023] Open
Abstract
AIMS Oxygen-pulse morphology and gas exchange analysis measured during cardiopulmonary exercise testing (CPET) has been associated with myocardial ischaemia. The aim of this analysis was to examine the relationship between CPET parameters, myocardial ischaemia and anginal symptoms in patients with chronic coronary syndrome and to determine the ability of these parameters to predict the placebo-controlled response to percutaneous coronary intervention (PCI). METHODS AND RESULTS Patients with severe single-vessel coronary artery disease (CAD) were randomized 1:1 to PCI or placebo in the ORBITA trial. Subjects underwent pre-randomization treadmill CPET, dobutamine stress echocardiography (DSE) and symptom assessment. These assessments were repeated at the end of a 6-week blinded follow-up period.A total of 195 patients with CPET data were randomized (102 PCI, 93 placebo). Patients in whom an oxygen-pulse plateau was observed during CPET had higher (more ischaemic) DSE score [+0.82 segments; 95% confidence interval (CI): 0.40 to 1.25, P = 0.0068] and lower fractional flow reserve (-0.07; 95% CI: -0.12 to -0.02, P = 0.011) compared with those without. At lower (more abnormal) oxygen-pulse slopes, there was a larger improvement of the placebo-controlled effect of PCI on DSE score [oxygen-pulse plateau presence (Pinteraction = 0.026) and oxygen-pulse gradient (Pinteraction = 0.023)] and Seattle angina physical-limitation score [oxygen-pulse plateau presence (Pinteraction = 0.037)]. Impaired peak VO2, VE/VCO2 slope, peak oxygen-pulse, and oxygen uptake efficacy slope was significantly associated with higher symptom burden but did not relate to severity of ischaemia or predict response to PCI. CONCLUSION Although selected CPET parameters relate to severity of angina symptoms and quality of life, only an oxygen-pulse plateau detects the severity of myocardial ischaemia and predicts the placebo-controlled efficacy of PCI in patients with single-vessel CAD.
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Affiliation(s)
- Sashiananthan Ganesananthan
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Christopher A Rajkumar
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Michael Foley
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Alexandra N Nowbar
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Simon A Thom
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
| | - Roland Wensel
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- DRK-Kliniken-Berlin and Charité Berlin, Germany
| | | | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Matthew Shun-Shin
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - James Howard
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Pinkstaff S, Peberdy MA, Fabiato A, Finucane S, Arena R. The Clinical Utility of Cardiopulmonary Exercise Testing in Suspected or Confirmed Myocardial Ischemia. Am J Lifestyle Med 2010. [DOI: 10.1177/1559827610362955] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Heart disease is a major cause of morbidity and mortality in the United States, with coronary artery disease (CAD) representing more than half of all cardiovascular events. Stable patients presenting with symptoms suggestive of CAD are likely to undergo an exercise electrocardiogram (ECG) and/ or imaging study as a first-line diagnostic assessment. A cardiopulmonary exercise test (CPX) is an ECG stress test plus ventilatory gas analysis. Recently, CPX has been used to detect exercise-induced myocardial ischemia (EIMI) suggestive of underlying CAD. Two CPX variables, oxygen pulse (VO2/HR) and the slope of oxygen consumption versus work rate (Δ VO2/ Δ WR), have been identified to be especially indicative of EIMI. Currently, there are a number of diagnostic tests available for the identification of CAD, with the most widely used being stress ECG, stress myocardial perfusion imaging (MPI) and echocardiography, and cardiac catheterization. Exercise ECG, although inexpensive, has a number of well-recognized limitations, including low sensitivity resulting in false-negative results. Stress (exercise or pharmaceutically induced) MPI and catheterization are more accurate but also more invasive and expensive. It appears that CPX may improve the diagnostic accuracy of exercise ECG. This review will address the potential utility of CPX in patients with suspected or confirmed myocardial ischemia.
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Affiliation(s)
- Sherry Pinkstaff
- Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia, , Department of Physiology and Biophysics, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
| | - Mary Ann Peberdy
- Department of Internal Medicine Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
| | - Alexander Fabiato
- Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia, Department of Physiology and Biophysics, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
| | - Sheryl Finucane
- Department of Internal Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
| | - Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia, Department of Physiology and Biophysics, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
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Ajisaka R, Watanabe S, Eda K, Sakamoto K, Saitou T, Yamaguchi I, Sugishita Y. Hemodynamic and thermal responses to a 30-minute constant-workload aerobic exercise in middle- or old-aged patients with cardiovascular diseases. JAPANESE CIRCULATION JOURNAL 2000; 64:370-6. [PMID: 10834453 DOI: 10.1253/jcj.64.370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the present investigation was to compare the hemodynamic and thermal responses to a 30-min aerobic exercise between middle- or old-aged patients with normal left ventricular function and those with left ventricular dysfunction. Constant-load sitting ergometer exercise of approximately 90% of the subject's oxygen uptake (VO2) at the anaerobic threshold for 30 min was conducted in 21 patients with left ventricular dysfunction (61+/-10 years, left ventricular ejection fraction (LVEF) 35+/-7%) and 24 patients with normal left ventricular function (59+/-9 years, LVEF 71+/-7%). Heart rate (HR), blood pressure, deep temperatures in the forehead and thigh, and forearm skin blood flow (SkBF) were measured every minute, and cardiac output (CO) and stroke volume (SV) were determined every 10 min with the dye-dilution technique during the exercise. Patients of both groups exhibited a progressive elevation in each temperature and an increase in SkBF during the exercise. Although the VO2 and CO remained stable, almost the same magnitude of decrease in SV as increase in HR was seen after the 10th min of exercise in both groups. The magnitude of the decrease in SV was greater in old-aged than middle-aged patients with left ventricular dysfunction. Thus, the downward drift in SV during a 30-min constant-load aerobic exercise might not be influenced by left ventricular function, but intensified by aging in patients with left ventricular dysfunction.
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Affiliation(s)
- R Ajisaka
- Institute of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.
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