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Hypoxic Exercise Exacerbates Hypoxemia and Acute Mountain Sickness in Obesity: A Case Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179078. [PMID: 34501667 PMCID: PMC8430682 DOI: 10.3390/ijerph18179078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 12/21/2022]
Abstract
Acute mountain sickness (AMS) is a common syndrome characterized by headache, dizziness, loss of appetite, weakness, and nausea. As a major public health issue, obesity has increased in high altitude urban residents and intermittent commuters to high altitudes. The present study investigated acute hypoxic exposure and hypoxic exercise on hypoxemia severity and AMS symptoms in a physically active obese man. In this case analysis, peripheral oxygen saturation (SpO2) was used to evaluate hypoxemia, heart rate (HR) and blood pressure (BP) were used to reflect the function of autonomic nervous system (ANS), and Lake Louise scoring (LLS) was used to assess AMS. The results showed that acute hypoxic exposure led to severe hypoxemia (SpO2 = 72%) and tachycardia (HRrest = 97 bpm), and acute hypoxic exercise exacerbated severe hypoxemia (SpO2 = 59%) and ANS dysfunction (HRpeak = 167 bpm, SBP/DBP = 210/97 mmHg). At the end of the 6-h acute hypoxic exposure, the case developed severe AMS (LLS = 10) symptoms of headache, gastrointestinal distress, cyanosis, vomiting, poor appetite, and fatigue. The findings of the case study suggest that high physical activity level appears did not show a reliable protective effect against severe hypoxemia, ANS dysfunction, and severe AMS symptoms in acute hypoxia exposure and hypoxia exercise.
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Prolonged Elevation of Tricuspid Regurgitation Pressure Gradient After Exercise in Patients With Exercise-induced Pulmonary Hypertension. Am J Cardiol 2021; 142:124-129. [PMID: 33279489 DOI: 10.1016/j.amjcard.2020.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/07/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022]
Abstract
It is necessary to measure the peak tricuspid regurgitation pressure gradient (TRPG) that is recorded at maximum exercise intensity when diagnosing exercise-induced pulmonary hypertension (ePH) on exercise stress echocardiography (ESE). However, it is difficult to measure maximum TRPG during the treadmill exercise. If ePH induced TRPG elevation continues during recovery period after exercise termination, this elevation will serve as a practical diagnostic standard. We aimed to assess whether the elevation of postexercise peak TRPG prolong soon after finishing exercise in patients with ePH. Seventy-four patients underwent symptom-limited ESE by using a semirecumbent bicycle ergometer. ePH was defined as peak TRPG > 50 mm Hg at maximum exercise. We measured peak TRPG during exercise and until 5 minutes afterward. Thirty-five patients were diagnosed with ePH; their median TRPG was 57 mm Hg [interquartile range: 52-62 mm Hg] at maximum exercise. Peak TRPG in patients with ePH was > 40 mm Hg until 2 minutes after exercise. The cut-off values of peak TRPG to detect ePH were 43 mm Hg just after exercise and 41 mm Hg at 1 minute afterward (areas under the curve: 0.98, 0.92, respectively; both p < 0.001). In conclusion, elevated peak TRPG persisted for at least 2 minutes after finishing exercise, and this time frame will therefore provide a new window for diagnosing ePH by ESE.
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Female False Positive Exercise Stress ECG Testing – Fact Versus Fiction. Heart Lung Circ 2019; 28:735-741. [DOI: 10.1016/j.hlc.2018.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/27/2018] [Accepted: 02/08/2018] [Indexed: 11/18/2022]
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Salden OAE, van Everdingen WM, Spee R, Doevendans PA, Cramer MJ. How I do it: feasibility of a new ultrasound probe fixator to facilitate high quality stress echocardiography. Cardiovasc Ultrasound 2018; 16:6. [PMID: 29580287 PMCID: PMC5870734 DOI: 10.1186/s12947-018-0124-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/05/2018] [Indexed: 12/23/2022] Open
Abstract
Background Stress echocardiography (SE) has recently regained momentum as an important diagnostic tool for the assessment of both ischemic and non-ischemic heart disease. Performing SE during physical exercise is challenging due to a suboptimal patient position and vigorous movements of the patient’s chest. This hampers a stable ultrasound position and reduces the diagnostic performance of SE. A stable ultrasound probe position would facilitate producing high quality images during continuous measurements. With Probefix (Usono, Eindhoven, The Netherlands), a newly developed tool to fixate the ultrasound probe to the patient’s chest, stabilization of the probe during physical exercise is possible. Implementation and results The technique of SE with the Probefix and its’ feasibility are evaluated in a small pilot study. Probefix fixates the ultrasound probe to the patient’s chest, using two chest straps and a fixation device. The ultrasound probe position and angle may be altered with a relative high degree of freedom. We tested the Probefix for continuous echocardiographic imaging in 12 study subjects during supine and upright ergometer stress tests. One patient was unable to perform exercise and in two study subjects good quality images were not achieved. In the other patients (82%) a stable probe position was obtained, with subsequent good quality echocardiographic images during SE. Conclusion We have demonstrated the feasibility of the Probefix support during ergometer tests in supine and upright positions and conclude that this external fixator may facilitate continuous monitoring of cardiac function in a group of patients. Electronic supplementary material The online version of this article (10.1186/s12947-018-0124-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- O A E Salden
- Department of Cardiology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - W M van Everdingen
- Department of Cardiology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - R Spee
- Department of Cardiology, Maxima Medisch Centrum, Veldhoven, The Netherlands
| | - P A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Netherlands Heart Institute, Central Military Hospital, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Gierula J, Paton MF, Lowry JE, Jamil HA, Byrom R, Drozd M, Garnham JO, Cubbon RM, Cairns DA, Kearney MT, Witte KK. Rate-Response Programming Tailored to the Force-Frequency Relationship Improves Exercise Tolerance in Chronic Heart Failure. JACC-HEART FAILURE 2018; 6:105-113. [DOI: 10.1016/j.jchf.2017.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/31/2017] [Accepted: 09/10/2017] [Indexed: 01/09/2023]
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Toward translating near-infrared spectroscopy oxygen saturation data for the non-invasive prediction of spatial and temporal hemodynamics during exercise. Biomech Model Mechanobiol 2016; 16:75-96. [PMID: 27376865 DOI: 10.1007/s10237-016-0803-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/21/2016] [Indexed: 01/08/2023]
Abstract
Image-based computational fluid dynamics (CFD) studies conducted at rest have shown that atherosclerotic plaque in the thoracic aorta (TA) correlates with adverse wall shear stress (WSS), but there is a paucity of such data under elevated flow conditions. We developed a pedaling exercise protocol to obtain phase contrast magnetic resonance imaging (PC-MRI) blood flow measurements in the TA and brachiocephalic arteries during three-tiered supine pedaling at 130, 150, and 170 % of resting heart rate (HR), and relate these measurements to non-invasive tissue oxygen saturation [Formula: see text] acquired by near-infrared spectroscopy (NIRS) while conducting the same protocol. Local quantification of WSS indices by CFD revealed low time-averaged WSS on the outer curvature of the ascending aorta and the inner curvature of the descending aorta (dAo) that progressively increased with exercise, but that remained low on the anterior surface of brachiocephalic arteries. High oscillatory WSS observed on the inner curvature of the aorta persisted during exercise as well. Results suggest locally continuous exposure to potentially deleterious indices of WSS despite benefits of exercise. Linear relationships between flow distributions and tissue oxygen extraction calculated from [Formula: see text] were found between the left common carotid versus cerebral tissue [Formula: see text] and the dAo versus leg tissue [Formula: see text]. A resulting six-step procedure is presented to use NIRS data as a surrogate for exercise PC-MRI when setting boundary conditions for future CFD studies of the TA under simulated exercise conditions. Relationships and ensemble-averaged PC-MRI inflow waveforms are provided in an online repository for this purpose.
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de Lima-Filho NN, Figueiredo MS, Vicari P, Cançado R, Carvalho ACDC, Bordin JO, Campos O. Exercise-Induced Abnormal Increase of Systolic Pulmonary Artery Pressure in Adult Patients With Sickle Cell Anemia: An Exercise Stress Echocardiography Study. Echocardiography 2014; 33:1880-1890. [PMID: 25521187 DOI: 10.1111/echo.12853] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) at rest is a risk factor for death in patients with sickle cell anemia (SCA). Exercise echocardiography (EE) can detect latent PH. We sought to investigate the occurrence of exercise-induced abnormal response of systolic pulmonary artery pressure (SPAP) in adult patients with SCA and normal SPAP at rest, and to identify the independent predictors of this abnormal response. METHODS AND RESULTS Forty-four adult patients with SCA and normal SPAP at rest (tricuspid regurgitant jet flow velocity [TRV] <2.5 m/sec) were studied and divided into 2 groups: exhibiting normal SPAP after treadmill EE (TRV ≤ 2.7 m/sec) (G1), and exhibiting abnormal exercise-induced increase of SPAP (TRV > 2.7 m/sec) (G2). TRV cutoff points at rest and during EE were based on data from healthy-matched control subjects. Abnormal response of SPAP with exercise occurred in 57% of the sample (G2), with mean TRV level of 3.39 ± 0.41 m/sec (range 2.8-4.5 m/sec), significantly higher than those of G1 (2.29 ± 0.25 m/sec, range 2.0-2.7 m/sec; P < 0.001). Multivariate analysis identified TRV value in resting conditions ≥2.25 m/sec (P < 0.05), left atrial volume index ≥41 mL/m2 (P < 0.05), and a E/e'-waves ratio ≥6.3 (P < 0.05) as independent predictors of exercise-induced increase of SPAP. CONCLUSION We concluded that adult patients with SCA and normal SPAP at rest may exhibit abnormal exercise-induced increase in SPAP, which was independently related to resting TRV levels, and indices of diastolic impairment and left ventricular filling pressure.
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Affiliation(s)
- Newton Nunes de Lima-Filho
- Cardiology Division, Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Maria Stella Figueiredo
- Hematology Division of Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Perla Vicari
- Hematology Division of Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Rodolfo Cançado
- Hematology Division, Holy House of Mercy of Sao Paulo, Sao Paulo, Brazil
| | | | - José Orlando Bordin
- Hematology Division of Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Orlando Campos
- Cardiology Division, Paulista School of Medicine-Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Larose J, King J, Brosseau L, Wells GA, Reid R, Maetzel A, Tugwell P, Huijbregts M, McCullough C, Loew L, Kenny GP. The effect of walking on cardiorespiratory fitness in adults with knee osteoarthritis. Appl Physiol Nutr Metab 2013; 38:886-91. [DOI: 10.1139/apnm-2012-0487] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Walking programs alone or in combination with behavioral interventions have proven effective at improving quality of life among older adults with osteoarthritis (OA). It is unclear, however, whether the combination of both of these treatments is more effective at improving cardiorespiratory fitness in older adults with knee OA than a walking program alone or than unsupervised self-directed walking. In this study, we assessed cardiorespiratory fitness with 3 programs: a structured supervised community-based aerobic walking program with a behavioral intervention (WB; n = 41); a supervised program of walking only (W; n = 42); and an unsupervised self-directed walking program (n = 32). We measured maximal oxygen uptake (V̇O2peak), exercise test duration, and workload, heart rate, and ventilation at maximum aerobic capacity in older adults with knee OA after 6 months of WB, W, or self-directed walking. Overall, V̇O2peak improved by 4% in female walkers (+0.9 ± 2.5 mL O2·kg−1·min−1; p < 0.001) and 5% in male walkers (+1.3 ± 2.7 mL O2·kg−1·min−1; p < 0.001), and the change in fitness was similar with all 3 walking interventions. In conclusion, low- to moderate-intensity walking may improve and (or) prevent decrements in cardiorespiratory fitness in older adults with OA. This response was comparable in supervised walkers with and without a behavioral intervention and in unsupervised self-directed walkers.
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Affiliation(s)
- Joanie Larose
- School of Human Kinetics, Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, 125 University, Montpetit Hall, Ottawa, ON K1N 6N5, Canada
| | - Judy King
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ont., Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ont., Canada
| | - George A. Wells
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont., Canada
| | - Robert Reid
- University of Ottawa Heart Institute, Ottawa, Ont., Canada
| | | | - Peter Tugwell
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ont., Canada
| | | | | | - Laurianne Loew
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ont., Canada
| | - Glen P. Kenny
- School of Human Kinetics, Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, 125 University, Montpetit Hall, Ottawa, ON K1N 6N5, Canada
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Peteiro J, Bouzas-Mosquera A, Estevez R, Pazos P, Piñeiro M, Castro-Beiras A. Head-to-Head Comparison of Peak Supine Bicycle Exercise Echocardiography and Treadmill Exercise Echocardiography at Peak and at Post-Exercise for the Detection of Coronary Artery Disease. J Am Soc Echocardiogr 2012; 25:319-26. [DOI: 10.1016/j.echo.2011.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Indexed: 11/16/2022]
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Weber TF, von Tengg-Kobligk H, Kopp-Schneider A, Ley-Zaporozhan J, Kauczor HU, Ley S. High-resolution phase-contrast MRI of aortic and pulmonary blood flow during rest and physical exercise using a MRI compatible bicycle ergometer. Eur J Radiol 2011; 80:103-8. [DOI: 10.1016/j.ejrad.2010.06.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/22/2010] [Accepted: 06/25/2010] [Indexed: 10/19/2022]
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Foster EL, Arnold JW, Jekic M, Bender JA, Balasubramanian V, Thavendiranathan P, Dickerson JA, Raman SV, Simonetti OP. MR-compatible treadmill for exercise stress cardiac magnetic resonance imaging. Magn Reson Med 2011; 67:880-9. [PMID: 22190228 DOI: 10.1002/mrm.23059] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 04/23/2011] [Accepted: 05/25/2011] [Indexed: 11/11/2022]
Abstract
This article describes an MR-safe treadmill that enables cardiovascular exercise stress testing adjacent to the MRI system, facilitating cardiac MR imaging immediately following exercise stress. The treadmill was constructed of nonferromagnetic components utilizing a hydraulic power system. Computer control ensured precise execution of the standard Bruce treadmill protocol commonly used for cardiovascular exercise stress testing. The treadmill demonstrated no evidence of ferromagnetic attraction and did not affect image quality. Treadmill performance met design specifications both inside and outside the MRI environment. Ten healthy volunteers performed the Bruce protocol with the treadmill positioned adjacent to the MRI table. Upon reaching peak stress (98 ± 8% of age-predicted maximum heart rate), the subjects lay down directly on the MRI table, a cardiac array coil was placed, an intravenous line connected, and stress cine and perfusion imaging performed. Cine imaging commenced on average within 24 ± 4 s and was completed within 40 ± 7 s of the end of exercise. Subject heart rates were 86 ± 9% of age-predicted maximum heart rate at the start of imaging and 81 ± 9% of age-predicted maximum heart rate upon completion of cine imaging. The MRI-compatible treadmill was shown to operate safely and effectively in the MRI environment.
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Affiliation(s)
- Eric L Foster
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
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12
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Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 2007; 20:1021-41. [PMID: 17765820 DOI: 10.1016/j.echo.2007.07.003] [Citation(s) in RCA: 510] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Patricia A Pellikka
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
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Nakashiki K, Kisanuki A, Otsuji Y, Yoshifuku S, Yuasa T, Takasaki K, Kuwahara E, Yu B, Uemura T, Mizukami N, Hamasaki S, Minagoe S, Tei C. Usefulness of a novel ultrasound transducer for continuous monitoring treadmill exercise echocardiography to assess coronary artery disease. Circ J 2006; 70:1297-302. [PMID: 16998262 DOI: 10.1253/circj.70.1297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The feasibility of a novel ultrasound probe, which can be attached to the left ventricular (LV) apex chest wall and allows free rotation around its long axis direction for the continuous monitoring of LV wall motion, was tested. METHODS AND RESULTS There were 36 subjects who had coronary artery disease (CAD). By attaching a novel ultrasound probe to the chest wall, the LV apical views were recorded during treadmill exercise stress echocardiography (Echo). The continuous monitoring of LV wall motion was satisfactorily feasible in 30 of 36 patients. The visualization rate of the overall LV segments was higher at rest (90%) compared to that during peak exercise (77%). The segments were better visualized in apical portions (90-100%) than in mid (77-96%) or basal portions (68-87%). The sensitivity, specificity, and accuracy for detecting CAD were 61, 100 and 77%, respectively. The wall motion score index 3 and 6 min after exercise decreased significantly compared to those at peak exercise. The number of segments with dyssynergy was highest at the peak exercise. Ischemic ST-T depression on electrocardiography was observed only at peak stress periods. CONCLUSIONS Continuous monitoring treadmill exercise Echo using a novel ultrasound probe seems feasible for the non-invasive and physiological assessment of CAD.
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Affiliation(s)
- Kenichi Nakashiki
- Department of Cardiovascular Medicine, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University Hospital, Kagoshima University, Sakuragaoka, Kagoshima, Japan.
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Shizukuda Y, Bolan CD, Tripodi DJ, Yau YY, Smith KP, Sachdev V, Birdsall CW, Sidenko S, Waclawiw MA, Leitman SF, Rosing DR. Left ventricular systolic function during stress echocardiography exercise in subjects with asymptomatic hereditary hemochromatosis. Am J Cardiol 2006; 98:694-8. [PMID: 16923464 DOI: 10.1016/j.amjcard.2006.03.055] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 03/13/2006] [Accepted: 03/13/2006] [Indexed: 11/21/2022]
Abstract
There is no information available on left ventricular (LV) systolic function and the response to stress echocardiography in asymptomatic subjects with hereditary hemochromatosis (HH). To evaluate this topic, 43 asymptomatic subjects with HH homozygous for the C282Y HFE gene mutation (22 untreated subjects [group A] and 21 long-term treated subjects [group B]) were compared with 21 age- and gender-matched normal volunteers negative for HFE mutations. Contractile reserve, as a measure of LV systolic function, was assessed using continuous echocardiographic imaging and electrocardiography during supine bicycle exercise. Nineteen subjects in group A had repeat tests after 6 months of induction phlebotomy therapy to assess the effect of iron removal. Exercise performance and hemodynamic variables of supine bicycle exercise were comparable between subjects with HH and controls. LV contractile reserve of asymptomatic subjects with HH was not impaired at either a 75-W submaximal exercise level (mean +/- SD difference in ejection fraction from baseline 13.8 +/- 6.2%, 11.5 +/- 6.8%, and 13.4 +/- 7.8% in groups A, B, and C, respectively; p = NS for all by analysis of variance) or at peak exercise (difference in ejection fraction from baseline 18.9 +/- 6.9%, 18.4 +/- 7.8%, and 20.3 +/- 8.1% in groups A, B, and C, respectively; p = NS for all by analysis of variance). However, the incidence of abnormal ischemic stress electrocardiographic responses was more frequent in subjects with HH as a whole (33%) compared with normal subjects (10%). Stress imaging revealed no regional wall motion abnormalities, suggesting that these were false-positive results. Iron removal by induction phlebotomy did not affect stress echocardiographic performance. In conclusion, LV systolic function during exercise in asymptomatic subjects with HH is preserved, and 6-month induction phlebotomy does not affect stress echocardiographic performance.
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Affiliation(s)
- Yukitaka Shizukuda
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Houck RC, Cooke J, Gill EA. Three-dimensional echo: transition from theory to real-time, a technology now ready for prime time. Curr Probl Diagn Radiol 2005; 34:85-105. [PMID: 15886612 DOI: 10.1016/j.cpradiol.2005.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Robin C Houck
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA 98104-2599, USA
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16
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Chesler RM, Stein RA. The clinical use of supine left lateral leg cycle ergometry for exercise electrocardiographic testing in women, as used in exercise echocardiography. J Am Soc Echocardiogr 2004; 17:361-6. [PMID: 15044871 DOI: 10.1016/j.echo.2003.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Two-dimensional exercise echocardiography is commonly performed in the supine (SUP) left lateral posture (SLL) to optimize imaging quality. OBJECTIVES To assess the clinical use of SLL cycle ergometry, we determined the metabolic, cardiovascular, and hemodynamic responses during graded leg cycle ergometry in women, performed in SLL, commonly used during exercise echocardiography, and compared our findings with those obtained during upright (UP) and SUP leg cycle ergometry. METHODS A total of 21 apparently healthy women performed leg cycle ergometry in 3 distinct postures (UP, SUP, and SLL). RESULTS Peak oxygen consumption and peak achieved workload during SLL cycle ergometry were significantly lower compared with UP cycle ergometry, indicating that in SLL physical work capacity would be underestimated compared with that obtained for the UP and SUP postures. The peak heart rate was significantly lower in SLL and the peak systolic blood pressure higher, compared with UP. Maximal rate pressure product was not significantly different among the postures, indicating the equivalent value of SLL with regard to augmenting myocardial oxygen demand during exercise. Stroke volume (calculated from aortic Doppler flow integral) was higher at rest, and increased to a smaller extent during exercise, in the SUP posture and SLL compared with UP. Similar peak values were attained for the 3 postures. CONCLUSIONS SLL is not a suitable modality for the assessment of functional status or for the derivation of target heart rates for exercise training in UP posture. However, SLL leg cycle ergometry exercise provokes a comparable stimulus for the detection of coronary artery disease, as it will increase myocardial oxygen demand to the same extent as UP leg cycle exercise.
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Affiliation(s)
- Roseann M Chesler
- State University of New York Downstate Medical Center, Brooklyn 11203, USA.
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17
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Sugeng L, Kirkpatrick J, Lang RM, Bednarz JE, Decara JM, Lammertin G, Spencer KT. Biplane stress echocardiography using a prototype matrix-array transducer. J Am Soc Echocardiogr 2003; 16:937-41. [PMID: 12931105 DOI: 10.1016/s0894-7317(03)00469-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Rapid image acquisition after cessation of exercise is essential for accurate stress echocardiography. Recently, a prototype matrix-array transducer has been developed that allows simultaneous acquisition of 2 imaging planes (biplane [BP] imaging). METHODS In all, 19 healthy volunteers underwent 2 separate stress echocardiographic studies. Images were acquired in traditional 2-dimensional or BP format pre-exercise and postexercise. RESULTS Total image acquisition time for 2-dimensional stress echocardiography was 38 +/- 8 seconds versus 29 +/- 8 seconds for BP imaging (P <.05). Heart rates were acquired closer to age-predicted maximum with BP imaging in the apical 3- and 2-chamber and parasternal long- and short-axis views (82%, 75%, 70%, 70% for BP vs 76%, 72%, 68%, 66% for 2-dimensional, respectively). CONCLUSION BP imaging using a recently developed matrix-array probe allows more rapid imaging postexercise, resulting in acquisition of poststress images at higher heart rates without compromising image quality.
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Affiliation(s)
- Lissa Sugeng
- Department of Medicine, University of Chicago, USA.
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18
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Modesto KM, Rainbird A, Klarich KW, Mahoney DW, Chandrasekaran K, Pellikka PA. Comparison of supine bicycle exercise and treadmill exercise Doppler echocardiography in evaluation of patients with coronary artery disease. Am J Cardiol 2003; 91:1245-8. [PMID: 12745112 DOI: 10.1016/s0002-9149(03)00275-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Karen M Modesto
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA
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Kim KT, Choi SW, Takahashi K, Kurokawa T, Yamasaki M. Change in double product during stepwise incremental exercise. JOURNAL OF PHYSIOLOGICAL ANTHROPOLOGY AND APPLIED HUMAN SCIENCE 2003; 22:143-7. [PMID: 12808227 DOI: 10.2114/jpa.22.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The purpose of this study was to observe the change in double product with increases in the intensity of bicycle exercise. Eleven young male adults participated in this study. The subjects performed graded bicycling exercise increasing 20 watts every 2 min from 0 watts until the heart rate (HR) reached 170 beats.min(-1). During exercise systolic blood pressure (SBP) and HR were continuously measured. Initially SBP gradually increased with the increase in workload, but when the intensity of exercise became even higher, the rate of increase slowed. On the other hand, the increase in HR was very small during the initial 5 min of exercise and when the intensity of exercise increased, the rate of increase of HR became higher. The polygonal regression analyses on the relation of double product to elapsed time revealed clear break-points. On average, the break-point of double product was 6.6 min (56 watts). These results clearly showed that the break-point of double product with an increase in workload appeared even though the workload was relatively low.
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Affiliation(s)
- Kyu Tae Kim
- Graduate School of Biosphere Science, Hiroshima University, Higashi-Hiroshima, Japan.
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Strizik B, Chiu S, Ilercil A, Alaeddini J, Oomen R, DiBitetto T, Strom J, Shirani J. Usefulness of isometric handgrip during treadmill exercise stress echocardiography. Am J Cardiol 2002; 90:420-2. [PMID: 12161235 DOI: 10.1016/s0002-9149(02)02502-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brian Strizik
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York 10461-2373, USA
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Rozanski A, Qureshi EA, Bornstein A. Postexercise left ventricular function: a comparative assessment by different noninvasive imaging modalities. Prog Cardiovasc Dis 2001; 43:335-50. [PMID: 11235848 DOI: 10.1053/pcad.2001.20503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The variety of noninvasive imaging modalities now available permits assessment of different aspects of left ventricular function in the postexercise state. Some of these modalities, such as first-pass radionuclide ventriculography, permit a nearly instantaneous assessment of left ventricular function in the early postexercise state. These modalities indicate that most exercise-induced left ventricular wall motion abnormalities resolve quickly after exercise. Resting wall motion abnormalities may also improve in the postexercise period; this response indicates the presence of hibernating myocardium capable of improving in response to myocardial revascularization procedures. On the other hand, all imaging techniques indicate that a certain percentage of exercise-induced wall motion abnormalities may persist into the postexercise period, and this finding signifies that severe coronary disease subtends the region of persisting wall motion abnormality. Further, if there is increased left ventricular size after exercise, both extensive and severe coronary disease are present. A conceptual framework for unifying these disparate findings is provided. These results underscore the importance of postexercise imaging in enhancing clinical assessment and imply that there are important technical considerations to contemplate when performing certain tests such as postexercise echocardiography.
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Affiliation(s)
- A Rozanski
- Department of Medicine, St Luke's-Roosevelt Hospital Center, New York, NY 10025, USA
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