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Lindblom H, Pernett F, Schagatay E, Holmström P. Effect of exercise intensity and apnea on splenic contraction and hemoglobin increase in well-trained cross-country skiers. Eur J Appl Physiol 2024; 124:2057-2067. [PMID: 38393417 PMCID: PMC11199288 DOI: 10.1007/s00421-024-05428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
The human spleen acts as a reservoir for red blood cells, which is mobilized into the systemic circulation during various conditions such as hypoxia and physical exertion. Cross-country (XC) skiers, renowned for their exceptional aerobic capacity, are regularly exposed to high-intensity exercise and local oxygen deficits. We investigated a putative dose-dependent relationship between splenic contraction and concomitant hemoglobin concentration ([Hb]) elevation across four exercise intensities in well-trained XC skiers. Fourteen male XC skiers voluntarily participated in a 2-day protocol, encompassing a serial apnea test and a V ˙ O2max test (day 1), followed by three submaximal exercise intensities on a roller skiing treadmill corresponding to 55, 70, and 85% of V ˙ O2max (day 2). Spleen volume was measured via ultrasonic imaging, and venous blood samples were used to determine [Hb] levels. Baseline spleen volume was similar (266(35) mL) for all conditions (NS). Notably, all conditions induced significant splenic contractions and transient [Hb] elevations. The V ˙ O2max test exhibited the most pronounced splenic contraction (35.8%, p < 0.001) and a [Hb] increase of 8.1%, while the 85% exercise intensity led to 27.1% contraction and the greatest [Hb] increase (8.3%, < 0.001) compared to baseline. The apnea test induced relatively smaller responses (splenic contraction: 20.4%, [Hb] = 3.3%, p < 0.001), akin to the response observed at the 70% exercise intensity (splenic contraction = 23%, [Hb] = 6.4%, p < 0,001) and 55% (splenic contraction = 20.0%, [Hb] = 4.8%, p < 0.001). This study shows a discernible dose-dependent relationship between splenic contraction and [Hb] increase with levels of exercise, effectively distinguishing between submaximal and maximal exercise intensity.
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Affiliation(s)
- Hampus Lindblom
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Frank Pernett
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Erika Schagatay
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Pontus Holmström
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
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2
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Cosentino N, Marenzi G, Muratori M, Magrì D, Cattadori G, Agostoni P. Fluid balance in heart failure. Eur J Prev Cardiol 2023; 30:ii9-ii15. [PMID: 37819223 DOI: 10.1093/eurjpc/zwad166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 10/13/2023]
Abstract
Fluid retention is a major determinant of symptoms in patients with heart failure (HF), and it is closely associated with prognosis. Hence, congestion represents a critical therapeutic target in this clinical setting. The first therapeutic strategy in HF patients with fluid overload is optimization of diuretic intervention to maximize water and sodium excretion. When diuretic therapy fails to relieve congestion, renal replacement therapy represents the only alternative option for fluid removal, as well as a way to restore diuretic responsiveness. On this background, the pathophysiology of fluid balance in HF is complex, with heart, kidney, and lung being deeply involved in volume regulation and management. Therefore, the interplay between these organs should be appreciated and considered when fluid overload in HF patients is targeted.
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Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
| | - Manuela Muratori
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Roma 00198, Italy
| | - Gaia Cattadori
- Unità Operativa Cardiologia Riabilitativa, IRCCS Multimedica, Milan 20123, Italy
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3
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Kittipibul V, Ganesh A, Coburn A, Coyne BJ, Gray JM, Molinger J, Ray N, Podgoreanu M, McCartney SL, Mamoun N, Fitzhugh RC, Lurz P, Green CL, Hernandez AF, Patel MR, Fudim M. Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance. J Am Heart Assoc 2023:e028780. [PMID: 37449573 PMCID: PMC10382122 DOI: 10.1161/jaha.122.028780] [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: 11/07/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Background Splanchnic nerve modulation (SNM) is an emerging procedure to reduce cardiac filling pressures in heart failure. Although the main contributor to reduction in cardiac preload is thought to be increased venous capacitance in the splanchnic circulation, supporting evidence is limited. We examined changes in venous capacitance surrogates pre- and post-SNM. Methods and Results This is a prespecified analysis of a prospective, open-label, single-arm interventional study evaluating the effects of percutaneous SNM with ropivacaine in chronic heart failure with elevated filling pressures at rest and with exercise. Patients underwent cardiopulmonary exercise testing with invasive hemodynamic assessment pre- and post-SNM. Blood pressure changes with modified Valsalva maneuver and hemoconcentration, pre- and post-SNM were compared using a repeated measures model. Inferior vena cava diameter and collapsibility (>50% decrease in size with inspiration), and presence of bendopnea pre- and post-SNM were also compared. Fifteen patients undergoing SNM (age 58 years, 47% women, 93% with left ventricular ejection fraction ≤35%) were included. After SNM, changes in systolic blood pressure during Valsalva (peak-to-trough) were greater (41 versus 48 mm Hg, P=0.025). Exercise-induced hemoconcentration was unchanged (0.63 versus 0.43 g/dL, P=0.115). Inferior vena cava diameter was reduced (1.59 versus 1.30 cm, P=0.034) with higher collapsibility (33% versus 73%, P=0.014). Bendopnea was less (47% versus 13%, P=0.025). Conclusions SNM resulted in increased venous capacitance, associated decreased cardiac preload, and decreased bendopnea. Minimally invasive measures of venous capacitance could serve as markers of successful SNM. Long-term effects of SNM on venous capacitance warrant further investigation for heart failure management. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03453151.
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Affiliation(s)
| | - Arun Ganesh
- Department of Anesthesiology Duke University Medical Center Durham NC
| | - Aubrie Coburn
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - Brian J Coyne
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - James Matthew Gray
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - Jeroen Molinger
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - Neil Ray
- Department of Anesthesiology Duke University Medical Center Durham NC
| | - Mihai Podgoreanu
- Department of Anesthesiology Duke University Medical Center Durham NC
| | | | - Negmeldeen Mamoun
- Department of Anesthesiology Duke University Medical Center Durham NC
| | | | - Philipp Lurz
- Heart Center Leipzig at University Leipzig Leipzig Germany
| | - Cynthia L Green
- Biostatistics and Bioinformatics Duke University Medical Center Durham NC
- Duke Clinical Research Institute Durham NC
| | - Adrian F Hernandez
- Division of Cardiology, Department of Medicine Duke University Durham NC
- Duke Clinical Research Institute Durham NC
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine Duke University Durham NC
- Duke Clinical Research Institute Durham NC
| | - Marat Fudim
- Division of Cardiology, Department of Medicine Duke University Durham NC
- Duke Clinical Research Institute Durham NC
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Lanfranchi F, D'Amico F, Raffa S, Pennone M, Donegani MI, Miceli A, Chiola S, Maggio S, Delucchi C, Cossu V, Morbelli S, Bauckneht M, Sambuceti G, Marini C. Spleen Perfusion as an Index of Gender Impact on Sympathetic Nervous System Response to Exercise. Front Physiol 2021; 12:780713. [PMID: 34975534 PMCID: PMC8715039 DOI: 10.3389/fphys.2021.780713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: Sympathetic nervous system (SNS) reaction to exercise is gender dependent. Nevertheless, clinically applicable methods to identify this difference are still missing. An organ largely sensitive to SNS is the spleen whose response to exercise can be easily evaluated, being included in the field of view of myocardial perfusion imaging (MPI). Here, we aimed to verify whether gender interferes with the spleen perfusion and its response to exercise. Methods: For this purpose, we evaluated 286 original scans of consecutive patients submitted to MPI in the course of 2019. Our standard procedure implies a single-day stress-rest sequence with a gap of ≥2 h between the administrations of 180 and 500 MBq of 99mTc-Sestamibi, respectively. Imaging is performed 30 min after radiotracer administration, with scan duration set at 25 and 35 s per view, respectively. Non-gated scans were reconstructed with the filtered back-projection method. A volume of interest was drawn on the spleen and heart to estimate the dose-normalized average counting rate that was expressed in normalized counts per seconds (NCPS). Results: In all subjects submitted to exercise MPI (n = 228), NCPS were higher during stress than at rest (3.52 ± 2.03 vs. 2.78 ± 2.07, respectively; p < 0.01). This effect was not detected in the 58 patients submitted to dipyridamole-stress. The response to exercise selectively involved the spleen, since NCPS in heart were unchanged irrespective of the used stressor. This same response was dependent upon gender, indeed spleen NCPS during stress were significantly higher in the 75 women than in the 153 men (3.86 ± 1.8 vs. 3.23 ± 1.6, respectively, p < 0.01). Again, this variance was not reproduced by heart. Finally, spleen NCPS were lower in the 173 patients with myocardial reversible perfusion defects (summed difference score ≥3) than in the remaining 55, despite similar values of rate pressure product at tracer injection. Conclusion: Thus, exercise interference on spleen perfusion can be detected during MPI. This effect is dependent upon gender and ischemia confirming the high sensitivity of this organ to SNS activation.
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Affiliation(s)
- Francesco Lanfranchi
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesca D'Amico
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Stefano Raffa
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | | | - Alberto Miceli
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Silvia Chiola
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Maggio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Vanessa Cossu
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Gianmario Sambuceti
- Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Marini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- CNR Institute of Molecular Bioimaging and Physiology (IBFM), Milan, Italy
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Abstract
PURPOSE OF REVIEW Exercise causes various dynamic changes in all body parts either in healthy subject or in heart failure (HF) patients. The present review of current knowledge about HF patients with reduced ejection fraction focuses on dynamic changes along a "metabo-hemodynamic" perspective. RECENT FINDINGS Studies on the dynamic changes occurring during exercise span many years. Thanks to the availability of advanced methods, it is nowadays possible to properly characterize respiratory, hemodynamic, and muscular function adjustments and their mismatch with the pulmonary and systemic circulations. Exercise is a dynamic event that involves several body functions. In HF patients, it is important to know at what level the limitation takes place in order to better manage these patients and to optimize therapeutic strategies.
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6
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Benes J, Kotrc M, Conrad MJ, Kautzner J, Melenovsky V, Jarolim P. Exercise dynamics of cardiac biomarkers and hemoconcentration in patients with chronic systolic heart failure. J Card Fail 2020; 26:1100-1105. [PMID: 32687881 DOI: 10.1016/j.cardfail.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/17/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jan Benes
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic;; Department of Medicine, First Faculty of Medicine, Charles University and Military University Hospital Prague, Czech Republic
| | - Martin Kotrc
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Michael J Conrad
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Josef Kautzner
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vojtech Melenovsky
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Accalai E, Vignati C, Salvioni E, Pezzuto B, Contini M, Cadeddu C, Meloni L, Agostoni P. Non-invasive estimation of stroke volume during exercise from oxygen in heart failure patients. Eur J Prev Cardiol 2020; 28:280-286. [PMID: 33611434 DOI: 10.1177/2047487320920755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022]
Abstract
AIMS In heart failure, oxygen uptake and cardiac output measurements at peak and during exercise are important in defining heart failure severity and prognosis. Several cardiopulmonary exercise test-derived parameters have been proposed to estimate stroke volume during exercise, including the oxygen pulse (oxygen uptake/heart rate). Data comparing measured stroke volume and the oxygen pulse or stroke volume estimates from the oxygen pulse at different stages of exercise in a sizeable population of healthy individuals and heart failure patients are lacking. METHODS We analysed 1007 subjects, including 500 healthy and 507 heart failure patients, who underwent cardiopulmonary exercise testing with stroke volume determination by the inert gas rebreathing technique. Stroke volume measurements were made at rest, submaximal (∼50% of exercise) and peak exercise. At each stage of exercise, stroke volume estimates were obtained considering measured haemoglobin at rest, predicted exercise-induced haemoconcentration and peripheral oxygen extraction according to heart failure severity. RESULTS A strong relationship between oxygen pulse and measured stroke volume was observed in healthy and heart failure subjects at submaximal (R2 = 0.6437 and R2 = 0.6723, respectively), and peak exercise (R2 = 0.6614 and R2 = 0.5662) but not at rest. In healthy and heart failure subjects, agreement between estimated and measured stroke volume was observed at submaximal (-3 ± 37 and -11 ± 72 ml, respectively) and peak exercise (1 ± 31 and 6 ± 29 ml, respectively) but not at rest. CONCLUSION In heart failure patients, stroke volume estimation and oxygen pulse during exercise represent stroke volume, albeit with a relevant individual data dispersion so that both can be used for population studies but cannot be reliably applied to a single subject. Accordingly, whenever needed stroke volume must be measured directly.
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Affiliation(s)
- Emanuele Accalai
- Università degli studi di Cagliari, UOC di Cardiologia-UTIC, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Italy
| | | | | | | | | | - Luigi Meloni
- Università degli studi di Cagliari, UOC di Cardiologia-UTIC, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Italy
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8
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Lvad pump speed increase is associated with increased peak exercise cardiac output and vo2, postponed anaerobic threshold and improved ventilatory efficiency. Int J Cardiol 2017; 230:28-32. [DOI: 10.1016/j.ijcard.2016.12.112] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/11/2016] [Accepted: 12/17/2016] [Indexed: 11/22/2022]
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9
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Abstract
The human spleen shows a decrease in volume of around 40% early during vigorous exercise and in response to other stressful stimuli such as maximal apnoea and the breathing of hypoxic gas mixtures. Contraction seems an active response, mediated by alpha-adrenergic fibres in the splenic nerve. Given the relatively small size of the human spleen, the effect upon physical performance is likely to be small; the augmentation of total blood volume is <2%, and even taking account of other causes of haemoconcentration during vigorous exercise, the increase of haematocrit is <10%. However, one of two studies suggested that the haemoconcentration may be sufficient to cause errors in the traditional method for calculating exercise-induced changes of plasma volume. The spleen also contributes leucocytes and platelets to the general circulation as part of the "fight or flight" reaction to stressors. The mobilisation of leucocytes proceeds more slowly than that of the red cells; it depends not only upon an active contraction of the spleen, but also a modulation of leucocyte adhesion molecules. Splenectomy impairs exercise performance in horses, but human performance data are lacking; overall health effects seem minimal, and many patients live many years after removal of their spleens.
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Affiliation(s)
- Roy J Shephard
- a Faculty of Kinesiology & Physical Education , University of Toronto , Toronto , Canada
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10
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Benedetto D, Rao CM, Cefalù C, Aguglia DO, Cattadori G, D’Ascola DG, Benedetto FA, Agostoni P, Sciomer S. Effects of blood transfusion on exercise capacity in thalassemia major patients. PLoS One 2015; 10:e0127553. [PMID: 26010540 PMCID: PMC4444349 DOI: 10.1371/journal.pone.0127553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/16/2015] [Indexed: 02/07/2023] Open
Abstract
Anemia has an important role in exercise performance. However, the direct link between rapid changes of hemoglobin and exercise performance is still unknown.To find out more on this topic, we studied 18 beta-thalassemia major patients free of relevant cardiac dysfunction (age 33.5±7.2 years,males = 10). Patients performed a maximal cardiopulmolmonary exercise test (cycloergometer, personalized ramp protocol, breath-by-breath measurements of expired gases) before and the day after blood transfusion (500 cc of red cell concentrates). After blood transfusion, hemoglobin increased from 10.5±0.8 g/dL to 12.1±1.2 (p<0.001), peak VO2 from 1408 to 1546mL/min (p<0.05), and VO2 at anaerobic threshold from 965 to 1024mL/min (p<0.05). No major changes were observed as regards heart and respiratory rates either at peak exercise or at anaerobic threshold. Similarly, no relevant changes were observed in ventilation efficiency, as evaluated by the ventilation vs. carbon dioxide production relationship, or in O2 delivery to the periphery as analyzed by the VO2 vs. workload relationship. The relationship between hemoglobin and VO2 changes showed, for each g/dL of hemoglobin increase, a VO2 increase = 82.5 mL/min and 35 mL/min, at peak exercise and at anaerobic threshold, respectively. In beta-thalassemia major patients, an acute albeit partial anemia correction by blood transfusion determinates a relevant increase of exercise performance, observed both at peak exercise and at anaerobic threshold.
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Affiliation(s)
| | - Carmelo Massimo Rao
- Azienda Bianchi Melacrino Morelli, Cardiology Department, Reggio di Calabria, Italy
| | | | | | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Sezione cardiovascolare, Università di Milano, Milano, Italy
- * E-mail:
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari e Respiratorie, Università “Sapienza”, Roma, Italy
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Magini A, Apostolo A, Salvioni E, Italiano G, Veglia F, Agostoni P. Alveolar-capillary membrane diffusion measurement by nitric oxide inhalation in heart failure. Eur J Prev Cardiol 2013; 22:206-12. [PMID: 24165475 DOI: 10.1177/2047487313510397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In heart failure, lung diffusion is reduced, it correlates with prognosis and exercise capacity, and it is a therapy target. DESIGN Diffusion is measured as CO total diffusion (DL(CO)), which has two components: membrane diffusion (Dm) and capillary volume, the latter related to CO and O2 competition for hemoglobin. DL(CO) needs to be corrected for hemoglobin. Diffusion can also be measured with NO (DL(NO)), which has a very high affinity for hemoglobin, and thus, the resistance of hemoglobin being trivial, it directly represents Dm. Therefore, Dm is directly calculated from DL(NO) through a correction factor. DL(NO) has never been measured in heart failure. The study aims at determining, in heart failure, DL(NO), Dm correction factor, and whether Dm(NO) provides Dm estimates comparable to Dm(CO). METHODS We measured DL(CO), Dm(CO) by multi-maneuver Roughton-Forster method, and DL(CO) and DL(NO) by single-breath maneuver in 50 heart failure and 50 healthy subjects. RESULTS DL(CO) was 21.9 ± 4.8 ml/mmHg per min and 16.8 ± 5.1 in healthy subjects and heart failure subjects, respectively (p < 0.001). DL(NO) was 88.6 ± 20.5 ml/mmHg per min and 72.5 ± 22.3, respectively (p < 0.001). The correction factors to obtain Dm from DL(NO) were 2.68 (entire population), 2.63 (healthy subjects) and 2.75 (heart failure subjects). Dm(CO) and Dm(NO) were 34.7 ± 10.9 ml/mmHg per min and 33.8 ± 7.6 in healthy subjects and 25.9 ± 2.0 and 26.4 ± 8.1 in heart failure subjects. CONCLUSIONS DL(NO) and Dm(NO) measurements are feasible in heart failure. Dm(CO) and Dm(NO) provide comparable results. The correction factor to calculate Dm from DL(NO) in heart failure is 2.75, which is little different from the 2.63 value we observed in healthy subjects.
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Affiliation(s)
| | | | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Italy Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, USA
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12
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Exercise intolerance in chronic heart failure: mechanisms and therapies. Part I. ACTA ACUST UNITED AC 2010; 17:637-42. [DOI: 10.1097/hjr.0b013e3283361dc5] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Agostoni P, Salvioni E, Debenedetti C, Vignati C, Cattadori G, Contini M, Magrì D, Palermo P, Gondoni E, Brusoni D, Fiorentini C, Apostolo A. Relationship of resting hemoglobin concentration to peak oxygen uptake in heart failure patients. Am J Hematol 2010; 85:414-7. [PMID: 20513118 DOI: 10.1002/ajh.21698] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anemia is frequent in chronic heart failure (HF). To calculate what change in peak oxygen uptake ( VO(2)) should be expected in the event of changes in hemoglobin concentration, we studied the correlation between peak VO(2) and hemoglobin concentration in a large HF population. We carried out retrospective analysis of all cardiopulmonary exercise tests (CPET) performed in our HF Clinic between June 2001 and March 2009 in HF patients who had a resting hemoglobin concentration measurement taken within 7 days of the CPET. We collected 967 CPETs, 704 tests were considered maximal and analyzed. We identified 181 patients (26%) as anemic. Peak VO(2) was lower (P < 0.001) in anemic patients (971 +/- 23 ml/min) compared with nonanemic (1243 +/- 18 ml/min). The slope of the VO(2) vs. hemoglobin ratio was 109 ml/min/g/dl at peak exercise. This correlation remained significant also when several confounding variables were analyzed by multivariate analysis. As an average, each gram of hemoglobin accounts, at peak exercise, for 109 ml/min change in VO(2) which is equivalent to 0.97 ml/min/kg. Therefore, in HF patients anemia treatment should increase VO(2) by 109 ml/min for each g/dl of hemoglobin increase.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Dipartimento di Scienze Cardiovascolari, Università di Milano, Milan, Italy.
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14
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Charloux A, Enache I, Richard R, Oswald-Mammosser M, Lonsdorfer-Wolf E, Piquard F, Geny B. Diffusing capacity of the lung for CO and pulmonary blood flow during incremental and intermittent exercise. Scand J Med Sci Sports 2010; 20:e121-9. [DOI: 10.1111/j.1600-0838.2009.00924.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. ACTA ACUST UNITED AC 2009; 16:249-67. [PMID: 19440156 DOI: 10.1097/hjr.0b013e32832914c8] [Citation(s) in RCA: 250] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cardiopulmonary exercise testing (CPET) is a methodology that has profoundly affected the approach to patients' functional evaluation, linking performance and physiological parameters to the underlying metabolic substratum and providing highly reproducible exercise capacity descriptors. This study provides professionals with an up-to-date review of the rationale sustaining the use of CPET for functional evaluation of cardiac patients in both the clinical and research settings, describing parameters obtainable either from ramp incremental or step constant-power CPET and illustrating the wealth of information obtainable through an experienced use of this powerful tool. The choice of parameters to be measured will depend on the specific goals of functional evaluation in the individual patient, namely, exercise tolerance assessment, training prescription, treatment efficacy evaluation, and/or investigation of exercise-induced adaptations of the oxygen transport/utilization system. The full potentialities of CPET in the clinical and research setting still remain largely underused and strong efforts are recommended to promote a more widespread use of CPET in the functional evaluation of cardiac patients.
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16
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Cattadori G, Schmid JP, Agostoni P. Noninvasive Measurement of Cardiac Output During Exercise by Inert Gas Rebreathing Technique. Heart Fail Clin 2009; 5:209-15. [DOI: 10.1016/j.hfc.2008.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Agostoni P, Cerino M, Palermo P, Magini A, Bianchi M, Bussotti M, Fiorelli G, Cappellini MD. Exercise capacity in patients with beta-thalassaemia intermedia. Br J Haematol 2005; 131:278-81. [PMID: 16197461 DOI: 10.1111/j.1365-2141.2005.05765.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Thalassaemia intermedia patients can suffer fatigue and exercise capacity reduction, possibly because of anaemia, deconditioning and lack of exercise-induced haemoconcentration. We studied 21 beta-thalassaemia intermedia patients, 10 splenectomised (group A) and 11 not splenectomised (group B). Patients were evaluated by cardiopulmonary exercise test with blood sampling for haemoglobin and plasma protein measurements at rest and peak. During exercise, an isolated increase of haemoglobin suggested spleen contraction while a parallel increase of haemoglobin and proteins suggested fluid filtration through capillary wall. Groups were homogeneous for age and gender. Peak oxygen consumption (VO2) was 22.5 +/- 4.4 ml/min/kg (51 +/- 14%) and 24.3 +/- 7.0 (53 +/- 12%) in groups A and B respectively [not significant (NS)]. At rest, haemoglobin was 8.8 g/dl in both groups. Exercise-induced increment was 0.4 +/- 0.2 and 1.0 +/- 0.4 g/dl (P < 0.001) for haemoglobin and 4.0 +/- 3.0 and 5.0 +/- 4.0 g/l (NS) for proteins, in groups A and B respectively. Anaemia was the major cause of peak VO2 reduction (1097 +/- 260 ml/min). However, anaemia did not explain the entire exercise capacity reduction, suggesting the presence of muscular deconditioning. Exercise capacity is reduced in beta-thalassaemia intermedia because of anaemia and muscular deconditioning. Spleen contraction does not significantly influence exercise capacity although exercise-induced haemoconcentration was greater in patients with spleen.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, Milan, Italy.
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Bussotti M, Andreini D, Agostoni P. Exercise-induced changes in exhaled nitric oxide in heart failure. Eur J Heart Fail 2004; 6:551-4. [PMID: 15302001 DOI: 10.1016/j.ejheart.2003.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2003] [Revised: 06/20/2003] [Accepted: 08/28/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In heart failure abnormalities of pulmonary function are frequently observed as shown by hyperpnea, reduced lung compliance, reduced alveolar-capillary gas diffusion, positive methacholine challenge and, during exercise, early expiratory flow limitation. Nitric oxide (NO) might be related to all the above abnormalities. AIMS We evaluated whether a correlation between exhaled NO (eNO) and lung function exists at rest and during exercise in heart failure. METHODS We studied 33 chronic heart failure patients and 11 healthy subjects with: (a) standard pulmonary function, (b) lung diffusion for carbon monoxide (DLco) including its subcomponents, capillary volume and membrane resistance and eNO both at rest and during light exercise, (c) maximal cycloergometer cardiopulmonary exercise test. RESULTS Forced expiratory volume in 1 s (FEV(1)) was reduced in heart failure patients (83+/-17% of predicted), as was DLco (75+/-18% of predicted) due to reduced membrane resistance (32.6+/-10.3 ml mmHg(-1) min(-1) vs. 39.9+/-6.9 in patients vs. controls, P<0.02). Exhaled NO was lower in patients vs. controls (9.7+/-5.4 ppm vs. 14.4+/-6.4, P<0.05) and was, during exercise, constant in patients and reduced in controls. No significant correlation was found between eNO and lung function. Vice-versa eNO changes during exercise were correlated with peak exercise oxygen consumption (r=0.560, P<0.001). CONCLUSIONS The hypothesis of a link between eNO and lung function in heart failure was not proved. The correlation between eNO changes during exercise and peak V(O(2)) might be due to hemoglobin oxygenation, which binds NO to hemoglobin.
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Affiliation(s)
- Maurizio Bussotti
- Centro Cardiologico Monzino IRCCS, Istituto di Cardiologia Università di Milano, via Parea 4, 20138 Milan, Italy
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Agostoni PG, Bussotti M, Palermo P, Guazzi M. Does lung diffusion impairment affect exercise capacity in patients with heart failure? Heart 2002; 88:453-9. [PMID: 12381630 PMCID: PMC1767418 DOI: 10.1136/heart.88.5.453] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether there is a relation between impairment of lung diffusion and reduced exercise capacity in chronic heart failure. DESIGN 40 patients with heart failure in stable clinical condition and 40 controls participated in the study. All subjects underwent standard pulmonary function tests plus measurements of resting lung diffusion (carbon monoxide transfer, TLCO), pulmonary capillary volume (VC), and membrane resistance (DM), and maximal cardiopulmonary exercise testing. In 20 patients and controls, the following investigations were also done: (1) resting and constant work rate TLCO; (2) maximal cardiopulmonary exercise testing with inspiratory O2 fractions of 0.21 and 0.16; and (3) rest and peak exercise blood gases. The other subjects underwent TLCO, DM, and VC measurements during constant work rate exercise. RESULTS In normoxia, exercise induced reductions of haemoglobin O2 saturation never occurred. With hypoxia, peak exercise uptake (peak O2) decreased from (mean (SD)) 1285 (395) to 1081 (396) ml/min (p < 0.01) in patients, and from 1861 (563) to 1771 (457) ml/min (p < 0.05) in controls. Resting TLCO correlated with peak O2 in heart failure (normoxia < hypoxia). In heart failure patients and normal subjects, TLCO and peak O2 correlated with O2 arterial content at rest and during peak exercise in both normoxia and hypoxia. TLCO, VC, and DM increased during exercise. The increase in TLCO was greater in patients who had a smaller reduction of exercise capacity with hypoxia. Alveolar-arterial O2 gradient at peak correlated with exercise capacity in heart failure during normoxia and, to a greater extent, during hypoxia. CONCLUSIONS Lung diffusion impairment is related to exercise capacity in heart failure.
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Affiliation(s)
- P G Agostoni
- Centro Cardiologico Monzino, IRCCS, Institute of Cardiology, University of Milan, Milan, Italy.
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Ikarugi H, Shibata M, Ishii K, Yamamoto J. Shear-induced platelet reactivity in middle-aged women after low-intensity exercise. Thromb Res 2001; 104:347-51. [PMID: 11738077 DOI: 10.1016/s0049-3848(01)00375-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- H Ikarugi
- Laboratory of Health and Sport Sciences, Kobe University of Commerce, Kobe, Japan.
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