1
|
Ogura A, Izawa KP, Tawa H, Kureha F, Wada M, Kanai M, Kubo I, Yoshikawa R, Matsuda Y. Impact of worsening renal function on peak oxygen uptake in patients with acute myocardial infarction. Nephrology (Carlton) 2021; 26:506-512. [PMID: 33605038 DOI: 10.1111/nep.13864] [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: 10/06/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
AIM Worsening renal function (WRF) induced by acute myocardial infarction (AMI) is a strong predictor of cardiovascular events and mortality. Peak oxygen uptake may contribute to prognosis in AMI patients with WRF, however, the impact of WRF on peak oxygen uptake is unclear. METHODS Among 154 patients with AMI who underwent emergency percutaneous coronary intervention and participated in phase II cardiac rehabilitation, those who underwent cardiopulmonary exercise testing were consecutively enrolled. WRF was defined as a ≥20% decrease in estimated glomerular filtration rate (eGFR [ml/min/1.73 m2 ]) from admission to that at cardiopulmonary exercise testing. The association of WRF with peak oxygen uptake was evaluated by multivariate regression analysis. The non-WRF group was divided into two subgroups according to eGFR <60/≥60 at cardiopulmonary exercise testing, and eGFR at cardiopulmonary exercise testing and peak oxygen uptake of all three groups were compared. RESULTS Ninety-four patients were enrolled in the final analysis. Multiple linear regression analysis showed that WRF was associated with peak oxygen uptake (p = .003). Comparing the non-WRF group with eGFR at cardiopulmonary exercise testing <60 and the WRF group, although eGFR at cardiopulmonary exercise testing was similar (p = 1.000), peak oxygen uptake in the WRF group was significantly lower (p = .026). CONCLUSION WRF, not eGFR at cardiopulmonary exercise testing was significantly associated with peak oxygen uptake in patients with AMI. This result suggests that when considering the relationship between renal function and peak oxygen uptake, WRF must be taken into account.
Collapse
Affiliation(s)
- Asami Ogura
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan.,Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan.,Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan.,Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
| | - Hideto Tawa
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Fumie Kureha
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Masaaki Wada
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan
| | - Masashi Kanai
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan.,Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
| | - Ikko Kubo
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan.,Cardiovascular Stroke Renal Project (CRP), Kobe, Japan
| | | | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| |
Collapse
|
2
|
Buekers J, Aerts JM, Theunis J, Houben-Wilke S, Franssen FME, Uszko-Lencer NHMK, Wouters EFM, Simons S, De Boever P, Spruit MA. Kinetic analyses as a tool to examine physiological exercise responses in a large sample of patients with COPD. J Appl Physiol (1985) 2020; 128:813-821. [PMID: 32134714 DOI: 10.1152/japplphysiol.00851.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Kinetic features such as oxygen uptake (V̇o2) mean response time (MRT), and gains of V̇o2, carbon dioxide output (V̇co2), and minute ventilation (V̇e) can describe physiological exercise responses during a constant work rate test of patients with chronic obstructive pulmonary disease (COPD). This study aimed to establish simple guidelines that can identify COPD patients for whom kinetic analyses are (un)likely to be reliable and examined whether slow V̇o2 responses and gains of V̇o2, V̇co2, and V̇e are associated with ventilatory, cardiovascular, and/or physical impairments. Kinetic features were examined for 265 COPD patients [forced expiratory volume in 1 s (FEV1): 54 ± 19%predicted] who performed a constant work rate test (duration > 180 s) with breath-by-breath measurements of V̇o2, V̇co2, and V̇e. Negative/positive predictive values were used to define cutoff values of relevant clinical variables below/above which kinetic analyses are (un)likely to be reliable. Kinetic feature values were unreliable for 21% (= 56/265) of the patients and for 79% (= 19/24) of the patients with a peak work rate (WRpeak)< 45 W. Kinetic feature values were considered reliable for 94% (= 133/142) of the patients with an FEV1 > 1.3 L. For patients exhibiting reliable kinetic feature values, V̇o2 MRT was associated with ventilatory (e.g., FEV1 %predicted: P < 0.001; r = -0.35) and physical (e.g., V̇o2peak %predicted: P = 0.009; r = -0.18) impairments. Gains were mainly associated with cardiac function and ventilatory constraints, representing both response efficiency and limitation. Kinetic analyses are likely to be unreliable for patients with a WRpeak < 45 W. Whereas gains enrich analyses of physiological exercise responses, V̇o2 MRT shows potential to serve as a motivation-independent, physiological indicator of physical performance.NEW & NOTEWORTHY A constant work rate test that is standardly performed during a prerehabilitation assessment is unable to provide reliable kinetic feature values for chronic obstructive pulmonary disease (COPD) patients with a peak work rate below 45 W. For patients suffering from less severe impairments, kinetic analyses are a powerful tool to examine physiological exercise responses. Especially oxygen uptake mean response time can serve as a motivation-independent, physiological indicator of physical performance in patients with COPD.
Collapse
Affiliation(s)
- Joren Buekers
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Measure, Model & Manage Bioresponses, Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Jean-Marie Aerts
- Measure, Model & Manage Bioresponses, Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Jan Theunis
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | | | - Frits M E Franssen
- Department of Research and Development, CIRO, Horn, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Nicole H M K Uszko-Lencer
- Department of Research and Development, CIRO, Horn, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research and Development, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sami Simons
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
3
|
Kusunose K, Seno H, Yamada H, Nishio S, Torii Y, Hirata Y, Saijo Y, Ise T, Yamaguchi K, Fukuda D, Yagi S, Soeki T, Wakatsuki T, Sata M. Right Ventricular Function and Beneficial Effects of Cardiac Rehabilitation in Patients With Systolic Chronic Heart Failure. Can J Cardiol 2018; 34:1307-1315. [PMID: 30146462 DOI: 10.1016/j.cjca.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It has been recognized that a comprehensive cardiac rehabilitation (CR) program improves mortality in patients with chronic heart failure. On the other hand, the magnitude of the improvement in exercise capacity after CR differs among individuals. The aim of this study was to assess the echocardiographic determinants of responders to CR using preload stress echocardiography. METHODS We prospectively enrolled 58 chronic heart failure patients with reduced left ventricular ejection fraction (aged 62 ± 11 years; 69% male; left ventricular ejection fraction 43% ± 7%) who had received optimized medical treatment in a CR program for 5 months. We performed preload echocardiographic studies using leg positive pressure (LPP) to assess the echocardiographic parameters during preload augmentation. We defined 41 patients as a development cohort to assess the predictive value of echocardiographic variables. Next, we validated results in the remaining 17 patients as a validation cohort. RESULTS In the development cohort, significant improvement in peak oxygen uptake (VO2) (>10%) after CR was observed in 58% patients. In a multivariable logistic regression model, the significant predictor of improvement in exercise capacity was right ventricular (RV) strain during LPP (odds ratio: 3.96 per 1 standard deviation; P = 0.01). An RV strain value of -16% during LPP had a good sensitivity of 0.79 and a specificity of 0.71 to identify patients with improvement in peak VO2. In the validation cohort, an optimal cutoff value of RV strain value was the same (area under the curve: 0.77, sensitivity: 0.78, specificity: 0.65). CONCLUSIONS RV strain during LPP may be an echocardiographic parameter for assessing beneficial effects of CR.
Collapse
Affiliation(s)
- Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
| | - Hiromitsu Seno
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Susumu Nishio
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Yuta Torii
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Yukina Hirata
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Yoshihito Saijo
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| |
Collapse
|
4
|
Poelaert J. Diastolic dysfunction and sepsis: the devil is in the detail. Br J Anaesth 2017; 119:555-557. [DOI: 10.1093/bja/aex325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
5
|
Trivi M, Thierer J, Kuschnir P, Acosta A, Marino J, Guglielmone R, Ronderos R. [Echocardiographic predictors of exercise capacity in patients with heart failure and systolic dysfunction: role of mitral regurgitation]. Rev Esp Cardiol 2011; 64:1096-9. [PMID: 21907482 DOI: 10.1016/j.recesp.2011.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 06/04/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Patients with heart failure and similar left ventricular systolic dysfunction have differing exercise capacity. The aim of this study was to identify echocardiographic predictors of exercise capacity in patients with heart failure and systolic dysfunction. METHODS We included 150 patients with class II (70%) or III (30%) heart failure with left ventricular ejection fraction below 40%. Six-minute walking test and cardiac color Doppler-echo, including tissue Doppler of mitral and tricuspid rings, were performed. Moderate and severe mitral regurgitation were considered as significant. Two groups were divided according to the median walking distance (290 m): Group 1, <290 m and Group 2, ≥290 m. RESULTS Mitral regurgitation was detected in 112 patients (75%), which was significant in 40 (27%). Group 1 showed more significant mitral regurgitation (35 vs 18%), increased left atrium area (27±1 vs 24±1cm(2)), mitral E amplitude (88±5 vs 72±3cm/s) and systolic pulmonary pressure (37±1 vs 32±1mmHg, all P<.05). By logistic regression analysis, only the presence of significant mitral regurgitation was independently associated with less walked distance (odds ratio: 3.44 95% confidence interval 1.02-11.66, P<.05). By multiple linear regression, the only independent predictor of walked distance was left atrium area (r=0.25, beta coefficient: -6.52±2, P<.01). CONCLUSIONS In patients with class II-III heart failure and left ventricular systolic dysfunction, the main echocardiographic predictors of exercise capacity are related to the presence of significant mitral regurgitation.
Collapse
Affiliation(s)
- Marcelo Trivi
- Servicios de Cardiología Clínica e Imágenes, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|
6
|
Explanation of the variance in quality of life and activity capacity of patients with heart failure by laboratory data. ACTA ACUST UNITED AC 2010; 17:375-9. [PMID: 19940776 DOI: 10.1097/hjr.0b013e328333e962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted to explain the variance in quality of life (QoL) and activity capacity of patients with congestive heart failure from pathophysiological changes as estimated by laboratory data. METHODS Peak oxygen consumption (peak VO2) and ventilation (VE)/carbon dioxide output (VCO2) slope derived from cardiopulmonary exercise testing, plasma N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and echocardiographic markers [left atrium (LA), left ventricular ejection fraction (LVEF)] were measured in 62 patients with congestive heart failure, who also completed the Minnesota Living with Heart Failure Questionnaire and the Specific Activity Questionnaire. All regression models were adjusted for age and sex. RESULTS On linear regression analysis, peak VO2 with P value less than 0.001, VE/VCO2 slope with P value less than 0.01, LVEF with P value less than 0.001, LA with P=0.001, and logNT-proBNP with P value less than 0.01 were found to be associated with QoL. On stepwise multiple linear regression, peak VO2 and LVEF continued to be predictive, accounting for 40% of the variability in Minnesota Living with Heart Failure Questionnaire score. On linear regression analysis, peak VO2 with P value less than 0.001, VE/VCO2 slope with P value less than 0.001, LVEF with P value less than 0.05, LA with P value less than 0.001, and logNT-proBNP with P value less than 0.001 were found to be associated with activity capacity. On stepwise multiple linear regression, peak VO2 and LA continued to be predictive, accounting for 53% of the variability in Specific Activity Questionnaire score. CONCLUSION Peak VO2 is independently associated both with QoL and activity capacity. In addition to peak VO2, LVEF is independently associated with QoL, and LA with activity capacity.
Collapse
|
7
|
Relation of ventricular-vascular coupling to exercise capacity in ischemic cardiomyopathy: a cardiac multi-modality imaging study. Int J Cardiovasc Imaging 2009; 26:151-9. [DOI: 10.1007/s10554-009-9516-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 09/27/2009] [Indexed: 12/26/2022]
|
8
|
Ciampi Q, Petruzziello B, Porta MD, Caputo S, Manganiello V, Astarita C, Villari B. Effect of intraventricular dyssynchrony on diastolic function and exercise tolerance in patients with heart failure. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:907-13. [DOI: 10.1093/ejechocard/jep094] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
9
|
Ciampi Q, Borzillo G, Barbato E, Petruzziello B, Betocchi S, Villari B. Diastolic function and BNP changes during exercise predict oxygen consumption in chronic heart failure patients. SCAND CARDIOVASC J 2009; 43:17-23. [PMID: 18609042 DOI: 10.1080/14017430802175720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED B-type natriuretic peptide (BNP) is a diagnostic and prognostic marker in heart failure (CHF) patients. AIM To assess the relation between BNP, diastolic function and exercise capacity in CHF patients. METHODS Fifty CHF patients underwent cardiopulmonary exercise testing. BNP levels were determined at baseline and at peak exercise. Patients were divided in two groups: with lower (<14 ml/kg/min) or higher (>or=14 ml/kg/min) peak oxygen consumption (VO(2)). RESULTS Seventeen patients with lower peak VO(2) showed larger incidence of restrictive pattern of the transmitral flow (7/17 vs 4/33, p =0.036). E/Ea ratio was inversely related with peak VO(2) (r =-0.419, p =0.004) and directly related with BNP levels at baseline (r =0.449, p =0.001) and at peak exercise (r =0.475, p =0.001). LV ejection fraction was similar in the two groups. Independent predictors of exercise tolerance were E/Ea ratio (p =0.003), lg BNP at baseline (p =0.034) and increase in lg BNP during exercise (p =0.038). CONCLUSIONS In CHF patients, E/Ea ratio is a predictor of exercise tolerance and is related with BNP level at rest and at peak exercise.
Collapse
Affiliation(s)
- Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy.
| | | | | | | | | | | |
Collapse
|
10
|
Pullen PR, Nagamia SH, Mehta PK, Thompson WR, Benardot D, Hammoud R, Parrott JM, Sola S, Khan BV. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail 2008; 14:407-13. [PMID: 18514933 DOI: 10.1016/j.cardfail.2007.12.007] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 12/17/2007] [Accepted: 12/20/2007] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite recent advances in pharmacologic and device therapy, morbidity and mortality from heart failure (HF) remain high. Yoga combines physical and breathing exercises that may benefit patients with HF. We hypothesized that an 8-week regimen of yoga in addition to standard medical therapy would improve exercise capacity, inflammatory markers, and quality of life (QoL) in patients with HF. METHODS AND RESULTS New York Heart Association Class I-III HF patients were randomized to yoga treatment (YT) or standard medical therapy (MT). Measurements included a graded exercise test (GXT) to V O(2Peak) and the following serum biomarkers: interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and extracellular superoxide dismutase (EC-SOD). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was administered to assess changes in QoL. A total of 19 patients were enrolled after the initial screening. Of the 19 patients, 9 were randomized to YT and 10 to MT. Patients had a mean EF of 25%. GXT time and V O(2Peak) were significantly improved in the YT versus MT groups (+18% in the YT and -7.5% in MT; P = .03 vs. control and +17 in YT and -7.1 in MT; P = .02, respectively). There were statistically significant reductions in serum levels of IL-6 and hsCRP and an increase in EC-SOD in the YT group (all P < .005 vs. MT). MLHFQ scores improved by 25.7% in the YT group and by 2.9% in the MT group. CONCLUSIONS Yoga improved exercise tolerance and positively affected levels of inflammatory markers in patients with HF, and there was also a trend toward improvements in QoL.
Collapse
Affiliation(s)
- Paula R Pullen
- Department of Kinesiology and Health, Georgia State University, Atlanta, Georgia, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Grotenhuis HB, Kroft LJM, van Elderen SGC, Westenberg JJM, Doornbos J, Hazekamp MG, Vliegen HW, Ottenkamp J, de Roos A. Right ventricular hypertrophy and diastolic dysfunction in arterial switch patients without pulmonary artery stenosis. Heart 2007; 93:1604-8. [PMID: 17277348 PMCID: PMC2095768 DOI: 10.1136/hrt.2006.109199] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess pulmonary flow dynamics and right ventricular (RV) function in patients without significant anatomical narrowing of the pulmonary arteries late after the arterial switch operation (ASO) by using magnetic resonance imaging (MRI). METHODS 17 patients (mean (SD), 16.5 (3.6) years after ASO) and 17 matched healthy subjects were included. MRI was used to assess flow across the pulmonary trunk, RV systolic and diastolic function, and RV mass. RESULTS Increased peak flow velocity (>1.5 m/s) was found across the pulmonary trunk in 14 of 17 patients. Increased RV mass was found in ASO patients: 14.9 (3.4) vs 10.0 (2.6) g/m2 in normal subjects (p<0.01). Delayed RV relaxation was found after ASO: mean tricuspid valve E/A peak flow velocity ratio = 1.60 (0.96) vs 1.92 (0.61) in normal subjects (p = 0.03), and E-deceleration gradients = -1.69 (0.73) vs -2.66 (0.96) (p<0.01). After ASO, RV mass correlated with pulmonary trunk peak flow velocity (r = 0.49, p<0.01) and tricuspid valve E-deceleration gradients (r = 0.35, p = 0.04). RV systolic function was well preserved in patients (ejection fraction = 53 (7)% vs 52 (8)% in normal subjects, p = 0.72). CONCLUSIONS Increased peak flow velocity in the pulmonary trunk was often observed late after ASO, even in the absence of significant pulmonary artery stenosis. Haemodynamic consequences were RV hypertrophy and RV relaxation abnormalities as early markers of disease, while systolic RV function was well preserved.
Collapse
Affiliation(s)
- H B Grotenhuis
- Leiden University Medical Centre, Department of Radiology, 2300 RC Leiden, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Palmieri V, Russo C, Palmieri EA, Arezzi E, Pezzullo S, Minichiello S, Martino S, Migliaresi P, Celentano A. Isolated left ventricular diastolic dysfunction: implications for exercise left ventricular performance in patients without congestive heart failure. J Am Soc Echocardiogr 2006; 19:491-8. [PMID: 16644431 DOI: 10.1016/j.echo.2005.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Clinical relevance of left ventricular (LV) diastolic dysfunction in the absence of congestive heart failure (CHF) and LV systolic dysfunction is not fully established. METHODS Asymptomatic outpatients, sedentary, with cardiovascular risk factors but no history of cardiovascular events, underwent echocardiographic evaluation of LV structure and function by standard Doppler, color M-mode, and Doppler tissue methods, and exercise testing with simultaneous noninvasive assessment of LV stroke index and cardiac index. LV ejection fraction less than 50% and significant valvular disease or stress test suggestive of coronary disease were additional exclusion criteria. RESULTS In 70 patients selected (40 +/- 10 years old, 63% men, 34% hypertensive, 34% diabetic, 4% diabetic and hypertensive, 11% with LV hypertrophy), LV diastolic dysfunction was detected in 26%, which was associated with hypertension, higher LV mass index, lower systolic function, lower peak exercise heart rate, and chronotropic reserve (all P < .05), and with lower peak exercise stroke index and cardiac index (both covariates adjusted P < .05), but not with lower peak exercise metabolic equivalents (P > .5). Abnormal LV relaxation was independently correlated with lower peak exercise cardiac index and stroke index (both P < .05). Peak exercise systolic and cardiac indices were comparable between patients with CHF risk factors (74%) versus those without. CONCLUSIONS Isolated LV diastolic dysfunction was independently associated with lower peak exercise LV systolic performance in patients without CHF. Its diagnosis may provide a target for aggressive CHF risk management.
Collapse
Affiliation(s)
- Vittorio Palmieri
- Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Rovner A, Greenberg NL, Thomas JD, Garcia MJ. Relationship of diastolic intraventricular pressure gradients and aerobic capacity in patients with diastolic heart failure. Am J Physiol Heart Circ Physiol 2005; 289:H2081-8. [PMID: 15937093 DOI: 10.1152/ajpheart.00951.2004] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We sought to elucidate the relationship between diastolic intraventricular pressure gradients (IVPG) and exercise tolerance in patients with heart failure using color M-mode Doppler. Diastolic dysfunction has been implicated as a cause of low aerobic potential in patients with heart failure. We previously validated a novel method to evaluate diastolic function that involves noninvasive measurement of IVPG using color M-mode Doppler data. Thirty-one patients with heart failure and 15 normal subjects were recruited. Echocardiograms were performed before and after metabolic treadmill stress testing. Color M-mode Doppler was used to determine the diastolic propagation velocity ( Vp) and IVPG off-line. Resting diastolic function indexes including myocardial relaxation velocity, Vp, and E/ Vp correlated well with V̇o2 max ( r = 0.8, 0.5, and −0.5, respectively, P < 0.001 for all). There was a statistically significant increase in Vp and IVPG in both groups after exercise, but the change in IVPG was higher in normal subjects compared with patients with heart failure (2.6 ± 0.8 vs. 1.1 ± 0.8 mmHg, P < 0.05). Increase in IVPG correlated with peak V̇o2 max ( r = 0.8, P < 0.001) and was the strongest predictor of exercise capacity. Myocardial relaxation is an important determinant of exercise aerobic capacity. In heart failure patients, impaired myocardial relaxation is associated with reduced diastolic suction force during exercise.
Collapse
Affiliation(s)
- Aleksandr Rovner
- Department of Cardiology, Barnes Jewish Hospital, St. Louis, Missouri, USA
| | | | | | | |
Collapse
|
14
|
Pepi M, Tamborini G, Maltagliati A, Guazzi M, Berna G, Susini F, Muratori M, Celeste F. Effects of acute angiotensin-converting enzyme inhibition on diastolic ventricular interaction in the dilated heart. Clin Cardiol 2004; 26:424-30. [PMID: 14524600 PMCID: PMC6654519 DOI: 10.1002/clc.4960260909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The normal and dilated heart behaves as a single functional unit during preload reduction: volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling. HYPOTHESIS We hypothesized that reduction of venous return induced by a physiologic stimulus (tilting) or by acute angiotensin-converting enzyme (ACE) inhibitors in dilated heart is likely to have a marked and similar effect on ventricular chamber geometry and filling. This study was designed to assess how the normal and dilated heart adapts to preload reduction. METHODS Twenty normal subjects and 20 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position (B) and after 40 degrees of head-up tilting (T). The following day, patients repeated supine (C) and tilting test (TC) after administration of captopril (25 mg s.l.). Right ventricular (RV) and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study. RESULTS In the two groups, T was associated with reduction of RV area and LV volumes; C and TC produced a similar effect on RV and LV. Changes in LV septal-lateral diameter and anterior-posterior diameter were different at each step of the study: during T (both groups) and after C and TC, the septallateral diameter increased slightly while the anterior-posterior diameter decreased. During T, mitral and tricuspid peak flow velocities decreased, peak late velocities were unchanged, and the deceleration time of mitral flow increased; the systolic forward flow of pulmonary venous flow decreased, the diastolic forward flow did not change, and the difference in duration between reverse pulmonary flow and mitral peak late flow decreased: C and CT induced similar changes. CONCLUSION Preload reduction induced by tilting or by ACE inhibitors induces profound and similar effects on LV and RV dimensions, LV geometry, and biventricular filling. Reduction of RV dimension is associated with adaptation of LV geometry and decrease of LV diastolic pressure, which facilitates LV filling and pulmonary venous drainage: ACE inhibition associated with tilting exerts an additional effect on these changes. These data confirm the role of ventricular interaction in modulating LV filling in heart failure.
Collapse
Affiliation(s)
- Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia dell'Università degli Studi, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Mejhert M, Linder-Klingsell E, Edner M, Kahan T, Persson H. Ventilatory variables are strong prognostic markers in elderly patients with heart failure. Heart 2002; 88:239-43. [PMID: 12181213 PMCID: PMC1767337 DOI: 10.1136/heart.88.3.239] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the safety and prognostic capacity of cardiopulmonary exercise testing in patients > or = 60 years old who are hospitalised with heart failure caused by left ventricular dysfunction. DESIGN Prospective study. SETTING University hospital. PATIENTS Study participants were 67 patients (66% men) with clinical heart failure stabilised on medical treatment. The study is a part of a nursing intervention study. Mean (SD) age was 74 (6) years, New York Heart Association functional class II-III, and ejection fraction 0.36 (0.11). INTERVENTIONS Cardiopulmonary exercise testing and echocardiography. MAIN OUTCOME MEASURES Peak oxygen consumption (VO2), peak ventilatory equivalents for carbon dioxide (VE/VCO2) and oxygen (VE/VO2), left ventricular volumes, and mortality. RESULTS Mean (SD) peak VO2 was 11.7 (3.7) ml/kg/min, peak VE/VCO2 43 (9), and peak VE/VO2 46 (11). During 12-59 months of follow up, 14 patients died. In univariate analyses peak VO2, VE/VO2, and VE/VCO2 were all strongly related (p < 0.01) to mortality. In a multivariate Cox regression analysis, peak VE/VCO2 was the strongest predictor of mortality (p < 0.001), followed by left ventricular end systolic volume (p < 0.001). A cut off of peak VE/VCO2 at > or = 45 gave a univariate hazard ratio of 6.7 for death during follow up. No adverse events occurred during the exercise test. CONCLUSION These findings extend results found in selected middle aged patients to elderly patients with heart failure and show that ventilatory parameters from a cardiopulmonary exercise test, such as peak VO2, VE/O2, and VE/VCO2 are powerful predictors of mortality.
Collapse
Affiliation(s)
- M Mejhert
- Section of Cardiology, Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
16
|
Morales FJ, Asencio MC, Oneto J, Lozano J, Otero E, Maestre M, Iraavedra M, Martínez P. Deceleration time of early filling in patients with left ventricular systolic dysfunction: functional and prognostic independent value. Am Heart J 2002; 143:1101-6. [PMID: 12075269 DOI: 10.1067/mhj.2002.122119] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although diastolic function parameters have been mentioned as significant predictors of functional capacity and prognosis in patients with left ventricular (LV) systolic dysfunction, it has not been fully elucidated whether they keep an independent predictive value when multiple parameters from a wide variety of examinations are considered. METHODS We prospectively studied 60 patients with New York Heart Association (NYHA) class II-IV chronic heart failure symptoms and LV ejection fraction <0.4. At the time of entry into the study, demographic data and functional class were obtained, and usual Doppler echocardiographic, radionuclide ventriculographic, cardiopulmonary exercise testing and hemodynamic variables were determined. Deceleration time of early filling (DT) and NYHA functional class were the only independent predictors of functional capacity as assessed by means of peak oxygen uptake (peak VO2). Mean follow-up was 21 +/- 6 months, and event-free survival was defined as the absence of cardiac death, urgent cardiac transplantation, or hospital admission requiring inotropic or mechanical support. RESULTS Multivariate Cox analysis showed that DT (P =.008), peak VO2 (P =.01), and NYHA class (P =.02) were independent predictors of event-free survival at 1 year. Patients in the lowest tertile of DT (<130 ms) had a significantly lower event-free survival than patients in the intermediate (44% vs 80%, P =.03) and in the highest tertile (44% vs 83%, P =.02). Patients with both a DT <130 milliseconds and a peak VO2 <14 mL/kg/min had the highest rate of events at 1 year (83% vs 22% for the remaining patients, relative risk 3.75, P <.001). CONCLUSIONS In patients with LV systolic dysfunction, DT is a powerful independent predictor of functional capacity and prognosis among a wide variety of variables. A shortened DT (<130 ms) identifies a subgroup of patients with a worse outcome, especially when combined with a reduced peak VO2 (<14 mL/kg/min).
Collapse
Affiliation(s)
- Francisco J Morales
- Department of Cardiology, Puerto Real University Hospital, Puerto Real, Cádiz, Spain.
| | | | | | | | | | | | | | | |
Collapse
|