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Watts JA, Kelly FR, Bauch TD, Murgo JP, Rubal BJ. Rest and exercise hemodynamic and metabolic findings in active duty soldiers referred for cardiac catheterization to exclude heart disease: Insights from past invasive cardiopulmonary exercise testing using multisensor high fidelity catheters. Catheter Cardiovasc Interv 2018; 91:35-46. [PMID: 28805343 DOI: 10.1002/ccd.27101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/09/2017] [Accepted: 03/25/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study describes results of iCPET from the past, which used submaximal stress and multisensor high-fidelity catheters to exclude heart disease in a unique population of young adults. BACKGROUND There has been resurgence in comprehensive hemodynamic evaluation of complex cardiovascular patients. Although dynamic assessments during cardiac catheterization have become commonplace, there remains limited information regarding left and right heart hemodynamic changes during supine exercise in young adults. METHODS The study population was derived from a retrospective review of catheterization records at Brooke Army Medical Center for active duty patients (ages: 19-40 years) in whom hemodynamic waveforms were obtained with multisensor high-fidelity catheters and supine exercise testing (53.1 ± 12.6 watts) and angiography performed to exclude heart disease. We report findings from 41 males and 1 female (ages: 19-40 years) found free of heart disease. RESULTS Submaximal exercise was associated with ≈ fourfold (P < 0.001) increase in minute ventilation (VE), O2 consumption (VO2 ) and carbon dioxide production (VCO2 ). VE/VCO2 ratio decreased (-16.8 ± 13.9%, P < 0.001) and VE/VCO2 slope was 22.6 ± 0.6 (±SE). Cardiac index (CI) increased with VO2 (ΔCI/ΔVO2 slope = 7.6 ± 2.2). Heart rate increased nearly 10 bpm per 100 mL O2 /min/M2 , whereas, changes in stroke volume were more variable. Pulmonary artery (PA) saturations fell from 77 to 55% (P < 0.001). No change was noted in mean right atrial pressures; PA pressures increased ≈10 mm Hg (P < 0.001). Pulmonary capillary wedge and left ventricular end-diastolic pressures increased ≈2 mm Hg (P < 0.001) but variability noted between individuals. CONCLUSION This study provides insight into past practices of invasive cardiopulmonary testing and furthers the understanding of metabolic and hemodynamic changes in a young population during supine submaximal exercise. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- James A Watts
- Cardiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Faith R Kelly
- Cardiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Terry D Bauch
- Geisinger Heart and Vascular Institute, Danville, Pennsylvania
| | - Joseph P Murgo
- University of Texas Health Science Center at San Antonio and Audie Murphy V.A. Memorial Hospital, San Antonio, Texas
| | - Bernard J Rubal
- Cardiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
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Connolly LJ, Nordsborg NB, Nyberg M, Weihe P, Krustrup P, Mohr M. Low-volume high-intensity swim training is superior to high-volume low-intensity training in relation to insulin sensitivity and glucose control in inactive middle-aged women. Eur J Appl Physiol 2016; 116:1889-97. [PMID: 27473445 DOI: 10.1007/s00421-016-3441-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/20/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE We tested the hypothesis that low-volume high-intensity swimming has a larger impact on insulin sensitivity and glucose control than high-volume low-intensity swimming in inactive premenopausal women with mild hypertension. METHODS Sixty-two untrained premenopausal women were randomised to an inactive control (n = 20; CON), a high-intensity low-volume (n = 21; HIT) or a low-intensity high-volume (n = 21; LIT) training group. During the 15-week intervention period, HIT performed 3 weekly 6-10 × 30-s all-out swimming intervals (average heart rate (HR) = 86 ± 3 % HRmax) interspersed by 2-min recovery periods and LIT swam continuously for 1 h at low intensity (average HR = 73 ± 3 % HRmax). Fasting blood samples were taken and an oral glucose tolerance test (OGTT) was conducted pre- and post-intervention. RESULTS After HIT, resting plasma [insulin] was lowered (17 ± 34 %; P < 0.05) but remained similar after LIT and CON. Following HIT, 60-min OGTT plasma [insulin] and [glucose] was lowered (24 ± 30 % and 10 ± 16 %; P < 0.05) but remained similar after LIT and CON. Total area under the curve for plasma [glucose] was lower (P < 0.05) after HIT than LIT (660 ± 141 vs. 860 ± 325 mmol min L(-1)). Insulin sensitivity (HOMA-IR) had increased (P < 0.05) by 22 ± 34 % after HIT, with no significant change after LIT or CON, respectively. Plasma soluble intracellular cell adhesion molecule 1 was lowered (P < 0.05) by 4 ± 8 and 3 ± 9 % after HIT and CON, respectively, while plasma soluble vascular cell adhesion molecule 1 had decreased (P < 0.05) by 8 ± 23 % after HIT only. CONCLUSIONS These findings suggest that low-volume high-intensity intermittent swimming is an effective and time-efficient training strategy for improving insulin sensitivity, glucose control and biomarkers of vascular function in inactive, middle-aged mildly hypertensive women.
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Affiliation(s)
- Luke J Connolly
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Nikolai B Nordsborg
- Department of Nutrition, Exercise and Sports, Section of Integrative Physiology, University of Copenhagen, Copenhagen, Denmark
| | - Michael Nyberg
- Department of Nutrition, Exercise and Sports, Section of Integrative Physiology, University of Copenhagen, Copenhagen, Denmark
| | - Pál Weihe
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
- Faculty of Natural and Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Peter Krustrup
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Department of Nutrition, Exercise and Sports, Section of Integrative Physiology, University of Copenhagen, Copenhagen, Denmark
| | - Magni Mohr
- Faculty of Natural and Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands.
- Department of Food and Nutrition, and Sport Sciences, Center for Health and Human Performance, University of Gothenburg, Gothenburg, Sweden.
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Mohr M, Nordsborg NB, Lindenskov A, Steinholm H, Nielsen HP, Mortensen J, Weihe P, Krustrup P. High-intensity intermittent swimming improves cardiovascular health status for women with mild hypertension. BIOMED RESEARCH INTERNATIONAL 2014; 2014:728289. [PMID: 24812628 PMCID: PMC4000940 DOI: 10.1155/2014/728289] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 11/21/2022]
Abstract
To test the hypothesis that high-intensity swim training improves cardiovascular health status in sedentary premenopausal women with mild hypertension, sixty-two women were randomized into high-intensity (n = 21; HIT), moderate-intensity (n = 21; MOD), and control groups (n = 20; CON). HIT performed 6-10 × 30 s all-out swimming interspersed by 2 min recovery and MOD swam continuously for 1 h at moderate intensity for a 15-week period completing in total 44 ± 1 and 43 ± 1 sessions, respectively. In CON, all measured variables were similar before and after the intervention period. Systolic BP decreased (P < 0.05) by 6 ± 1 and 4 ± 1 mmHg in HIT and MOD; respectively. Resting heart rate declined (P < 0.05) by 5 ± 1 bpm both in HIT and MOD, fat mass decreased (P < 0.05) by 1.1 ± 0.2 and 2.2 ± 0.3 kg, respectively, while the blood lipid profile was unaltered. In HIT and MOD, performance improved (P < 0.05) for a maximal 10 min swim (13 ± 3% and 22 ± 3%), interval swimming (23 ± 3% and 8 ± 3%), and Yo-Yo IE1 running performance (58 ± 5% and 45 ± 4%). In conclusion, high-intensity intermittent swimming is an effective training strategy to improve cardiovascular health and physical performance in sedentary women with mild hypertension. Adaptations are similar with high- and moderate-intensity training, despite markedly less total time spent and distance covered in the high-intensity group.
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Affiliation(s)
- Magni Mohr
- Sport and Health Sciences, College of Life and Environmental Sciences, St. Luke's Campus, University of Exeter, Exeter EX12LU, UK
- Department of Food and Nutrition, and Sport Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Nikolai Baastrup Nordsborg
- Department of Nutrition, Exercise and Sports, Copenhagen Centre for Team Sport and Health, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Annika Lindenskov
- The Faroese Confederation of Sports and Olympic Committee, 100 Torshavn, Faroe Islands
| | - Hildigunn Steinholm
- Department of Nursing, Faculty of Natural and Health Sciences, University of the Faroe Islands, 100 Torshavn, Faroe Islands
| | | | - Jann Mortensen
- Department of Medicine, The Faroese National Hospital, 100 Torshavn, Faroe Islands
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Pal Weihe
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, 100 Torshavn, Faroe Islands
| | - Peter Krustrup
- Sport and Health Sciences, College of Life and Environmental Sciences, St. Luke's Campus, University of Exeter, Exeter EX12LU, UK
- Department of Nutrition, Exercise and Sports, Copenhagen Centre for Team Sport and Health, University of Copenhagen, 2100 Copenhagen, Denmark
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Steding-Ehrenborg K, Jablonowski R, Arvidsson PM, Carlsson M, Saltin B, Arheden H. Moderate intensity supine exercise causes decreased cardiac volumes and increased outer volume variations: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2013; 15:96. [PMID: 24156367 PMCID: PMC4015552 DOI: 10.1186/1532-429x-15-96] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 10/01/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effects on left and right ventricular (LV, RV) volumes during physical exercise remains controversial. Furthermore, no previous study has investigated the effects of exercise on longitudinal contribution to stroke volume (SV) and the outer volume variation of the heart. The aim of this study was to determine if LV, RV and total heart volumes (THV) as well as cardiac pumping mechanisms change during physical exercise compared to rest using cardiovascular magnetic resonance (CMR). METHODS 26 healthy volunteers (6 women) underwent CMR at rest and exercise. Exercise was performed using a custom built ergometer for one-legged exercise in the supine position during breath hold imaging. Cardiac volumes and atrio-ventricular plane displacement were determined. Heart rate (HR) was obtained from ECG. RESULTS HR increased during exercise from 60±2 to 94±2 bpm, (p<0.001). LVEDV remained unchanged (p=0.81) and LVESV decreased with -9±18% (p<0.05) causing LVSV to increase with 8±3% (p<0.05). RVEDV and RVESV decreased by -7±10% and -24±14% respectively, (p<0.001) and RVSV increased 5±17% during exercise although not statistically significant (p=0.18). Longitudinal contribution to RVSV decreased during exercise by -6±15% (p<0.05) but was unchanged for LVSV (p=0.74). THV decreased during exercise by -4±1%, (p<0.01) and total heart volume variation (THVV) increased during exercise from 5.9±0.5% to 9.7±0.6% (p<0.001). CONCLUSIONS Cardiac volumes and function are significantly altered during supine physical exercise. THV becomes significantly smaller due to decreases in RVEDV whilst LVEDV remains unchanged. THVV and consequently radial pumping increases during exercise which may improve diastolic suction during the rapid filling phase.
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Affiliation(s)
- Katarina Steding-Ehrenborg
- Copenhagen Muscle Research Centre, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Hvidovre Hospital, Copenhagen, Denmark
| | - Robert Jablonowski
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - Per M Arvidsson
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - Bengt Saltin
- Copenhagen Muscle Research Centre, Copenhagen, Denmark
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
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Hudsmith LE, Tyler DJ, Emmanuel Y, Petersen SE, Francis JM, Watkins H, Clarke K, Robson MD, Neubauer S. (31)P cardiac magnetic resonance spectroscopy during leg exercise at 3 Tesla. Int J Cardiovasc Imaging 2009; 25:819-26. [PMID: 19697152 DOI: 10.1007/s10554-009-9492-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Accepted: 08/10/2009] [Indexed: 12/01/2022]
Abstract
Investigation of phosphorus ((31)P) magnetic resonance spectroscopy under stress conditions provides a non-invasive tool to examine alterations in cardiac high-energy phosphate metabolism that may not be evident at rest. Our aim was to establish cardiac (31)P MR spectroscopy during leg exercise at 3T. The increased field strength should provide a higher signal to noise ratio than at lower field strengths. Furthermore, relatively high temporal resolution at a sufficiently fine spatial resolution should be feasible. (31)P MR spectra were obtained with a 3D acquisition weighted chemical shift imaging sequence in 20 healthy volunteers at rest, during dynamic physiological leg exercise and after recovery at 3T. Haemodynamic measurements were made throughout and the rate pressure product calculated. With exercise, the mean heart rate increased by 73%, achieving a mean increase in rate pressure product of 115%. The corrected PCr/ATP ratio for subjects at rest was 2.02 +/- 0.43, exercise 2.14 +/- 0.67 (P = 0.54 vs. rest) and at recovery 2.03 +/- 0.52 (P = 0.91 vs. rest, P = 0.62 vs. exercise). A cardiac (31)P MR spectroscopy physiological exercise-recovery protocol is feasible at 3T. There was no significant change in high-energy cardiac phosphate metabolite concentrations in healthy volunteers at rest, during physiological leg exercise or during recovery. When applied to patients with heart disease, this protocol should provide insights into physiological and pathological cardiac metabolism.
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Affiliation(s)
- Lucy E Hudsmith
- The University of Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, Oxford, OX3 9DU, UK.
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Larsson M, Bjällmark A, Johnson J, Winter R, Brodin LA, Lundbäck S. State diagrams of the heart--a new approach to describing cardiac mechanics. Cardiovasc Ultrasound 2009; 7:22. [PMID: 19473478 PMCID: PMC2693107 DOI: 10.1186/1476-7120-7-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 05/27/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac time intervals have been described as a measure of cardiac performance, where prolongation, shortening and delay of the different time intervals have been evaluated as markers of cardiac dysfunction. A relatively recently developed method with improved ability to measure cardiac events is Tissue Doppler Imaging (TDI), allowing accurate measurement of myocardial movements. METHODS We propose the state diagram of the heart as a new visualization tool for cardiac time intervals, presenting comparative, normalized data of systolic and diastolic performance, providing a more complete overview of cardiac function. This study aimed to test the feasibility of the state diagram method by presenting examples demonstrating its potential use in the clinical setting and by performing a clinical study, which included a comparison of the state diagram method with established echocardiography methods (E/E' ratio, LVEF and WMSI). The population in the clinical study consisted of seven patients with non ST-elevation myocardial infarction (NSTEMI) and seven control subjects, individually matched according to age and gender. The state diagram of the heart was generated from TDI curves from seven positions in the myocardium, visualizing the inter- and intraventricular function of the heart by displaying the cardiac phases. RESULTS The clinical examples demonstrated that the state diagram allows for an intuitive visualization of pathological patterns as ischemia and dyssynchrony. Further, significant differences in percentage duration between the control group and the NSTEMI group were found in eight of the totally twenty phases (10 phases for each ventricle), e.g. in the transition phases (Pre-Ejection and Post-Ejection). These phases were significantly longer (> 2.18%) for the NSTEMI group than for the control group (p < 0.05). No significant differences between the groups were found for the established echocardiography methods. CONCLUSION The test results clearly indicate that the state diagram has potential to be an efficient tool for visualization of cardiac dysfunction and for detection of NSTEMI.
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Affiliation(s)
- Matilda Larsson
- School for Technology and Health, Royal Institute of Technology, Alfred Nobels Allé 10, SE-14152 Huddinge, Sweden.
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