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Brochhagen J, Coll Barroso MT, Baumgart C, Freiwald J, Hoppe MW. Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls. BMC Cardiovasc Disord 2020; 20:378. [PMID: 32811426 PMCID: PMC7437074 DOI: 10.1186/s12872-020-01661-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background Maximum oxygen uptake is an established measurement of diagnosing chronic heart failure and underlies various central and peripheral factors. However, central and peripheral factors are little investigated, because they are usually measured invasively. The aim of this study was to compare non-invasively measured central and peripheral factors of oxygen uptake between patients with chronic heart failure and healthy controls. Methods Ten male patients with heart failure with reduced ejection fraction (62 ± 4 years; body mass index: 27.7 ± 1.8 kg/m2; ejection fraction: 30 ± 4%) and ten male healthy controls (59 ± 3 years; body mass index: 27.7 ± 1.3 kg/m2) were tested for blood pressure, heart rate, stroke volume, cardiac output, and cardiac power output (central factors) as well as muscle oxygen saturation of the vastus lateralis and biceps brachii muscle (peripheral factors) during an incremental cycling test. Stroke volume and muscle oxygen saturation were non-invasively measured by a bioreactance analysis and near-infrared spectroscopy, respectively. Additionally, a maximum isometric strength test of the knee extensors was conducted. Magnitude-based inferences were computed for statistical analyses. Results Patients had a likely to most likely lower oxygen uptake, mean arterial pressure, and heart rate at maximum load as well as very likely lower isometric peak torque. Contrary, patients had a possibly to likely higher stroke volume and muscle oxygen saturation of the vastus lateralis muscle at maximum load. Differences in cardiac output, cardiac power output, and muscle oxygen saturation of the biceps brachii muscle at maximum load were unclear. Conclusions Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls. Therefore, it is promising to measure both types of factors in patients with chronic heart failure to optimize the diagnosis and therapy.
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Affiliation(s)
- Joana Brochhagen
- Institute of Movement and Training Science I, University of Leipzig, Jahnallee 59, 04109, Leipzig, Germany. .,Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119, Wuppertal, Germany.
| | | | - Christian Baumgart
- Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119, Wuppertal, Germany
| | - Jürgen Freiwald
- Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119, Wuppertal, Germany
| | - Matthias Wilhelm Hoppe
- Institute of Movement and Training Science I, University of Leipzig, Jahnallee 59, 04109, Leipzig, Germany
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2
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Barroso MTC, Hoppe MW, Boehme P, Krahn T, Kiefer C, Kramer F, Mondritzki T, Pirez P, Dinh W. Test-Retest Reliability of Non-Invasive Cardiac Output Measurement during Exercise in Healthy Volunteers in Daily Clinical Routine. Arq Bras Cardiol 2019; 113:231-239. [PMID: 31291418 PMCID: PMC6777898 DOI: 10.5935/abc.20190116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022] Open
Abstract
Background Thoracic bioreactance (TB), a noninvasive method for the measurement of
cardiac output (CO), shows good test-retest reliability in healthy adults
examined under research and resting conditions. Objective In this study, we evaluate the test-retest reliability of CO and cardiac
power (CPO) output assessment during exercise assessed by TB in healthy
adults under routine clinical conditions. Methods 25 test persons performed a symptom-limited graded cycling test in an
outpatient office on two different days separated by one week.
Cardiorespiratory (power output, VO2peak) and hemodynamic
parameters (heart rate, stroke volume, CO, mean arterial pressure, CPO) were
measured at rest and continuously under exercise using a spiroergometric
system and bioreactance cardiograph (NICOM, Cheetah Medical). Results After 8 participants were excluded due to measurement errors (outliers),
there was no systematic bias in all parameters under all conditions (effect
size: 0.2-0.6). We found that all noninvasively measured CO showed
acceptable test-retest-reliability (intraclass correlation coefficient:
0.59-0.98; typical error: 0.3-1.8). Moreover, peak CPO showed better
reliability (intraclass correlation coefficient: 0.80-0.85; effect size:
0.9-1.1) then the TB CO, thanks only to the superior reliability of MAP
(intraclass correlation coefficient: 0.59-0.98; effect size: 0.3-1.8). Conclusion Our findings preclude the clinical use of TB in healthy subject population
when outliers are not identified.
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Affiliation(s)
- Michael Thomas Coll Barroso
- Helios Clinics Wuppertal - Department of Cardiology, University Hospital Witten/Herdecke, Wuppertal - Germany
| | - Matthias Wilhelm Hoppe
- University Wuppertal - Department of Movement and Training Science, Wuppertal - Germany.,Department of Orthopedic, Trauma, Hand and Neuro Surgery, Klinikum Osnabrück GmbH, Osnabrück - Germany
| | - Philip Boehme
- Helios Clinics Wuppertal - Department of Cardiology, University Hospital Witten/Herdecke, Wuppertal - Germany.,Bayer AG - Open Innovation & Digital Technologies, Wuppertal - Germany
| | - Thomas Krahn
- Bayer AG - Research & Development, Pharmaceuticals, Biomarker Research, Wuppertal - Germany
| | - Christian Kiefer
- Helios Clinics Wuppertal - Department of Cardiology, University Hospital Witten/Herdecke, Wuppertal - Germany
| | - Frank Kramer
- Bayer AG - Translational Science, Clinical Sciences Experimental, Wuppertal - Germany
| | - Thomas Mondritzki
- Helios Clinics Wuppertal - Department of Cardiology, University Hospital Witten/Herdecke, Wuppertal - Germany.,Bayer AG - Research & Development, Pharmaceutical, Preclinical Research, Wuppertal - Germany
| | - Phillipe Pirez
- Bayer AG - Translational Science, Clinical Sciences Experimental, Wuppertal - Germany
| | - Wilfried Dinh
- Helios Clinics Wuppertal - Department of Cardiology, University Hospital Witten/Herdecke, Wuppertal - Germany.,Bayer AG - Translational Science, Clinical Sciences Experimental, Wuppertal - Germany
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3
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Tannvik TD, Rimehaug AE, Skjærvold NK, Kirkeby‐Garstad I. Post cardiac surgery stunning reduces stroke work, but leaves cardiac power output unchanged in patients with normal ejection fraction. Physiol Rep 2018; 6:e13781. [PMID: 29998610 PMCID: PMC6041697 DOI: 10.14814/phy2.13781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/25/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022] Open
Abstract
This study assesses positional changes in cardiac power output and stroke work compared with classic hemodynamic variables, measured before and after elective coronary artery bypass graft surgery. The hypothesis was that cardiac power output was altered in relation to cardiac stunning. The study is a retrospective analysis of data from two previous studies performed in a tertiary care university hospital. Thirty-six patients scheduled for elective coronary artery bypass graft surgery, with relatively preserved left ventricular function, were included. A pulmonary artery catheter and a radial artery catheter were placed preoperatively. Cardiac power output and stroke work were calculated through thermodilution both supine and standing prior to induction of anesthesia and again day one postoperatively. Virtually all systemic hemodynamic parameters changed significantly from pre- to postoperatively, and from supine to standing. Cardiac power output was maintained at 0.9-1.0 (±0.3) W both pre- and postoperatively and from supine to standing on both days. Stroke work fell from pre- to postoperatively from 1.1 to 0.8 J (P < 0.001), there was a significant fall in stroke work with positional change preoperatively from 1.1 to 0.9 J (P < 0.001). Postoperatively the stroke work remained at 0.8 J despite positional change. Cardiac power output was the only systemic hemodynamic variable which remained unaltered during all changes. Stroke work appears to be a more sensitive marker for temporary cardiovascular dysfunction than cardiac power output. Further studies should explore the relationship between stroke work and cardiac performance and whether cardiac power output is an autoregulated intrinsic physiological parameter.
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Affiliation(s)
- Tomas D. Tannvik
- Department of Anaesthesia and Intensive CareSt Olav's HospitalTrondheim University HospitalTrondheimNorway
- Faculty of Medicine and Health SciencesInstitute of Circulation and Medical ImagingNorges Teknisk‐Naturvitenskapelige UniversitetTrondheimNorway
| | - Audun E. Rimehaug
- Department of Anaesthesia and Intensive CareSt Olav's HospitalTrondheim University HospitalTrondheimNorway
| | - Nils K. Skjærvold
- Department of Anaesthesia and Intensive CareSt Olav's HospitalTrondheim University HospitalTrondheimNorway
- Faculty of Medicine and Health SciencesInstitute of Circulation and Medical ImagingNorges Teknisk‐Naturvitenskapelige UniversitetTrondheimNorway
| | - Idar Kirkeby‐Garstad
- Department of Anaesthesia and Intensive CareSt Olav's HospitalTrondheim University HospitalTrondheimNorway
- Faculty of Medicine and Health SciencesInstitute of Circulation and Medical ImagingNorges Teknisk‐Naturvitenskapelige UniversitetTrondheimNorway
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4
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Lafountain RA, da Silveira JS, Varghese J, Mihai G, Scandling D, Craft J, Swain CB, Franco V, Raman SV, Devor ST, Simonetti OP. Cardiopulmonary exercise testing in the MRI environment. Physiol Meas 2016; 37:N11-25. [DOI: 10.1088/0967-3334/37/4/n11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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5
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Van Iterson EH, Karpen SR, Baker SE, Wheatley CM, Morgan WJ, Snyder EM. Impaired cardiac and peripheral hemodynamic responses to inhaled β₂-agonist in cystic fibrosis. Respir Res 2015; 16:103. [PMID: 26341519 PMCID: PMC4560914 DOI: 10.1186/s12931-015-0270-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/19/2015] [Indexed: 11/25/2022] Open
Abstract
Background Pulmonary system dysfunction is a hallmark of cystic fibrosis (CF) disease. In addition to impaired cystic fibrosis transmembrane conductance regulator protein, dysfunctional β2-adrenergic receptors (β2AR) contribute to low airway function in CF. Recent observations suggest CF may also be associated with impaired cardiac function that is demonstrated by attenuated cardiac output (Q), stroke volume (SV), and cardiac power (CP) at both rest and during exercise. However, β2AR regulation of cardiac and peripheral vascular tissue, in-vivo, is unknown in CF. We have previously demonstrated that the administration of an inhaled β-agonist increases SV and Q while also decreasing SVR in healthy individuals. Therefore, we aimed to assess cardiac and peripheral hemodynamic responses to the selective β2AR agonist albuterol in individuals with CF. Methods 18 CF and 30 control (CTL) subjects participated (ages 22 ± 2 versus 27 ± 2 and BSA = 1.7 ± 0.1 versus 1.8 ± 0.0 m2, both p < 0.05). We assessed the following at baseline and at 30- and 60-minutes following nebulized albuterol (2.5mg diluted in 3.0mL of normal saline) inhalation: 12-lead ECG for HR, manual sphygmomanometry for systolic and diastolic blood pressure (SBP and DBP, respectively), acetylene rebreathe for Q and SV. We calculated MAP = DBP + 1/3(SBP–DBP); systemic vascular resistance (SVR) = (MAP/Q)•80; CP = Q•MAP; stroke work (SW) = SV•MAP; reserve (%change baseline to 30- or 60-minutes). Hemodynamics were indexed to BSA (QI, SVI, SWI, CPI, SVRI). Results At baseline, CF demonstrated lower SV, SVI, SW, and SWI but higher HR than CTL (p < 0.05); other measures did not differ. At 30-minutes, CF demonstrated higher HR and SVRI, but lower Q, SV, SVI, CP, CPI, SW, and SWI versus CTL (p < 0.05). At 60-minutes, CF demonstrated higher HR, SVR, and SVRI, whereas all cardiac hemodynamics were lower than CTL (p < 0.05). Reserves of CP, SW, and SVR were lower in CF versus CTL at both 30 and 60-minutes (p < 0.05). Conclusions Cardiac and peripheral hemodynamic responsiveness to acute β2AR stimulation via albuterol is attenuated in individuals with CF, suggesting β2AR located in cardiac and peripheral vascular tissue may be dysfunctional in this population.
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Affiliation(s)
- Erik H Van Iterson
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE., Minneapolis, MN, 55455, USA. .,Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Stephen R Karpen
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA.
| | - Sarah E Baker
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA. .,Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Courtney M Wheatley
- College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA. .,Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Wayne J Morgan
- Department of Pediatrics, University of Arizona, 1501 N. Campbell Avenue, Room 3301, Tucson, AZ, 85724, USA.
| | - Eric M Snyder
- School of Kinesiology, University of Minnesota, Cooke Hall, 1900 University Ave SE., Minneapolis, MN, 55455, USA. .,College of Pharmacy, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA.
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6
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Paap D, Takken T. Reference values for cardiopulmonary exercise testing in healthy adults: a systematic review. Expert Rev Cardiovasc Ther 2014; 12:1439-53. [DOI: 10.1586/14779072.2014.985657] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Klasnja AV, Jakovljevic DG, Barak OF, Popadic Gacesa JZ, Lukac DD, Grujic NG. Cardiac power output and its response to exercise in athletes and non-athletes. Clin Physiol Funct Imaging 2013; 33:201-5. [PMID: 23522013 DOI: 10.1111/cpf.12013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/21/2012] [Indexed: 11/30/2022]
Abstract
Cardiac power output (CPO) is an integrative measure of overall cardiac function as it accounts for both, flow- and pressure-generating capacities of the heart. The purpose of the present study was twofold: (i) to assess cardiac power output and its response to exercise in athletes and non-athletes and (ii) to determine the relationship between cardiac power output and reserve and selected measures of cardiac function and structure. Twenty male athletes and 32 age- and gender-matched healthy sedentary controls participated in this study. CPO was calculated as the product of cardiac output and mean arterial pressure, expressed in watts. Measures of hemodynamic status, cardiac structure and pumping capability were assessed by echocardiography. CPO was assessed at rest and after peak bicycle exercise. At rest, the two groups had similar values of cardiac power output (1·08 ± 0·2 W versus 1·1 ± 0·24 W, P>0·05), but the athletes demonstrated lower systolic blood pressure (109·5 ± 6·2 mmHg versus 117·2 ± 8·2 mmHg, P<0·05) and thicker posterior wall of the left ventricle (9·8 ± 1 mm versus 9 ± 1·1 mm, P<0·05). Peak CPO was higher in athletes (5·87 ± 0·75 W versus 5·4 ± 0·69 W, P<0·05) as was cardiac reserve (4·92 ± 0·66 W versus 4·26 ± 0·61 W, P<0·05), respectively. Peak exercise CPO and reserve were only moderately correlated with end-diastolic volume (r = 0·54; r = 0·46, P<0·05) and end-diastolic left ventricular internal diameter (r = 0·48; r = 0·42, P<0·05), respectively. Athletes demonstrated greater maximal cardiac pumping capability and reserve than non-athletes. The study provides new evidence that resting measures of cardiac structure and function need to be considered with caution in interpretation of maximal cardiac performance.
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Affiliation(s)
- Aleksandar V Klasnja
- Department of Physiology, Medical faculty, University of Novi Sad, Novi Sad, Serbia.
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8
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Jakovljevic DG, Popadic-Gacesa JZ, Barak OF, Nunan D, Donovan G, Trenell MI, Grujic NG, Brodie DA. Relationship between peak cardiac pumping capability and indices of cardio-respiratory fitness in healthy individuals. Clin Physiol Funct Imaging 2012; 32:388-93. [PMID: 22856346 DOI: 10.1111/j.1475-097x.2012.01143.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 03/27/2012] [Indexed: 11/28/2022]
Abstract
Cardiac power output (CPO) is a unique and direct measure of overall cardiac function (i.e. cardiac pumping capability) that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the relationship between peak exercise CPO and selected indices of cardio-respiratory fitness. Thirty-seven healthy adults (23 men and 14 women) performed an incremental exercise test to volitional fatigue using the Bruce protocol with gas exchange and ventilatory measurements. Following a 40-min recovery, the subjects performed a constant maximum workload exercise test at or above 95% of maximal oxygen consumption. Cardiac output was measured using the exponential CO(2) rebreathing method. The CPO, expressed in W, was calculated as the product of the mean arterial blood pressure and cardiac output. At peak exercise, CPO was well correlated with cardiac output (r = 0·92, P<0·01), stroke volume (r = 0·90, P<0·01) and peak oxygen consumption (r = 0·77, P<0·01). The coefficient of correlation was moderate between CPO and anaerobic threshold (r = 0·47, P<0·01), oxygen pulse (r = 0·57, P<0·01), minute ventilation (r = 0·53, P<0·01) and carbon dioxide production (r = 0·56, P<0·01). Small but significant relationship was found between peak CPO and peak heart rate (r = 0·23, P<0·05). These findings suggest that only peak cardiac output and stroke volume truly reflect CPO. Other indices of cardio-respiratory fitness such as oxygen consumption, anaerobic threshold, oxygen pulse, minute ventilation, carbon dioxide production and heart rate should not be used as surrogates for overall cardiac function and pumping capability of the heart.
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9
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Hall SG, Garcia J, Larson DF, Smith R. Cardiac power index: staging heart failure for mechanical circulatory support. Perfusion 2012; 27:456-61. [PMID: 22695792 DOI: 10.1177/0267659112450933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Cardiac power output has been shown to quantify cardiac reserve. Cardiac reserve is defined as the difference between basal and maximal cardiac performance. We compared cardiac power index to other commonly used hemodynamic parameters to validate its usefulness to stage heart failure patients and determine the optimal time for implantation of mechanical circulatory support. A retrospective study of twenty-eight heart failure patients implanted with mechanical circulatory support was analyzed at three levels of drug therapy. Subjects were further separated into two categories: survived versus deceased. Cardiac power index was the only statistically significant hemodynamic parameter that identified cardiac reserve (p<0.05) in this patient population. These results showed that a cardiac power index at or below 0.34 Watts/m(2) resulted in increased mortality rate, ninety days post-implantation. CONCLUSION Cardiac reserve was a determinant of post-device survival; therefore, these data suggest that device implantation should occur prior to the 0.34 Watts/m(2) threshold.
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Affiliation(s)
- S G Hall
- Circulatory Sciences Graduate Perfusion Program, The University of Arizona, Tucson, Arizona, USA
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10
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Schlader ZJ, Mündel T, Barnes MJ, Hodges LD. Peak cardiac power output in healthy, trained men. Clin Physiol Funct Imaging 2011; 30:480-4. [PMID: 20718806 DOI: 10.1111/j.1475-097x.2010.00959.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Previous investigations into peak cardiac power output (CPO peak) have been limited to clinical populations and healthy, but non-athletic adults, and normative data on trained individuals would allow a greater understanding of this parameter. Therefore, we recruited eight healthy, well-trained male cyclists. Peak oxygen consumption ((.)VO₂ peak) was assessed using an incremental ergometer test, and following a 40-min recovery period, peak cardiac output ((.)QT peak) was measured during a constant load test that elicited (.)VO₂ peak (±5%) using the Defares CO₂ rebreathing technique. CPO peak was calculated as described by Cooke et al. (1998). Mean (±SD) values during the constant load test were: (.)VO₂ peak, 4.94 ± 0.41 l min⁻¹; (.)QT peak, 36.5 ± 3.7 l min⁻¹; mean arterial pressure, 123 ± 8 mmHg and CPO peak, 9.9 ± 1.0 W. These results demonstrate CPO peak in a well-trained population to be approximately twice those observed in healthy, but non-athletic adults. The current data provide useful information regarding the upper limits and possible 'trainability' of cardiac pumping capacity for sedentary and clinically compromised individuals.
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Affiliation(s)
- Zachary J Schlader
- Division of Exercise and Sports Science, Institute of Food, Nutrition and Human Health, Massey University, Palmerston North, New Zealand
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11
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Ohashi Y, Ibrahim H, Furtado L, Kingdom J, Carvalho JCA. Non-Invasive Hemodynamic Assessment of Non-pregnant, Healthy Pregnant and Preeclamptic Women using Bio-Reactance. Braz J Anesthesiol 2010; 60:603-13, 335-40. [DOI: 10.1016/s0034-7094(10)70075-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/14/2010] [Indexed: 10/26/2022] Open
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Jakovljevic DG, George RS, Donovan G, Nunan D, Henderson K, Bougard RS, Yacoub MH, Birks EJ, Brodie DA. Comparison of cardiac power output and exercise performance in patients with left ventricular assist devices, explanted (recovered) patients, and those with moderate to severe heart failure. Am J Cardiol 2010; 105:1780-5. [PMID: 20538130 DOI: 10.1016/j.amjcard.2010.01.362] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 01/29/2010] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
Abstract
Peak cardiac power output (CPO), as a direct measurement of overall cardiac function, has been shown to be a most powerful predictor of prognosis for patients with chronic heart failure. The present study assessed CPO and exercise performance in patients implanted with a left ventricular assist device (LVAD), those explanted due to myocardial recovery, and those with moderate to severe heart failure. Hemodynamic and respiratory gas exchange measurements were undertaken at rest and at peak graded exercise. These were performed in 54 patients-20 with moderate to severe heart failure, 18 with implanted LVADs, and 16 with explanted LVADs. At rest there was a nonsignificant difference in CPO among groups (p >0.05). Peak CPO was significantly higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 1.90 +/- 0.45 W, implanted LVAD 2.37 +/- 0.55 W, explanted LVAD 3.39 +/- 0.61 W, p <0.01) as was peak cardiac output (heart failure 9.1 +/- 2.1 L/min, implanted LVAD 12.4 +/- 2.2 L/min, explanted LVD 14.6 +/- 2.9 L/min, p <0.01). Peak oxygen consumption was higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 15.8 +/- 4.1 ml/kg/min, implanted LVAD 19.8 +/- 5.8 ml/kg/min, explanted LVAD 28.2 +/- 5.0 ml/kg/min, p <0.05) as was anaerobic threshold (heart failure 11.2 +/- 1.9 ml/kg/min, implanted LVAD 14.7 +/- 4.9 ml/kg/min, explanted LVAD 21.4 +/- 5.0 ml/kg/min, p <0.05). In conclusion, peak CPO differentiates well during cardiac restoration using LVADs and emphasizes the benefits of this therapy. CPO has the potential to be a key physiologic marker of heart failure severity and can guide management of patients with LVAD.
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13
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Resting measures and physiological responses to exercise for the determination of prognosis in patients with chronic heart failure: useful tools for clinical decision-making. Cardiol Rev 2010; 18:171-7. [PMID: 20539100 DOI: 10.1097/crd.0b013e3181c4ae0c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite recent advances in the management of chronic heart failure (CHF), the prognosis of many of these patients remains dire. The need for an accurate prognosis in these patients has led to the identification of several indicators purported to represent the impact of the disease. Such indicators often are obtained at rest and are not always accurate at determining the clinical status of CHF patients. As a result, the relationship between prognostic indicators and clinical outcomes is frequently weak. On the other hand, physiological responses to acute exercise may unmask patients with the worst clinical status and identify those at increased risk of poor outcomes. Therefore, the present review appraises the value of several prognostic indicators for patients with CHF collected at rest and in response to exercise. In particular, it contrasts the value and accuracy of predictors of mortality widely used in clinical settings, such as oxygen uptake, ventilatory efficiency, and left ventricular ejection fraction, with new and more direct indicators of ventricular systolic and diastolic function.
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14
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Hogan TS. Exercise-induced reduction in systemic vascular resistance: a covert killer and an unrecognised resuscitation challenge? Med Hypotheses 2009; 73:479-84. [PMID: 19631477 DOI: 10.1016/j.mehy.2009.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 06/06/2009] [Accepted: 06/11/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Systemic vascular resistance falls in exercise as a consequence of metabolically-linked vasodilatation in active skeletal muscles. This exercise-induced vasodilatation is closely linked with reduced muscle tissue oxygen tension in and is characterised by reduced response to adrenergic vasoconstrictor mechanisms which is often referred to as functional sympatholysis. Systemic arterial blood pressure in exercise is maintained at normal or, more commonly, at elevated levels by increase in cardiac output and increased sympathetic vasomotor tone. Recovery of normal resting skeletal muscle tissue oxygen tension and skeletal muscle vascular tone after exercise depends on the post-exercise recovery process. This process requires ongoing elevated skeletal muscle perfusion and can therefore be predicted to be impaired in shock and cardiopulmonary resuscitation scenarios. Comprehensive consideration of this exercise physiology and its extrapolation into shock, cardiac arrest and resuscitation scenarios supports the proposal that exercise-induced sympatholytic vasodilatation in skeletal muscle may be of considerable unrecognised significance for resuscitation medicine. MAIN HYPOTHESIS: Reduced systemic vascular resistance due to pre-existing exercise-induced sympatholytic vasodilatation in skeletal muscle can significantly exacerbate systemic arterial hypotension in acute shock states and resuscitation scenarios. SUB-HYPOTHESES: 1. Onset of syncope, clinical shock states and pulseless electrical activity can occur at significantly higher cardiac output levels in subjects who were engaged in immediate pre-morbid exercise as compared to resting subjects. 2. The efficacy of external chest compression in generating coronary and cerebral perfusion in cardiopulmonary resuscitation can be significantly impaired when cardiac arrest has occurred during exercise. 3. The efficacy of adrenergic vasopressor agents in resuscitation scenarios can be significantly impaired in subjects who were engaged in immediate pre-morbid exercise. CURRENT EVIDENCE The limited available evidence is compatible with the hypothesis being true but does not provide direct confirmation. There is no evidence available directly supporting or refuting the hypothesis. IMPLICATIONS Significant potential clinical implications are outlined relating to the management of cardiopulmonary and trauma resuscitation for patients who were involved in immediate pre-morbid exercise, particularly, but not exclusively, at higher exercise intensities. There are also significant potential prognostic implications. CONCLUSION Reduction in systemic vascular resistance due to exercise-induced sympatholytic vasodilatation in skeletal muscle may largely explain the reported poor success rate for cardiopulmonary resuscitation with prompt defibrillation for sudden cardiac arrest in young previously healthy athletes. Investigation of this unexplored area of pathophysiology poses major difficulties but could lead to significant improvements in the outcomes of resuscitation for patients who were involved in immediate pre-morbid exercise.
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Affiliation(s)
- Tom S Hogan
- Department of Anaesthesia, Connolly Hospital, Dublin 15, Ireland.
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Heringlake M, Kox T, Poeling J, Klaus S, Hanke T, Franz N, Eberhardt F, Heinze H, Armbruster FP, Bahlmann L. The effects of physical exercise on plasma levels of relaxin, NTproANP, and NTproBNP in patients with ischemic heart disease. Eur J Med Res 2009; 14:106-12. [PMID: 19380280 PMCID: PMC3352058 DOI: 10.1186/2047-783x-14-3-106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The insulin-like and vasodilatatory polypeptide relaxin (RLX), formerly known as a pregnancy hormone, has gained interest as a potential humoral mediator in human heart failure. Controversy exists about the relation between plasma levels of RLX and the severity of heart failure. The present study was designed to determine the course of RLX, atrial, and brain natriuretic peptide (NT-proANP and NT-proBNP) during physical exercise in patients with ischemic heart disease (IHD) and to relate hormone levels to peak cardiac power output (CPO) as a measure of cardiopulmonary function with prognostic relevance. 40 patients with IHD were studied during right-heart-catheterization at rest and during supine bicycle ergometry. RLX, NTproBNP, and NTproANP were determined before, during exercise, and after recovery. NT-proANP and NT-proBNP levels increased during maximal charge, and recovery while RLX levels decreased. Cardiac power output at maximal charge correlated inversely with NTproANP and NTproBNP but positively with RLX. Patients with high degree heart failure (CPO < 1.96 W) had higher NTproANP and NTproB-NP and lower RLX levels than patients with low degree heart failure. While confirming the role of NTproANP and NTproBNP as markers for the severity of heart failure, the present data do not support the concept that plasma levels of RLX are related to the severity of myocardial dysfunction and that systemic RLX acts as a compensatory vasodilatatory response hormone in ischemic heart disease.
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Hodges LD, Sandercock GRH, Das SK, Brodie DA. Randomized controlled trial of supervised exercise to evaluate changes in cardiac function in patients with peripheral atherosclerotic disease. Clin Physiol Funct Imaging 2007; 28:32-7. [PMID: 18005078 DOI: 10.1111/j.1475-097x.2007.00770.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Peripheral atherosclerotic disease (PAD) is a condition characterized by low functional capacity which is associated with impaired free living, ambulation and low exercise tolerance. The purpose of this randomized controlled study was to evaluate whether changes in maximal walking time are associated with adaptations in cardiovascular function following supervised exercise. METHODS After ethics approval, 28 patients (63 +/- 11 years) completed a graded treadmill test (2 min stages, 3.2 km h(-1), with gradient increasing 2% every 2 min) until they reached level three or four on the claudication pain scale. Peak oxygen consumption was assessed on a breath-by-breath basis, by online expiratory gas analysis. Following a 40-min recovery period, peak cardiac output was measured using the non-invasive carbon dioxide rebreathing method described by Defares (J Appl Physiol, 13, 1958, 159). Peak cardiac power output was then computed using the equation described by Cooke et al. (Heart, 1998, 79, 289). Patients were randomly assigned to one of two groups: supervised, who exercised at the hospital twice weekly for 12 weeks or control, who received normal treatment which included encouragement to walk regularly. RESULTS After 12 weeks, there were no significant changes in body mass, peak oxygen consumption, peak cardiac output, peak heart rate, peak cardiac power output, respiratory exchange ratio or rating of perceived exertion in both the supervised and control group. There was a significant improvement (91%) in maximal walking distance following the supervised exercise programme. Although patients' peak cardiovascular measurements were unchanged, the patients in the supervised exercise group were able to complete a higher workload at the end of the 12 weeks of exercise, for the equivalent demands on the circulation system. CONCLUSIONS The findings from this study suggest that a short-term period of supervised exercise training results in an improved walking time in patients with limiting claudication because of PAD. It also demonstrated that the cardiovascular system becomes more efficient in meeting the demands of exercise. It is recommended that individuals with PAD should undertake exercise as a form of treatment.
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Affiliation(s)
- L D Hodges
- Research Centre for Health Studies, Chalfont St Giles, Buckinghamshire, UK.
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