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Goulart CDL, Agostoni P, Salvioni E, Silva RN, Bassi-Dibai D, Roscani MG, Arena R, Myers J, Borghi-Silva A. Phenotyping cardiopulmonary exercise testing measures in heart failure with reduced ejection fraction: A comparison between Italy and Brazil. Heart Lung 2024; 65:54-58. [PMID: 38402757 DOI: 10.1016/j.hrtlng.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND While patients with heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) constitutes a global health crisis the incidence, prevalence and prognosis of the disease may differ depending on the continent and country. OBJECTIVE To profile, analyze and compare cardiopulmonary exercise testing (CPET) data of patients with HFrEF between Italian and Brazilian cohorts. METHODS In this observational study, a total of 630 patients with clinical and functional diagnosis of HFrEF (315 patients from Brazil and 315 patients from Italy) performed CPET. RESULTS Although Brazilian patients were slightly younger (Brazil 60±10 vs Italy 64±11 p<0.001) with a better peak oxygen consumption (V̇O2), circulatory power and left ventricular ejection fraction (LVEF) (p<0.01), ventilatory inefficiency and oscillation ventilation was higher when compared to the Italian cohort. When stratifying patients with LVEF≤30 % and age≥60 years, Brazilian patients presented worse ventilatory efficiency, and lower peak V̇O2 compared to the Italian cohort. CONCLUSION Patients with HFrEF from Brazil exhibited higher ventilatory inefficiency and a greater prevalence of oscillatory ventilation during CPET compared to patients with the same diagnosis from Italy.
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Affiliation(s)
- Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP 13565-905, Brazil
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | | | - Rebeca Nunes Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP 13565-905, Brazil
| | - Daniela Bassi-Dibai
- Postgraduate Program in Management in Health Programs and Services, Universidade CEUMA, São Luís, MA, Brazil
| | - Meliza Goi Roscani
- Cardiology and Exercise Research Center Laboratory, Department of Medicine, Federal University of São Carlos, SP, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto CA, United States
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP 13565-905, Brazil.
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Canada JM, Park TS, Ravindra K, Chiabrando JG, Del Buono MG, van Wezenbeek J, Trankle CR, Kadariya D, Keen L, Carbone S, Billingsley H, Wohlford GF, Arena R, Van Tassell BW, Abbate A. Comparison of Cardiorespiratory Fitness in Black or African American Versus Caucasian Patients With Heart Failure. J Cardiopulm Rehabil Prev 2022; 42:39-44. [PMID: 34793367 PMCID: PMC8602869 DOI: 10.1097/hcr.0000000000000605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Cardiopulmonary exercise testing (CPX) is a well-established assessment with important insight into prognosis and therapeutic efficacy in patients with heart failure (HF). Prior studies have identified several clinical differences between Black or African American (B-AA) and Caucasian patients with HF. Differences in key CPX responses between these two groups require further investigation. METHODS Using a database consisting of subjects with symptomatic HF who had undergone CPX for inclusion in various prospective randomized clinical trials, we identified 198 (n = 94 [47%] B-AA; n = 105 [53%] Caucasian) patients with a qualifying baseline CPX. Significant univariate predictors of peak oxygen uptake (V˙o2peak) were included in a multivariate linear regression model. RESULTS When compared with Caucasian patients, B-AA were younger (mean ± SD = 54.8 ± 10.0 vs 57.9 ± 9.6 yr, P = .03), had higher C-reactive protein (CRP) (median [IQR] = 4.9 [2.3, 8.8] vs 1.9 [0.6, 5.5] mg/L, P < .0001), lower hemoglobin (13.0 ± 1.8 vs 13.8 ± 1.6 g/dL, P = .003), and lower left ventricular ejection fraction (LVEF) (40 [32, 51] vs 53 [43, 59]%, P < .00010). During CPX, B-AA patients also had lower V˙o2peak (14.6 ± 3.9 vs 17.6 ± 4.8 mL·kg-1·min-1, P < .0001). No differences were observed between B-AA and Caucasian in the minute ventilation/carbon dioxide production (V˙e/V˙co2) slope (P = .14). The difference in V˙o2peak between B-AA and Caucasian was largely attenuated after adjusting for age, body mass index, CRP, N-terminal pro-brain natriuretic peptide, hemoglobin, LVEF, and peak HR (14.1: 95% CI, 13.2-14.9 vs 15.6: 95% CI, 14.4-16.8 mL·kg-1·min-1, P = .053). CONCLUSIONS Directly measured V˙o2peak was significantly lower in B-AA than in Caucasians with HF. This is largely explained by differences in clinical characteristics, whereas no significant differences were observed in the V˙e/V˙co2 slope.
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Affiliation(s)
- Justin M. Canada
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
| | - Tae Shik Park
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
| | - Krishna Ravindra
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
| | - Juan G. Chiabrando
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
- Interventional Cardiology Service, Hospital Italiano de
Buenos Aires, Buenos Aires, Argentina
| | - Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
- Department of Cardiovascular and Thoracic Sciences,
Catholic University of the Sacred Heart, L.go A. Gemelli, 1, 00168 Rome, Italy
| | - Jessie van Wezenbeek
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
| | - Cory R. Trankle
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
| | - Dinesh Kadariya
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
| | - Larry Keen
- Department of Psychology, Virginia State University,
Petersburg, Virginia, United States
| | - Salvatore Carbone
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
- Department of Kinesiology & Health Sciences, College
of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia,
United States
| | - Hayley Billingsley
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
- Department of Kinesiology & Health Sciences, College
of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia,
United States
| | - George F. Wohlford
- Department of Pharmacotherapy and Outcome Sciences,
Virginia Commonwealth University, Richmond, Virginia, United States
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health
Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Benjamin W. Van Tassell
- Department of Pharmacotherapy and Outcome Sciences,
Virginia Commonwealth University, Richmond, Virginia, United States
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth
University, Richmond, Virginia, United States
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Abstract
PURPOSE OF REVIEW Despite attention to racial disparities in outcomes for heart failure (HF) and other chronic diseases, progress against these inequities has been gradual at best. The disparities of COVID-19 and police brutality have highlighted the pervasiveness of systemic racism in health outcomes. Whether racial bias impacts patient access to advanced HF therapies is unclear. RECENT FINDINGS As documented in other settings, racial bias appears to operate in HF providers' consideration of patients for advanced therapy. Multiple medical and psychosocial elements of the evaluation process are particularly vulnerable to bias. SUMMARY Reducing gaps in access to advanced therapies will require commitments at multiple levels to reduce barriers to healthcare access, standardize clinical operations, research the determinants of patient success and increase diversity among providers and researchers. Progress is achievable but likely requires as disruptive and investment of immense resources as in the battle against COVID-19.
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Affiliation(s)
- Raymond C Givens
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Cardiorespiratory Fitness Change and Mortality Risk Among Black and White Patients: Henry Ford Exercise Testing (FIT) Project. Am J Med 2017; 130:1177-1183. [PMID: 28344150 DOI: 10.1016/j.amjmed.2017.02.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Little is known about the relationship of change in cardiorespiratory fitness and mortality risk in Black patients. This study assessed change in cardiorespiratory fitness and its association with all-cause mortality risk in Black and White patients. METHODS This is a retrospective, longitudinal, observational cohort study of 13,345 patients (age = 55 ± 11 years; 39% women; 26% black) who completed 2 exercise tests, at least 12 months apart at Henry Ford Hospital, Detroit, Mich. All-cause mortality was identified through April 2013. Data were analyzed in 2015-2016 using Cox regression to calculate hazard ratios (HR) for risk of mortality associated with change in sex-specific cardiorespiratory fitness. RESULTS Mean time between the tests was 3.4 years (interquartile range 1.9-5.6 years). During 9.1 years (interquartile range 6.3-11.6 years) of follow-up, there were 1931 (14%) deaths (16.5% black, 13.7% white). For both races, change in fitness from Low to the Intermediate/High category resulted in a significant reduction of death risk (HR 0.65 [95% confidence interval (CI), 0.49-0.87] for Black; HR 0.41 [95% CI, 0.34-0.51] for White). Each 1-metabolic-equivalent-of-task increase was associated with a reduced mortality risk in black (HR 0.84 [95% CI, 0.81-0.89]) and white (HR 0.87 [95% CI, 0.82-0.86]) patients. There was no interaction by race. CONCLUSIONS Among black and white patients, change in cardiorespiratory fitness from Low to Intermediate/High fitness was associated with a 35% and 59% lower risk of all-cause mortality, respectively.
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Carlisle JB. Predicting risk after aneurysm surgery - a reply. Anaesthesia 2015; 70:1320-2. [PMID: 26449293 DOI: 10.1111/anae.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Low cardiorespiratory fitness (CRF) is a well-established risk factor for all-cause and cardiovascular disease mortality. African Americans have higher rates of cardiovascular disease compared with their Caucasian counterparts. However, the extent to which lower CRF levels contribute to the excess risk in African Americans has not been fully explored. The purpose of this review is to: (i) explore the literature evaluating the relationship between CRF and mortality specifically in African American populations; and (ii) critically evaluate the studies which have compared CRF between African American and Caucasians in epidemiological studies and clinical trials. We have further discussed several potential mechanisms that may contribute to the observation of lower CRF levels in African American compared with Caucasian adults, including potential racial differences in physical activity levels, muscle fiber type distribution, and hemoglobin levels. If lower CRF is generally present in African Americans compared with Caucasians, and is of a clinically meaningful difference, this may represent an important public health concern.
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The Heart Failure Survival Score outperforms the peak oxygen consumption for heart transplantation selection in the era of device therapy. J Heart Lung Transplant 2011; 30:315-25. [DOI: 10.1016/j.healun.2010.09.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 09/23/2010] [Accepted: 09/25/2010] [Indexed: 12/25/2022] Open
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Castro RRT, Pedrosa S, Nóbrega ACL. Different ventilatory responses to progressive maximal exercise test performed with either the arms or legs. Clinics (Sao Paulo) 2011; 66:1137-42. [PMID: 21876964 PMCID: PMC3148454 DOI: 10.1590/s1807-59322011000700003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 03/12/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aimed to compare respiratory responses, focusing on the time-domain variability of ventilatory components during progressive cardiopulmonary exercise tests performed on cycle or arm ergometers. METHODS The cardiopulmonary exercise tests were conducted on twelve healthy volunteers on either a cycle ergometer or an arm ergometer following a ramp protocol. The time-domain variabilities (the standard deviations and root mean squares of the successive differences) of the minute ventilation, tidal volume and respiratory rate were calculated and normalized to the number of breaths. RESULTS There were no significant differences in the timing of breathing throughout the exercise when the cycle and arm ergometer measurements were compared. However, the arm exercise time-domain variabilities for the minute ventilation, tidal volume and respiratory rate were significantly greater than the equivalent values obtained during leg exercise. CONCLUSION Although the type of exercise does not influence the timing of breathing when dynamic arm and leg exercises are compared, it does influence time-domain ventilatory variability of young, healthy individuals. The mechanisms that influence ventilatory variability during exercise remain to be studied.
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Affiliation(s)
- Renata R T Castro
- Exercise Physiology Laboratory, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil.
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Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Kitzman DW, Peberdy MA, Bensimhon D, Chase P, Guazzi M. Cardiopulmonary exercise testing is equally prognostic in young, middle-aged and older individuals diagnosed with heart failure. Int J Cardiol 2010; 151:278-83. [PMID: 20580105 DOI: 10.1016/j.ijcard.2010.05.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 04/20/2010] [Accepted: 05/30/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous research has demonstrated the prognostic value of cardiopulmonary exercise testing (CPX) in elderly patients with heart failure (HF). Investigations that have comprehensively examined the value of CPX across different age groups are lacking. The purpose of the present investigation was to evaluate the prognostic value of CPX in young, middle-aged and older patients with HF. METHODS A total of 1605 subjects (age: 59.2 ± 13.7 years, 78% male) underwent CPX and were subsequently tracked for major cardiac events. Ventilatory efficiency (VE/VCO(2) slope) and peak oxygen consumption (VO(2)), both absolute and percent-predicted, were determined. The prognostic value of these CPX variables was assessed in ≤ 45, 46-65 and ≥ 66 year subgroups. RESULTS The three year event rates for major cardiac events in the ≤ 45, 46-65 and ≥ 66 year subgroups were 8.8%, 6.0% and 5.7%, respectively. The VE/VCO(2) slope (Hazard ratio ≥ 1.07, p<0.001), peak VO(2) (Hazard ratio ≤ 0.87, p<0.001) and percent-predicted peak VO(2) (Hazard ratio 0 ≤ 0.98, p<0.001) were all significant prognostic markers in each age subgroup. While the VE/VCO(2) slope carried the greatest prognostic strength, peak VO(2) and percent-predicted peak VO(2) were retained in multivariate analyses (Residual Chi-Square ≥ 5.2, p<0.05). With respect to peak VO(2), the actual value was the more robust prognostic marker in the ≤ 45 and ≥ 66 year subgroups while the percent-predicted expression provided better predictive resolution in subjects who were 46-65 years old. CONCLUSIONS These results indicate that, irrespective of a patient's age at presentation, CPX provides valuable prognostic information in the HF population.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia 23298-0224, USA.
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Goda A, Lund LH, Mancini DM. Comparison across races of peak oxygen consumption and heart failure survival score for selection for cardiac transplantation. Am J Cardiol 2010; 105:1439-44. [PMID: 20451691 DOI: 10.1016/j.amjcard.2009.12.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 12/28/2009] [Accepted: 12/28/2009] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to determine whether peak oxygen consumption (VO(2)) and the Heart Failure Survival Score (HFSS) predict prognosis in European-American, African-American, and Hispanic-American patients with chronic heart failure referred for heart transplantation. The peak VO(2) and the HFSS have previously been shown to effectively risk stratify patients with chronic heart failure and are criteria for the listing for heart transplantation. However, the effect of race on the predictive value of these variables has not been studied. A total of 715 patients with congestive heart failure (433 European American, 126 African American, 123 Hispanic American, and 33 other), who had been referred for heart transplantation, underwent cardiopulmonary exercise testing with measurement of the peak VO(2) and calculation of the HFSS. A total of 354 patients had died or undergone urgent heart transplantation or implantation of a left ventricular assist device during the 962 +/- 912 days of follow-up. On univariate and multivariate Cox hazard analysis, both peak VO(2) and the HFSS were powerful prognostic markers in the overall cohort and in the separate races. In the receiver operating characteristic curve analysis, the areas under the curve at 1 and 2 years of follow-up were greater for the HFSS than for peak VO(2). In conclusion, HFSS and peak VO(2) can be used for transplant selection; however, in the era of modern therapy and across races and genders, the HFSS might perform better than the peak VO(2).
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Affiliation(s)
- Ayumi Goda
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Elmariah S, Goldberg LR, Allen MT, Kao A. The Effects of Race on Peak Oxygen Consumption and Survival in Patients With Systolic Dysfunction. J Card Fail 2010; 16:332-9. [DOI: 10.1016/j.cardfail.2009.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/11/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
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Abstract
Clinical consequences of heart failure are fatigue, dyspnea, and progressive impairment of exercise tolerance. Regular exercise training is associated with health-improving effects. In patients with stable heart failure, exercise training can relieve symptoms, improve exercise capacity and quality of life, as well as reduce hospitalization and, to some extent, risk of mortality. Progressive exercise training is associated with pulmonary, cardiovascular, and skeletal muscle metabolic adaptations that increase oxygen delivery and energy production. This Review focuses on current knowledge of mechanisms by which progressive and moderate exercise training can have sustained beneficial effects on patients with heart failure.
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Lavie CJ, Milani RV, Allerton TD. Peak Oxygen Consumption and Heart Failure Prognosis-Does Race, Sex, or Fat Explain the Discrepancy? ACTA ACUST UNITED AC 2009; 15:41-2. [DOI: 10.1111/j.1751-7133.2008.00048.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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