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Agostoni P, Mapelli M, Salvioni E, Mattavelli I, Banfi C, Bonomi A, Biondi ML, Rovai S, Tamborini G, Muratori M, Ghulam Ali S, Ghilardi S, De Martino F, Vignati C, Palermo P, Gugliandolo P, Elia D, Moscucci F, Cassandro R, Andreini D, Mancini E, Harari S. Symptomatic post COVID patients have impaired alveolar capillary membrane function and high VE/VCO 2. Respir Res 2024; 25:82. [PMID: 38331869 PMCID: PMC10851544 DOI: 10.1186/s12931-023-02602-3] [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: 05/22/2023] [Accepted: 11/12/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Post COVID-19 syndrome is characterized by several cardiorespiratory symptoms but the origin of patients' reported symptomatology is still unclear. METHODS Consecutive post COVID-19 patients were included. Patients underwent full clinical evaluation, symptoms dedicated questionnaires, blood tests, echocardiography, thoracic computer tomography (CT), spirometry including alveolar capillary membrane diffusion (DM) and capillary volume (Vcap) assessment by combined carbon dioxide and nitric oxide lung diffusion (DLCO/DLNO) and cardiopulmonary exercise test. We measured surfactant derive protein B (immature form) as blood marker of alveolar cell function. RESULTS We evaluated 204 consecutive post COVID-19 patients (56.5 ± 14.5 years, 89 females) 171 ± 85 days after the end of acute COVID-19 infection. We measured: forced expiratory volume (FEV1) 99 ± 17%pred, FVC 99 ± 17%pred, DLCO 82 ± 19%, DM 47.6 ± 14.8 mL/min/mmHg, Vcap 59 ± 17 mL, residual parenchymal damage at CT 7.2 ± 3.2% of lung tissue, peakVO2 84 ± 18%pred, VE/VCO2 slope 112 [102-123]%pred. Major reported symptoms were: dyspnea 45% of cases, tiredness 60% and fatigability 77%. Low FEV1, Vcap and high VE/VCO2 slope were associated with persistence of dyspnea. Tiredness was associated with high VE/VCO2 slope and low PeakVO2 and FEV1 while fatigability with high VE/VCO2 slope. SPB was fivefold higher in post COVID-19 than in normal subjects, but not associated to any of the referred symptoms. SPB was negatively associated to Vcap. CONCLUSIONS In patients with post COVID-19, cardiorespiratory symptoms are linked to VE/VCO2 slope. In these patients the alveolar cells are dysregulated as shown by the very high SPB. The Vcap is low likely due to post COVID-19 pulmonary endothelial/vasculature damage but DLCO is only minimally impaired being DM preserved.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via Parea, 4, 20138, Milan, Italy.
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | | | | | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Sara Rovai
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | | | - Fabiana De Martino
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Unità Funzionale di Cardiologia, Casa di Cura Tortorella, Salerno, Italy
| | | | | | | | - Davide Elia
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, MultiMedica IRCCS, Milan, Italy
| | - Federica Moscucci
- DAI Internal Medicine and Medical Specialities, Policlinico Umberto I, Rome, Italy
| | - Roberto Cassandro
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, MultiMedica IRCCS, Milan, Italy
| | - Daniele Andreini
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Sergio Harari
- Department of Clinical Sciences and Community Health, University of Milan, Via Parea, 4, 20138, Milan, Italy
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, MultiMedica IRCCS, Milan, Italy
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Vignati C, Contini M, Salvioni E, Lombardi C, Caravita S, Bilo G, Swenson ER, Parati G, Agostoni P. Exercise in hypoxia: a model from laboratory to on-field studies. Eur J Prev Cardiol 2023; 30:ii40-ii46. [PMID: 37819224 DOI: 10.1093/eurjpc/zwad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 10/13/2023]
Abstract
Clinical outcome and quality of life of patients with chronic heart failure (HF) have greatly improved over the last two decades. These results and the availability of modern lifts allow many cardiac patients to spend leisure time at altitude. Heart failure per se does not impede a safe stay at altitude, but exercise at both simulated and real altitudes is associated with a reduction in performance, which is inversely proportional to HF severity. For example, in normal subjects, the reduction in functional capacity is ∼2% every 1000 m altitude increase, whereas it is 4 and 10% in HF patients with normal or slightly diminished exercise capacity and in HF patients with markedly diminished exercise capacity, respectively. Also, the on-field experience with HF patients at altitude confirms safety and shows overall similar data to that reported at simulated altitude. Even 'optimal' HF treatment in patients spending time at altitude or at hypoxic conditions is likely different from optimal treatment at sea level, particularly with regard to the selectivity of β-blockers. Furthermore, high altitude, both simulated and on-field, represents a stimulating model of hypoxia in HF patients and healthy subjects. Our data suggest that spending time at altitude (<3500 m) can be safe even for HF patients, provided that subjects are free from comorbidities that may directly interfere with the adaptation to altitude and are stable. However, HF patients experience a reduction of exercise capacity directly proportional to HF severity and altitude. Finally, HF patients should be tested for functional capacity and must undergo a specific 'hypoxic-tailored treatment' to avoid pharmacological interference with altitude adaptation mechanisms, particularly with regard to the selectivity of β-blockers.
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Affiliation(s)
- Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Via Parea, Milano 20138, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Parea, Milano 20138, Italy
| | - Mauro Contini
- Centro Cardiologico Monzino, IRCCS, Via Parea, Milano 20138, Italy
| | | | - Carolina Lombardi
- Sleep Medicine Center, Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Erik R Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea, Milano 20138, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Parea, Milano 20138, Italy
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3
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Magrì D, Palermo P, Salvioni E, Mapelli M, Gallo G, Vignati C, Mattavelli I, Gugliandolo P, Maruotti A, Di Loro PA, Fiori E, Sciomer S, Agostoni P. Influence of exertional oscillatory breathing and its temporal behavior in patients with heart failure and reduced ejection fraction. Int J Cardiol 2023:S0167-5273(23)00659-9. [PMID: 37164295 DOI: 10.1016/j.ijcard.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/12/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Exertional oscillatory breathing (EOV) represents an emerging prognostic marker in heart failure (HF) patients, however little is known about EOV meaning with respect to its disappearance/persistence during cardiopulmonary exercise test (CPET). The present single-center study evaluated EOV clinical and prognostic impact in a large cohort of reduced ejection fraction HF patients (HFrEF) and, contextually, if a specific EOV temporal behavior might be an addictive risk predictor. METHODS AND RESULTS Data from 1.866 HFrEF patients on optimized medical therapy were analysed. The primary cardiovascular (CV) study end-point was cardiovascular death, heart transplantation or LV assistance device (LVAD) implantation at 5-years. For completeness a secondary end-point of total mortality at 5- years was also explored. EOV presence was identified in 251 patients (13%): 142 characterized by EOV early cessation (Group A) and 109 by EOV persistence during the whole CPET (Group B). The entire EOV Group showed worse clinical and functional status than NoEOV Group (n = 1.615) and, within the EOV Group, Group B was characterized by a more severe HF. At CV survival analysis, EOV patients showed a poorer outcome than the NoEOV Group (events 27.1% versus 13.1%, p < 0.001) both unpolished and after matching for main confounders. Instead, no significant differences were found between EOV Group A and B with respect to CV outcome. Conversely the analysis for total mortality failed to be significant. CONCLUSIONS Our analysis, albeit retrospective, supports the inclusion of EOV into a CPET-centered clinical and prognostic evaluation of the HFrEF patients. EOV characterizes per se a more advanced HFrEF stage with an unfavorable CV outcome. However, the EOV persistence, albeit suggestive of a more severe HF, does not emerge as a further prognostic marker.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University, Rome, Italy
| | | | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Dept. of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milan, Italy
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University, Rome, Italy
| | | | | | | | - Antonello Maruotti
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne - Libera Università Maria Ss Assunta; Department of Mathematics, University of Bergen, Norway; School of Computing, University of Portsmouth, United Kingdom
| | | | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza" University, Rome, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Dept. of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milan, Italy..
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Huang J, McDonnell BJ, Lawley JS, Byrd J, Stöhr EJ, Cornwell WK. Impact of Mechanical Circulatory Support on Exercise Capacity in Patients With Advanced Heart Failure. Exerc Sport Sci Rev 2022; 50:222-229. [PMID: 36095073 PMCID: PMC9475848 DOI: 10.1249/jes.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Approximately 6 million individuals have heart failure in the United States alone and 15 million in Europe. Left ventricular assist devices (LVAD) improve survival in these patients, but functional capacity may not fully improve. This article examines the hypothesis that patients supported by LVAD experience persistent reductions in functional capacity and explores mechanisms accounting for abnormalities in exercise tolerance.
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Affiliation(s)
- Janice Huang
- Department of Medicine-Cardiology. University of Colorado Anschutz Medical Campus, Aurora CO
| | - Barry J. McDonnell
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff UK
| | - Justin S. Lawley
- Department of Sport Science, University of Innsbruck, Innsbruck Austria
| | - Jessica Byrd
- Department of Medicine-Cardiology. University of Colorado Anschutz Medical Campus, Aurora CO
| | - Eric J. Stöhr
- Faculty of Philosophical Sciences, Institute of Sport Science, Leibniz University Hannover, Hannover, Germany
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, NY, USA
| | - William K. Cornwell
- Department of Medicine-Cardiology. University of Colorado Anschutz Medical Campus, Aurora CO
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora CO
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5
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Mapelli M, Salvioni E, Paneroni M, Gugliandolo P, Bonomi A, Scalvini S, Raimondo R, Sciomer S, Mattavelli I, La Rovere MT, Agostoni P. Brisk walking can be a maximal effort in heart failure patients: a comparison of cardiopulmonary exercise and 6 min walking test cardiorespiratory data. ESC Heart Fail 2021; 9:812-821. [PMID: 34970846 PMCID: PMC8934957 DOI: 10.1002/ehf2.13781] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022] Open
Abstract
Aims Cardiopulmonary exercise test (CPET) and 6 min walking test (6MWT) are frequently used in heart failure (HF). CPET is a maximal exercise, whereas 6MWT is a self‐selected constant load test usually considered a submaximal, and therefore safer, exercise, but this has not been tested previously. The aim of this study was to compare the cardiorespiratory parameters collected during CPET and 6MWT in a large group of healthy subjects and patients with HF of different severity. Methods and results Subjects performed a standard maximal CPET and a 6MWT wearing a portable device allowing breath‐by‐breath measurement of cardiorespiratory parameters. HF patients were grouped according to their CPET peak oxygen uptake (peakV̇O2). One hundred and fifty‐five subjects were enrolled, of whom 40 were healthy (59 ± 8 years; male 67%) and 115 were HF patients (69 ± 10 years; male 80%; left ventricular ejection fraction 34.6 ± 12.0%). CPET peakV̇O2 was 13.5 ± 3.5 mL/kg/min in HF patients and 28.1 ± 7.4 mL/kg/min in healthy subjects (P < 0.001). 6MWT‐V̇O2 was 98 ± 20% of the CPET peakV̇O2 values in HF patients, while 72 ± 20% in healthy subjects (P < 0.001). 6MWT‐V̇O2 was >110% of CPET peakV̇O2 in 42% of more severe HF patients (peakV̇O2 < 12 mL/kg/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between V̇O2 at 6MWT, reported as a percentage of CPET peakV̇O2 vs. 6MWT V̇O2 reported as the absolute value, progressively increased as exercise limitation did. Conclusions In conclusion, the last minute of 6MWT must be perceived as a maximal or even supramaximal exercise activity in patients with more severe HF. Our findings should influence the safety procedures needed for the 6MWT in HF.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Parea, 4-20138, Milan, Italy
| | | | - Mara Paneroni
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Brescia, Italy
| | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Simonetta Scalvini
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Brescia, Italy
| | - Rosa Raimondo
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Varese, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza' Rome University, Rome, Italy
| | | | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Pavia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Parea, 4-20138, Milan, Italy
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6
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Abstract
PURPOSE OF REVIEW Exercise causes various dynamic changes in all body parts either in healthy subject or in heart failure (HF) patients. The present review of current knowledge about HF patients with reduced ejection fraction focuses on dynamic changes along a "metabo-hemodynamic" perspective. RECENT FINDINGS Studies on the dynamic changes occurring during exercise span many years. Thanks to the availability of advanced methods, it is nowadays possible to properly characterize respiratory, hemodynamic, and muscular function adjustments and their mismatch with the pulmonary and systemic circulations. Exercise is a dynamic event that involves several body functions. In HF patients, it is important to know at what level the limitation takes place in order to better manage these patients and to optimize therapeutic strategies.
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7
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van Ooij PJAM. The Young Elite Swimmer and the Lung: An Editorial. Arch Bronconeumol 2020. [PMID: 33441239 DOI: 10.1016/j.arbres.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pieter Jan A M van Ooij
- Diving Medical Centre, Royal Netherlands Navy, PO Box 10.000, 1780 CA Den Helder, The Netherlands; Department of Pulmonology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Saint-Pierre MD, Abdulnour J, Sabbagh R, Neder JA. Low DLCO predicts all-cause hospital admissions in patients with reduced left ventricular ejection fraction or diastolic dysfunction. ERJ Open Res 2020; 6:00095-2020. [PMID: 32714956 PMCID: PMC7369432 DOI: 10.1183/23120541.00095-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/15/2020] [Indexed: 11/11/2022] Open
Abstract
The diffusing capacity of the lung for carbon monoxide (DLCO) can be decreased in many disease states, including COPD and interstitial lung disease [1, 2]. Low DLCO can also be seen in those with clinically relevant congestive heart failure (CHF) due to its deleterious consequences on lung volumes, perfusion and gas exchange efficiency [3, 4]. Pulmonary function testing results are frequently available in patients with CHF. DLCO measurements have previously been shown to impact exercise capacity in CHF patients with either reduced or preserved left ventricular ejection fraction (LVEF) [5–7]. Impaired DLCO has also been suggested as a potential predictor of negative clinical outcomes in CHF [8]. We, therefore, aimed to determine if patients with reduced LVEF or isolated diastolic dysfunction on echocardiography and a low DLCO are at a higher risk of hospital admissions than their counterparts with a preserved DLCO. Confirmation of this hypothesis would support the need for closer monitoring of CHF patients who also present with a reduced DLCO. A low DLCO should be valued as a predictor of all-cause hospital admissions in patients with reduced LVEF or isolated diastolic dysfunction. The severity of the impairment seen on DLCO testing also appears to affect the risk of hospitalisation.https://bit.ly/3e4r8bH
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Del Buono MG, Arena R, Borlaug BA, Carbone S, Canada JM, Kirkman DL, Garten R, Rodriguez-Miguelez P, Guazzi M, Lavie CJ, Abbate A. Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 73:2209-2225. [PMID: 31047010 DOI: 10.1016/j.jacc.2019.01.072] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
Exercise intolerance is the cardinal symptom of heart failure (HF) and is of crucial relevance, because it is associated with a poor quality of life and increased mortality. While impaired cardiac reserve is considered to be central in HF, reduced exercise and functional capacity are the result of key patient characteristics and multisystem dysfunction, including aging, impaired pulmonary reserve, as well as peripheral and respiratory skeletal muscle dysfunction. We herein review the different modalities to quantify exercise intolerance, the pathophysiology of HF, and comorbid conditions as they lead to reductions in exercise and functional capacity, highlighting the fact that distinct causes may coexist and variably contribute to exercise intolerance in patients with HF.
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Affiliation(s)
- Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois; Total Cardiology Research Network, Calgary, Alberta, Canada
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Salvatore Carbone
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Ryan Garten
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School, New Orleans, Louisiana
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
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Neder JA, Rocha A, Berton DC, O'Donnell DE. Clinical and Physiologic Implications of Negative Cardiopulmonary Interactions in Coexisting Chronic Obstructive Pulmonary Disease-Heart Failure. Clin Chest Med 2020; 40:421-438. [PMID: 31078219 DOI: 10.1016/j.ccm.2019.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and heart failure with reduced ejection fraction (HF) frequently coexist in the elderly. Expiratory flow limitation and lung hyperinflation due to COPD may adversely affect central hemodynamics in HF. Low lung compliance, increased alveolar-capillary membrane thickness, and abnormalities in pulmonary perfusion because of HF further deteriorates lung function in COPD. We discuss how those negative cardiopulmonary interactions create challenges in clinical interpretation of pulmonary function and cardiopulmonary exercise tests in coexisting COPD-HF. In the light of physiologic concepts, we also discuss the influence of COPD or HF on the current medical treatment of each disease.
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Affiliation(s)
- J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Division of Respirology and Sleep Medicine, Department of Medicine, Kingston Health Science Center, Queen's University, Richardson House, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada.
| | - Alcides Rocha
- Heart Failure-COPD Outpatients Service and Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Danilo C Berton
- Division of Respirology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology and Sleep Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
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11
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Van Iterson EH. Isocapnic buffering: An inconvenient truth about cardiopulmonary exercise testing in heart failure. Eur J Prev Cardiol 2019; 26:1104-1106. [DOI: 10.1177/2047487319832747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erik H Van Iterson
- Section of Preventive Cardiology and Rehabilitation, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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12
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Effects of bi-level positive airway pressure on ventilatory and perceptual responses to exercise in comorbid heart failure-COPD. Respir Physiol Neurobiol 2019; 266:18-26. [PMID: 31005600 DOI: 10.1016/j.resp.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/28/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022]
Abstract
This study tested the hypothesis that, by increasing the volume available for tidal expansion (inspiratory capacity, IC), bi-level positive airway pressure (BiPAP™) would lead to greater beneficial effects on dyspnea and exercise intolerance in comorbid heart failure (HF)-chronic obstructive pulmonary disease (COPD) than HF alone. Ten patients with HF and 9 with HF-COPD (ejection fraction = 30 ± 6% and 35 ± 7%; FEV1 = 83 ± 12% and 65 ± 15% predicted, respectively) performed a discontinuous exercise protocol under sham ventilation or BiPAP™. Time to intolerance increased with BiPAP™ only in HF-COPD (p < 0.05). BiPAP™ led to higher tidal volume and lower duty cycle with longer expiratory time (p < 0.05). Of note, BiPAP™ improved IC (by ∼0.5 l) across exercise intensities only in HF-COPD. These beneficial consequences were associated with lower dyspnea scores at higher levels of ventilation (p < 0.05). By improving the qualitative" (breathing pattern and operational lung volumes) and sensory (dyspnea) features of exertional ventilation, BiPAP™ might allow higher exercise intensities to be sustained for longer during cardiopulmonary rehabilitation in HF-COPD.
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Apostolo A, Paolillo S, Contini M, Vignati C, Tarzia V, Campodonico J, Mapelli M, Massetti M, Bejko J, Righini F, Bottio T, Bonini N, Salvioni E, Gugliandolo P, Parati G, Lombardi C, Gerosa G, Salvi L, Alamanni F, Agostoni P. Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance. J Heart Lung Transplant 2018; 37:1361-1371. [DOI: 10.1016/j.healun.2018.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022] Open
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14
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The alveolar to arterial oxygen partial pressure difference is associated with pulmonary diffusing capacity in heart failure patients. Respir Physiol Neurobiol 2016; 233:1-6. [DOI: 10.1016/j.resp.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/18/2022]
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Kee K, Stuart-Andrews C, Ellis MJ, Wrobel JP, Nilsen K, Sharma M, Thompson BR, Naughton MT. Increased Dead Space Ventilation Mediates Reduced Exercise Capacity in Systolic Heart Failure. Am J Respir Crit Care Med 2016; 193:1292-300. [DOI: 10.1164/rccm.201508-1555oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Magrì D, Banfi C, Maruotti A, Farina S, Vignati C, Salvioni E, Morosin M, Brioschi M, Ghilardi S, Tremoli E, Agostoni P. Plasma immature form of surfactant protein type B correlates with prognosis in patients with chronic heart failure. A pilot single-center prospective study. Int J Cardiol 2015; 201:394-9. [PMID: 26310985 DOI: 10.1016/j.ijcard.2015.08.105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/03/2015] [Accepted: 08/09/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Gas exchange abnormalities are part of the heart failure (HF) syndrome and growing interest raised on possible biomarkers of alveolar-capillary unit damage. The present pilot single-center study sought to investigate the prognostic values of circulating surfactant protein type B (SP-B) in a cohort of systolic HF patients. METHODS One hundred and fifty-one HF stable outpatients and 37 healthy subjects underwent a full clinical assessment, including pulmonary function and lung diffusion for carbon monoxide (DLco), maximal cardiopulmonary exercise test and measurements for both circulating immature and mature forms of SP-B. Study end-points were hospitalization due to HF worsening and cardiovascular mortality. RESULTS Immature SP-B, but not the mature form, was significantly higher in HF patients than in controls and was independently related to DLco, peak oxygen uptake and ventilatory efficiency. During the follow-up (median: 995 days; interquartile range: 739-1247 days), 97 patients experimented at least one HF hospitalization and 9 died for cardiovascular causes. At univariate analysis immature SP-B levels were significantly related to both cardiovascular death (p=0.033) and HF hospitalization (p<0.001). At multivariate analysis, immature SP-B levels remained independently associated to HF hospitalization (hazard ratio: 2.304; 95% confidence interval 1.858-3.019; p<0.001). CONCLUSIONS Present data confirm a strong relationship between circulating immature SP-B levels, gas exchange abnormalities and exercise limitations in stable HF as well as they are consistent with the use of immature SP-B in HF clinical risk assessment. Larger prospective studies are needed to confirm its prognostic role as well as to evaluate whether immature SP-B plasma concentration varies in response to specific treatment.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, University "La Sapienza", Rome, Italy
| | - Cristina Banfi
- Centro Cardiologico Monzino, IRCCS, University of Milan, Italy
| | - Antonello Maruotti
- Southampton Statistical Sciences Research Institute, School of Mathematics, University of Southampton, United Kingdom; Department of Public Institutions, Economy and Society, University "Roma Tre", Rome, Italy
| | - Stefania Farina
- Centro Cardiologico Monzino, IRCCS, University of Milan, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, University of Milan, Italy
| | | | - Marco Morosin
- Centro Cardiologico Monzino, IRCCS, University of Milan, Italy; Cardiovascular Dept., "Ospedali Riuniti", Trieste, Postgraduate School of Cardiovascular Sciences, University of Trieste, Italy
| | - Maura Brioschi
- Centro Cardiologico Monzino, IRCCS, University of Milan, Italy
| | | | - Elena Tremoli
- Centro Cardiologico Monzino, IRCCS, University of Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, University of Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy.
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Agostoni P, Magini A, Apostolo A. Reply to commentary on: Confusion in reporting pulmonary diffusion capacity for nitric oxide and the alveolar-capillary membrane conductance for nitric oxide. Eur J Prev Cardiol 2015; 22:314-6. [DOI: 10.1177/2047487314528873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Italy
- Dipartimento di Malattie Cardiovascolari, Università di Milano, Italy
| | - Alessandra Magini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Italy
| | - Anna Apostolo
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Italy
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Oliveira MF, Zelt JTJ, Jones JH, Hirai DM, O'Donnell DE, Verges S, Neder JA. Does impaired O2 delivery during exercise accentuate central and peripheral fatigue in patients with coexistent COPD-CHF? Front Physiol 2015; 5:514. [PMID: 25610401 PMCID: PMC4285731 DOI: 10.3389/fphys.2014.00514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/15/2014] [Indexed: 02/04/2023] Open
Abstract
Impairment in oxygen (O2) delivery to the central nervous system ("brain") and skeletal locomotor muscle during exercise has been associated with central and peripheral neuromuscular fatigue in healthy humans. From a clinical perspective, impaired tissue O2 transport is a key pathophysiological mechanism shared by cardiopulmonary diseases, such as chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). In addition to arterial hypoxemic conditions in COPD, there is growing evidence that cerebral and muscle blood flow and oxygenation can be reduced during exercise in both isolated COPD and CHF. Compromised cardiac output due to impaired cardiopulmonary function/interactions and blood flow redistribution to the overloaded respiratory muscles (i.e., ↑work of breathing) may underpin these abnormalities. Unfortunately, COPD and CHF coexist in almost a third of elderly patients making these mechanisms potentially more relevant to exercise intolerance. In this context, it remains unknown whether decreased O2 delivery accentuates neuromuscular manifestations of central and peripheral fatigue in coexistent COPD-CHF. If this holds true, it is conceivable that delivering a low-density gas mixture (heliox) through non-invasive positive pressure ventilation could ameliorate cardiopulmonary function/interactions and reduce the work of breathing during exercise in these patients. The major consequence would be increased O2 delivery to the brain and active muscles with potential benefits to exercise capacity (i.e., ↓central and peripheral neuromuscular fatigue, respectively). We therefore hypothesize that patients with coexistent COPD-CHF stop exercising prematurely due to impaired central motor drive and muscle contractility as the cardiorespiratory system fails to deliver sufficient O2 to simultaneously attend the metabolic demands of the brain and the active limb muscles.
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Affiliation(s)
- Mayron F Oliveira
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP) São Paulo, Brazil
| | - Joel T J Zelt
- Laboratory of Clinical Exercise Physiology, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University Kingston, ON, Canada
| | - Joshua H Jones
- Laboratory of Clinical Exercise Physiology, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University Kingston, ON, Canada
| | - Daniel M Hirai
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP) São Paulo, Brazil ; Laboratory of Clinical Exercise Physiology, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University Kingston, ON, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University Kingston, ON, Canada
| | - Samuel Verges
- HP2 Laboratory, Grenoble Alpes University Grenoble, France
| | - J Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP) São Paulo, Brazil ; Laboratory of Clinical Exercise Physiology, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University Kingston, ON, Canada
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Magini A, Apostolo A, Salvioni E, Italiano G, Veglia F, Agostoni P. Alveolar-capillary membrane diffusion measurement by nitric oxide inhalation in heart failure. Eur J Prev Cardiol 2013; 22:206-12. [PMID: 24165475 DOI: 10.1177/2047487313510397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In heart failure, lung diffusion is reduced, it correlates with prognosis and exercise capacity, and it is a therapy target. DESIGN Diffusion is measured as CO total diffusion (DL(CO)), which has two components: membrane diffusion (Dm) and capillary volume, the latter related to CO and O2 competition for hemoglobin. DL(CO) needs to be corrected for hemoglobin. Diffusion can also be measured with NO (DL(NO)), which has a very high affinity for hemoglobin, and thus, the resistance of hemoglobin being trivial, it directly represents Dm. Therefore, Dm is directly calculated from DL(NO) through a correction factor. DL(NO) has never been measured in heart failure. The study aims at determining, in heart failure, DL(NO), Dm correction factor, and whether Dm(NO) provides Dm estimates comparable to Dm(CO). METHODS We measured DL(CO), Dm(CO) by multi-maneuver Roughton-Forster method, and DL(CO) and DL(NO) by single-breath maneuver in 50 heart failure and 50 healthy subjects. RESULTS DL(CO) was 21.9 ± 4.8 ml/mmHg per min and 16.8 ± 5.1 in healthy subjects and heart failure subjects, respectively (p < 0.001). DL(NO) was 88.6 ± 20.5 ml/mmHg per min and 72.5 ± 22.3, respectively (p < 0.001). The correction factors to obtain Dm from DL(NO) were 2.68 (entire population), 2.63 (healthy subjects) and 2.75 (heart failure subjects). Dm(CO) and Dm(NO) were 34.7 ± 10.9 ml/mmHg per min and 33.8 ± 7.6 in healthy subjects and 25.9 ± 2.0 and 26.4 ± 8.1 in heart failure subjects. CONCLUSIONS DL(NO) and Dm(NO) measurements are feasible in heart failure. Dm(CO) and Dm(NO) provide comparable results. The correction factor to calculate Dm from DL(NO) in heart failure is 2.75, which is little different from the 2.63 value we observed in healthy subjects.
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Affiliation(s)
| | | | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Italy Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, USA
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Agostoni P. Considerations on Safety and Treatment of Patients with Chronic Heart Failure at High Altitude. High Alt Med Biol 2013; 14:96-100. [DOI: 10.1089/ham.2012.1117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Dipartimento di scienze cliniche e di comunità, Università di Milano, Milan Italy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington
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Triposkiadis F, Starling RC, Boudoulas H, Giamouzis G, Butler J. The cardiorenal syndrome in heart failure: cardiac? renal? syndrome? Heart Fail Rev 2013; 17:355-66. [PMID: 22086438 DOI: 10.1007/s10741-011-9291-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There has been increasing interest on the so-called cardiorenal syndrome (CRS), defined as a complex pathophysiological disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other. In this review, we contend that there is lack of evidence warranting the adoption of a specific clinical construct such as the CRS within the heart failure (HF) syndrome by demonstrating that: (a) the approaches and tools regarding the definition of kidney involvement in HF are suboptimal; (b) development of renal failure in HF is often confounded by age, hypertension, and diabetes; (c) worsening of renal function (WRF) in HF may be largely independent of alterations in cardiac function; (d) the bidirectional association between HF and renal failure is not unique and represents one of the several such associations encountered in HF; and (e) inflammation is a common denominator for HF and associated noncardiac morbidities. Based on these arguments, we believe that dissecting one of the multiple bidirectional associations in HF and constructing the so-called cardiorenal syndrome is not justified pathophysiologically. Fully understanding of all morbid associations and not only the cardiorenal is of great significance for the clinician who is caring for the patient with HF.
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Contini M, Apostolo A, Cattadori G, Paolillo S, Iorio A, Bertella E, Salvioni E, Alimento M, Farina S, Palermo P, Loguercio M, Mantegazza V, Karsten M, Sciomer S, Magrì D, Fiorentini C, Agostoni P. Multiparametric comparison of CARvedilol, vs. NEbivolol, vs. BIsoprolol in moderate heart failure: the CARNEBI trial. Int J Cardiol 2013; 168:2134-40. [PMID: 23506636 DOI: 10.1016/j.ijcard.2013.01.277] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several β-blockers, with different pharmacological characteristics, are available for heart failure (HF) treatment. We compared Carvedilol (β1-β2-α-blocker), Bisoprolol (β1-blocker), and Nebivolol (β1-blocker, NO-releasing activity). METHODS Sixty-one moderate HF patients completed a cross-over randomized trial, receiving, for 2 months each, Carvedilol, Nebivolol, Bisoprolol (25.6 ± 12.6, 5.0 ± 2.4 and 5.0 ± 2.4 mg daily, respectively). At the end of each period, patients underwent: clinical evaluation, laboratory testing, echocardiography, spirometry (including total DLCO and membrane diffusion), O2/CO2 chemoreceptor sensitivity, constant workload, in normoxia and hypoxia (FiO2=16%), and maximal cardiopulmonary exercise test. RESULTS No significant differences were observed for clinical evaluation (NYHA classification, Minnesota questionnaire), laboratory findings (including kidney function and BNP), echocardiography, and lung mechanics. DLCO was lower on Carvedilol (18.3 ± 4.8*mL/min/mmHg) compared to Nebivolol (19.9 ± 5.1) and Bisoprolol (20.0 ± 5.0) due to membrane diffusion 20% reduction (*=p<0.0001). Constant workload exercise showed in hypoxia a faster VO2 kinetic and a lower ventilation with Carvedilol. Peripheral and central sensitivity to CO2 was lower in Carvedilol while response to hypoxia was higher in Bisoprolol. Ventilation efficiency (VE/VCO2 slope) was 26.9 ± 4.1* (Carvedilol), 28.8 ± 4.0 (Nebivolol), and 29.0 ± 4.4 (Bisoprolol). Peak VO2 was 15.8 ± 3.6*mL/kg/min (Carvedilol), 16.9 ± 4.1 (Nebivolol), and 16.9 ± 3.6 (Bisoprolol). CONCLUSIONS β-Blockers differently affect several cardiopulmonary functions. Lung diffusion and exercise performance, the former likely due to lower interference with β2-mediated alveolar fluid clearance, were higher in Nebivolol and Bisoprolol. On the other hand, Carvedilol allowed a better ventilation efficiency during exercise, likely via a different chemoreceptor modulation. Results from this study represent the basis for identifying the best match between a specific β-blocker and a specific HF patient.
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Abstract
Lung function abnormalities both at rest and during exercise are frequently observed in patients with chronic heart failure, also in the absence of respiratory disease. Alterations of respiratory mechanics and of gas exchange capacity are strictly related to heart failure. Severe heart failure patients often show a restrictive respiratory pattern, secondary to heart enlargement and increased lung fluids, and impairment of alveolar-capillary gas diffusion, mainly due to an increased resistance to molecular diffusion across the alveolar capillary membrane. Reduced gas diffusion contributes to exercise intolerance and to a worse prognosis. Cardiopulmonary exercise test is considered the “gold standard” when studying the cardiovascular, pulmonary, and metabolic adaptations to exercise in cardiac patients. During exercise, hyperventilation and consequent reduction of ventilation efficiency are often observed in heart failure patients, resulting in an increased slope of ventilation/carbon dioxide (VE/VCO2) relationship. Ventilatory efficiency is as strong prognostic and an important stratification marker. This paper describes the pulmonary abnormalities at rest and during exercise in the patients with heart failure, highlighting the principal diagnostic tools for evaluation of lungs function, the possible pharmacological interventions, and the parameters that could be useful in prognostic assessment of heart failure patients.
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Le parcours de l’oxygène au cours de l’exercice incrémental. Rev Mal Respir 2012; 29:1224-37. [DOI: 10.1016/j.rmr.2012.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 05/14/2012] [Indexed: 10/27/2022]
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Poole DC, Hirai DM, Copp SW, Musch TI. Muscle oxygen transport and utilization in heart failure: implications for exercise (in)tolerance. Am J Physiol Heart Circ Physiol 2012; 302:H1050-63. [PMID: 22101528 PMCID: PMC3311454 DOI: 10.1152/ajpheart.00943.2011] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/17/2011] [Indexed: 01/01/2023]
Abstract
The defining characteristic of chronic heart failure (CHF) is an exercise intolerance that is inextricably linked to structural and functional aberrations in the O(2) transport pathway. CHF reduces muscle O(2) supply while simultaneously increasing O(2) demands. CHF severity varies from moderate to severe and is assessed commonly in terms of the maximum O(2) uptake, which relates closely to patient morbidity and mortality in CHF and forms the basis for Weber and colleagues' (167) classifications of heart failure, speed of the O(2) uptake kinetics following exercise onset and during recovery, and the capacity to perform submaximal exercise. As the heart fails, cardiovascular regulation shifts from controlling cardiac output as a means for supplying the oxidative energetic needs of exercising skeletal muscle and other organs to preventing catastrophic swings in blood pressure. This shift is mediated by a complex array of events that include altered reflex and humoral control of the circulation, required to prevent the skeletal muscle "sleeping giant" from outstripping the pathologically limited cardiac output and secondarily impacts lung (and respiratory muscle), vascular, and locomotory muscle function. Recently, interest has also focused on the dysregulation of inflammatory mediators including tumor necrosis factor-α and interleukin-1β as well as reactive oxygen species as mediators of systemic and muscle dysfunction. This brief review focuses on skeletal muscle to address the mechanistic bases for the reduced maximum O(2) uptake, slowed O(2) uptake kinetics, and exercise intolerance in CHF. Experimental evidence in humans and animal models of CHF unveils the microvascular cause(s) and consequences of the O(2) supply (decreased)/O(2) demand (increased) imbalance emblematic of CHF. Therapeutic strategies to improve muscle microvascular and oxidative function (e.g., exercise training and anti-inflammatory, antioxidant strategies, in particular) and hence patient exercise tolerance and quality of life are presented within their appropriate context of the O(2) transport pathway.
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Affiliation(s)
- David C Poole
- Departments of Anatomy and Physiology, and Kinesiology, Kansas State University, Manhattan, KS 66506-5802, USA.
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Oxygen Kinetics and Heart Rate Response during Early Recovery from Exercise in Patients with Heart Failure. Cardiol Res Pract 2012; 2012:512857. [PMID: 22312564 PMCID: PMC3270536 DOI: 10.1155/2012/512857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/09/2011] [Accepted: 10/13/2011] [Indexed: 11/20/2022] Open
Abstract
Background. The purpose of this study was to assess the post-exercise O2 uptake and heart rate response in patients with heart failure (HF) in comparison to healthy individuals. Methods and Results. Exercise testing of all subjects was conducted according to the RITE-protocol. The study subjects were classified according to their peak oxygen uptake (peak VO2) in four groups: healthy individuals with a peak VO2 >22 mL/kg/min (group 1, n: 50), and patients with HF and a peak VO2 of 18–22 mL/kg/min, (group 2, n: 48), 14–18 mL/kg/min (group 3, n: 57), and <14 mL/kg/min (group 4, n: 31). Both peak VO2 and HR declined more slowly in the patients with HF than in the normal subjects. Recovery of VO2 and HR followed monoexponential kinetics in the early post-recovery phase. This enabled the determination of a time constant for both HR and VO2 (TC VO2 and TC HR). From group 1 to 4 there was a prolongation of the time constant for VO2 and HR: TC VO2 (group 1: 110 ± 34, group 2: 197 ± 43, group 3: 238 ± 80, and group 4: 278 ± 50 sec), and TC HR (group 1: 148 ± 82, group 2: 290 ± 65, group 3: 320 ± 58, and group 4: 376 ± 55 sec). Conclusion. The rate of decline of VO2 and HR in the early post-exercise phase is inversely related to the peak VO2. The time constant for oxygen uptake (TC VO2) and heart rate (TC HR) might prove a useful parameter for more precise monitoring and grading of HF.
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Karsten M, Contini M, Cefalù C, Cattadori G, Palermo P, Apostolo A, Bussotti M, Magrì D, Salvioni E, Farina S, Sciomer S, Catai AM, Agostoni P. Effects of carvedilol on oxygen uptake and heart rate kinetics in patients with chronic heart failure at simulated altitude. Eur J Prev Cardiol 2011; 19:444-51. [DOI: 10.1177/1741826711402736] [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: 11/17/2022]
Abstract
Background: The response to moderate exercise at altitude in heart failure (HF) is unknown. Methods and results: We evaluated 30 HF patients, (NYHA I-III, 25 M/5 F; 59 ± 10 years; LVEF = 39.6 ± 7.1%), in stable clinical conditions, treated with carvedilol at the maximal tolerated dose. We performed a maximal cardiopulmonary exercise test (CPET) with ramp protocol at sea level to evaluate patients’ performance and two moderate intensity constant workload CPETs (50% of peak workload) at sea level (normoxia) and simulated altitude (hypoxia). Oxygen uptake ([Formula: see text]) and heart rate (HR) on-kinetics at constant workload were assessed calculating the time constant (τ) with a monoexponential equation. [Formula: see text] and HR were higher in hypoxia (0.944 ± 0.233 vs 1.031 ± 0.264 l/min; 100 ± 23 vs 108 ± 22 bpm; p < 0.001). On-kinetics showed a different behavior of τ being [Formula: see text] faster in hypoxia (67.1 ± 23.0 vs. 56.3 ± 19.7 s; p = 0.026) and HR faster in normoxia (49.3 ± 19.4 vs. 62.2 ± 22.5 s; p = 0.018). Ten patients, who lowered oxygen kinetics in hypoxia, had greater HR increase during maximal CPET suggesting lower functional betablockade. The higher τ of [Formula: see text] in hypoxia is likely to be due to a peripheral effect of carvedilol mediated either by β- or α-receptor. Conclusion: HF patients performing moderate exercise at 2000 m simulated altitude have 20% [Formula: see text] increase without trouble at the beginning of exercise when treated with carvedilol.
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Affiliation(s)
- Marlus Karsten
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Laboratório de Fisioterapia Cardiovascular, Núcleo de Pesquisa em Exercício Físico, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | | | | | | | | | | | - Maurizio Bussotti
- Cardiologia Riabilitativa, Fondazione S Maugeri, IRCCS, Milan, Italy
| | - Damiano Magrì
- U.O. Cardiologia, S. Andrea Hospital, “Sapienza”, Rome University, Rome, Italy
| | | | | | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche e Geriatriche, ‘Sapienza’, Rome University, Rome, Italy
| | - Aparecida Maria Catai
- Laboratório de Fisioterapia Cardiovascular, Núcleo de Pesquisa em Exercício Físico, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Division of Critical Care and Respiratory Medicine, University of Washington, Seattle, USA
- Dipartimento di Scienze Cardiovascolari, Università di Milano, Milan, Italy
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Lewis GD, Murphy RM, Shah RV, Pappagianopoulos PP, Malhotra R, Bloch KD, Systrom DM, Semigran MJ. Pulmonary vascular response patterns during exercise in left ventricular systolic dysfunction predict exercise capacity and outcomes. Circ Heart Fail 2011; 4:276-85. [PMID: 21292991 DOI: 10.1161/circheartfailure.110.959437] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated resting pulmonary arterial pressure (PAP) in patients with left ventricular systolic dysfunction (LVSD) purports a poor prognosis. However, PAP response patterns to exercise in LVSD and their relationship to functional capacity and outcomes have not been characterized. METHODS AND RESULTS Sixty consecutive patients with LVSD (age 60±12 years, left ventricular ejection fraction 0.31±0.07, mean±SD) and 19 controls underwent maximum incremental cardiopulmonary exercise testing with simultaneous hemodynamic monitoring. During low-level exercise (30 W), LVSD subjects, compared with controls, had greater augmentation in mean PAPs (15±1 versus 5±1 mm Hg), transpulmonary gradients (5±1 versus 1±1 mm Hg), and effective pulmonary artery elastance (0.05±0.02 versus -0.03±0.01 mm Hg/mL, P<0.0001 for all). A linear increment in PAP relative to work (0.28±0.12 mm Hg/W) was observed in 65% of LVSD patients, which exceeded that observed in controls (0.07±0.02 mm Hg/W, P<0.0001). Exercise capacity and survival was worse in patients with a PAP/watt slope above the median than in patients with a lower slope. In the remaining 35% of LVSD patients, exercise induced a steep initial increment in PAP (0.41±0.16 mm Hg/W) followed by a plateau. The plateau pattern, compared with a linear pattern, was associated with reduced peak Vo(2) (10.6±2.6 versus 13.1±4.0 mL · kg(-1) · min(-1), P=0.005), lower right ventricular stroke work index augmentation with exercise (5.7±3.8 versus 9.7±5.0 g/m(2), P=0.002), and increased mortality (hazard ratio 8.1, 95% CI 2.7 to 23.8, P<0.001). CONCLUSIONS A steep increment in PAP during exercise and failure to augment PAP throughout exercise are associated with decreased exercise capacity and survival in patients with LVSD, and may therefore represent therapeutic targets. CLINICAL TRIAL INFORMATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00309790.
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Affiliation(s)
- Gregory D Lewis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.
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Taylor BJ, Johnson BD. The pulmonary circulation and exercise responses in the elderly. Semin Respir Crit Care Med 2010; 31:528-38. [PMID: 20941654 DOI: 10.1055/s-0030-1265894] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aging is associated with a progressive deterioration in the structure and function of the pulmonary circulation. Remodeling of the pulmonary vasculature occurs from maturity to senescence that is characterized by an increase in pulmonary vascular stiffness, pulmonary vascular pressures, and pulmonary vascular resistance along with increased heterogeneity of alveolar ventilation and pulmonary perfusion and decreased pulmonary capillary blood volume and membrane diffusing capacity that is consistent with a reduction in alveolar-capillary surface area. In theory, the aforementioned age-related changes in the pulmonary circulation may conspire to make elderly individuals more susceptible to gas exchange abnormalities during exercise. However, despite the erosion in ventilatory reserve with aging, the healthy older adult appears able to maintain alveolar ventilation at a level that allows maintenance of arterial blood gases within normal limits, even during heavy exercise. This ability to maintain adequate gas exchange likely occurs because age-related reductions in the maximal metabolic demand of exercise occur at a rate equal to or greater than the rate of deterioration in ventilatory reserve. A more prominent aspect of aging is the loss of lung elastic recoil that is associated with a modest reduction in the expiratory boundary of the maximal flow-volume envelope. This in turn increases the severity of expiratory airflow limitation and induces dynamic lung hyperinflation during exercise. The consequences of this age-associated decrease in elastic recoil on the pulmonary circulation are speculative, but an age-associated decline in elastic recoil may influence pulmonary vascular resistance and cardiac output, in addition to its impact on the work and oxygen cost of breathing.
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Affiliation(s)
- Bryan J Taylor
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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Olson TP, Joyner MJ, Dietz NM, Eisenach JH, Curry TB, Johnson BD. Effects of respiratory muscle work on blood flow distribution during exercise in heart failure. J Physiol 2010; 588:2487-501. [PMID: 20457736 DOI: 10.1113/jphysiol.2009.186056] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Heart failure (HF) patients have a reduced cardiac reserve and increased work of breathing. Increased locomotor muscle blood flow demand may result in competition between respiratory and locomotor vascular beds. We hypothesized that HF patients would demonstrate improved locomotor blood flow with respiratory muscle unloading during activity. Ten patients (ejection fraction = 31 +/- 3%) and 10 controls (CTL) underwent two cycling sessions (60% peak work). Session 1 (S1): 5 min of normal breathing (NB), 5 min respiratory muscle unloading with a ventilator, and 5 min of NB. Session 2 (S2): 5 min NB, 5 min of respiratory muscle loading with inspiratory resistance, and 5 min of NB. Measurements included: leg blood flow (LBF, thermodilution), cardiac output (Q), and oesophageal pressure (P(pl), index of pleural pressure). S1: P(pl) was reduced in both groups (HF: 73 +/- 8%; CTL: 60 +/- 13%, P < 0.01). HF: Q increased (9.6 +/- 0.4 vs. 11.3 +/- 0.8 l min(-1), P < 0.05) and LBF increased (4.8 +/- 0.8 vs. 7.3 +/- 1.1 l min(-1), P < 0.01); CTL: no changes in Q (14.7 +/- 1.0 vs. 14.8 +/- 1.6 l min(-1)) or LBF (10.9 +/- 1.8 vs. 10.3 +/- 1.7 l min(-1)). S2: P(pl) increased in both groups (HF: 172 +/- 16%, CTL: 220 +/- 40%, P < 0.01). HF: no change was observed in Q(10.0 +/- 0.4 vs. 10.3 +/- 0.8 l min(-1)) or LBF (5.0 +/- 0.6 vs. 4.7 +/- 0.5 l min(-1)); CTL: increased (15.4 +/- 1.4 vs. 16.9 +/- 1.5 l min(-1), P < 0.01) and LBF remained unchanged (10.7 +/- 1.5 vs. 10.3 +/- 1.8 l min(-1)). These data suggest HF patients preferentially steal blood flow from locomotor muscles to accommodate the work of breathing during activity. Further, HF patients are unable to vasoconstrict locomotor vascular beds beyond NB when presented with a respiratory load.
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Affiliation(s)
- Thomas P Olson
- Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Resting lung function in the assessment of the exercise capacity in patients with chronic heart failure. Am J Med Sci 2010; 339:210-5. [PMID: 20220330 DOI: 10.1097/maj.0b013e3181c78540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the lung involvement in patients with chronic heart failure (CHF), the significance of lung function abnormalities to functional status in these patients is still controversial. We postulated that in patients with CHF, resting lung function assessment may provide information of clinical relevance on exercise capacity, expressed as peak oxygen uptake (VO2) and ventilatory response to CO2 production (VE/VCO2) during a maximal exercise. METHODS We studied 49 clinically stable patients with CHF (38 men, age range: 25-78 years) (New York Heart Association class range: I-IV) with left ventricular ejection fraction <40%. Patients with chronic obstructive pulmonary disease were excluded. Patients performed pulmonary function tests and maximal incremental exercise test. RESULTS Resting spirometry was related to the exercise capacity (P < 0.05), expressed as peak VO2. By means of receiver operating characteristic curve analysis, the forced expiratory volume at first second (FEV1) cutoff point, which better identified patients with a peak VO2 < or =14 mL/kg/min, was <79% of predicted value (0.79 sensitivity and 0.73 specificity). Resting lung diffusion capacity for carbon monoxide and end-tidal pressure of CO2 (PETCO2) were inversely correlated to VE/VCO2 (P < 0.01). The lung diffusion capacity for carbon monoxide and PETCO2 cutoff points, which better identified patients with VE/VCO2 value >34, were <58% of predicted (0.92 sensitivity and 0.42 specificity) and <33 mm Hg (0.67 sensitivity and 0.92 specificity), respectively. CONCLUSIONS In patients with CHF, resting lung function, including spirometry, lung diffusion capacity, and PETCO2, can provide clinically useful information on exercise capacity, by predicting peak VO2 and VE/VCO2 slope. The results of this study highlight the role of resting lung function in the assessment of the functional status of cardiac patients.
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Agostoni P, Palermo P, Contini M. Respiratory Effects of β-blocker Therapy in Heart Failure. Cardiovasc Drugs Ther 2009; 23:377-84. [DOI: 10.1007/s10557-009-6195-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Magrì D, Brioschi M, Banfi C, Schmid JP, Palermo P, Contini M, Apostolo A, Bussotti M, Tremoli E, Sciomer S, Cattadori G, Fiorentini C, Agostoni P. Circulating Plasma Surfactant Protein Type B as Biological Marker of Alveolar-Capillary Barrier Damage in Chronic Heart Failure. Circ Heart Fail 2009; 2:175-80. [DOI: 10.1161/circheartfailure.108.819607] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Damiano Magrì
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Maura Brioschi
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Cristina Banfi
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Jean Paul Schmid
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Pietro Palermo
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Mauro Contini
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Anna Apostolo
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Maurizio Bussotti
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Elena Tremoli
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Susanna Sciomer
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Gaia Cattadori
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Cesare Fiorentini
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
| | - Piergiuseppe Agostoni
- From the Centro Cardiologico Monzino-IRCCS (D.M., M. Brioschi, C.B., P.P., M.C., A.A., M. Bussotti, E.T., G.C., C.F., P.A.), Istituto di Cardiologia, Università di Milano, Milan, Italy; Unità Operativa Complessa di Cardiologia, Azienda Ospedaliera Sant’Andrea (D.M.), Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Policlinico Umberto I (S.S.), Università degli Studi di Roma “La Sapienza,” Italy; Swiss Cardiovascular Center Bern (J.P.S.), Cardiovascular Prevention and
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Roulaud M, Donal E, Raud-Raynier P, Denjean A, de Bisschop C. Does exercise have deleterious consequences for the lungs of patients with chronic heart failure? Respir Med 2009; 103:393-400. [DOI: 10.1016/j.rmed.2008.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 09/24/2008] [Accepted: 09/29/2008] [Indexed: 12/01/2022]
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Cattadori G, Wasserman K, Meloni C, Mustaq S, Contini M, Apostolo A, Andreini D, Magrì D, Sciomer S, Veglia F, Berna G, Introcaso G, Palermo P, Fiorentini C, Agostoni P. Alveolar Membrane Conductance Decreases as BNP Increases During Exercise in Heart Failure. Rationale for BNP in the Evaluation of Dyspnea. J Card Fail 2009; 15:136-44. [DOI: 10.1016/j.cardfail.2008.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 09/05/2008] [Accepted: 10/03/2008] [Indexed: 11/26/2022]
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Agostoni P, Apostolo A, Albert RK. Mechanisms of periodic breathing during exercise in patients with chronic heart failure. Chest 2008; 133:197-203. [PMID: 18187746 DOI: 10.1378/chest.07-1439] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Periodic breathing (PB) in heart failure (HF) is attributed to many factors, including low cardiac output delaying the time it takes pulmonary venous blood to reach the central and peripheral chemoreceptors, low lung volume, lung congestion, augmented chemoreceptor sensitivity, and the narrow difference between eupneic carbon dioxide tension and apneic/hypoventilatory threshold. METHODS AND RESULTS We measured expired gases, ventilation, amplitude, and duration of PB in 23 patients with PB during progressive exercise tests done with 0 mL, 250 mL, or 500 mL of added dead space. Periodicity of PB remained constant despite heart rate, oxygen consumption, and minute ventilation increasing. Within each PB cycle, starting from the beginning of exercise, the largest (peak) tidal volume approached maximum observed tidal volume, while the smallest (nadir) tidal volume increased as exercise power output increased. PB ceased when nadir tidal volume reached peak tidal volume. End-tidal carbon dioxide increased with added dead space, and PB ceased progressively earlier during the exercise done with increased dead space. CONCLUSION Circulatory delay does not contribute to the PB observed in exercising HF patients. The pattern of gradually increasing nadir tidal volume during exercise and the effect of dead space on both PB ceasing and end-tidal carbon dioxide suggest that low tidal volume and carbon dioxide apnea threshold are important contributors to PB that occurs during exercise in HF.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, Via Parea 4, 20138 Milan, Italy.
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Bussotti M, Montorsi P, Amato M, Magini A, Baldassarre D, Tantardini F, Veglia F, Agostoni P. Sildenafil improves the alveolar-capillary function in heart failure patients. Int J Cardiol 2007; 126:68-72. [PMID: 17490765 DOI: 10.1016/j.ijcard.2007.03.118] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 01/22/2007] [Accepted: 03/30/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sildenafil is used for pulmonary hypertension treatment and its use is safe in chronic heart failure (HF) patients. AIMS To analyze the effects of sildenafil on lung mechanics, gas diffusion, exhaled nitric oxide (eNO) at rest and during exercise in chronic HF. We did so to evaluate if sildenafil prevents exercise-induced pulmonary edema formation. METHODS We studied 22 chronic HF males. We measured after a single dose of placebo, sildenafil (25 mg) and sildenafil (100 mg), lung diffusion (DLCO), molecular diffusion (DM), pulmonary capillary volume (VC), eNO, all at rest and during exercise, standard pulmonary function, and maximal cardiopulmonary exercise. RESULTS At rest sildenafil improved pulmonary mechanics and DLCO from 23.1+/-6.3 ml/mmHg/min to 23.9+/-6.4 (25 mg, p<0.05) and to 25.3+/-6.7 100 mg, p<0.02). Sildenafil (100 mg) prevents edema formation (highest DM/VC during exercise). At rest eNO was low and not affected by tested drugs. With light exercise eNO was higher with sildenafil 100 mg. Peak VO(2) increased with sildenafil from 1376+/-331 ml/min to 1471+/-375 (25 mg, p<0.01) and 1524+/-461 (100 mg, p<0.02). Peak VO(2) increase was related to DLCO improvement. CONCLUSION In chronic HF sildenafil increases exercise performance, improves lung mechanics and gas diffusion and prevents exercise-induced pulmonary edema formation probably by restoring NO pathways.
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Affiliation(s)
- Maurizio Bussotti
- Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, via Parea 4, 20138, Milan, Italy.
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Agostoni P, Contini M, Magini A, Apostolo A, Cattadori G, Bussotti M, Veglia F, Andreini D, Palermo P. Carvedilol reduces exercise-induced hyperventilation: A benefit in normoxia and a problem with hypoxia. Eur J Heart Fail 2006; 8:729-35. [PMID: 16533619 DOI: 10.1016/j.ejheart.2006.02.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 10/27/2005] [Accepted: 02/01/2006] [Indexed: 11/25/2022] Open
Abstract
AIMS To evaluate whether carvedilol influences exercise hyperventilation and the ventilatory response to hypoxia in heart failure (HF). METHODS AND RESULTS Fifteen HF patients participated to this double blind, randomised, placebo controlled, cross-over study. Patients were evaluated by quality of life questionnaire, echocardiography, pulmonary function and cardiopulmonary exercise tests (ramp and constant workload) both in normoxia (FiO2 = 21%) and hypoxia (FiO2 = 16%, equivalent to a simulated altitude of 2000 m). Carvedilol improved clinical condition and reduced left ventricle size, but had no effect on lung mechanics. In normoxia during exercise, ventilation was lower, V(CO2) unchanged and PaCO2 (constant workload) or PetCO2 (ramp) higher with carvedilol, exercise capacity was unchanged (peak workload 92+/-22 and 90+/-22W for placebo and carvedilol, respectively). Abnormal V(E)/V(CO2) slope was reduced by carvedilol. Hypoxia increased ventilation but less with carvedilol; exercise capacity decreased to 87+/-21W (placebo) and to 80+/-11 W (carvedilol, p < 0.01). With hypoxia, carvedilol decreased V(E)/V(CO2) slope. At constant workload exercise with hypoxia, PaO2 decreased to 69+/-6 mm Hg (placebo) and to 64+/-5 (carvedilol, p < 0.01). CONCLUSION Carvedilol reduced hyperventilation possibly by reducing peripheral chemoreflex sensitivity as suggested by PaCO2 increase with normoxia and PaO2 decrease with hypoxia without V(CO2) and V(D)/V(T) changes. Lessening hyperventilation is beneficial when breathing normally, but detrimental when hyperventilation is needed for exercise at high altitude.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, Italy.
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Piepoli MF, Corrà U, Agostoni PG, Belardinelli R, Cohen-Solal A, Hambrecht R, Vanhees L. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Part I: definition of cardiopulmonary exercise testing parameters for appropriate use in chronic heart failure. ACTA ACUST UNITED AC 2006; 13:150-64. [PMID: 16575267 DOI: 10.1097/01.hjr.0000209812.05573.04] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiopulmonary exercise testing (CPET) provides a global assessment of the integrated response to exercise involving the pulmonary, cardiovascular, haematopoietic, neuropsychological, and skeletal muscle systems. This information cannot be obtained through investigation of the individual organ systems in isolation. The non-invasive, dynamic physiological overview permits the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision making. The use of CPET in management of the chronic heart failure patient is increasing with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity and that, furthermore, overall health status and prognosis are predicted better by indices of exercise tolerance than by resting measurements. Our aim is to produce a statement which provides recommendations on the interpretation and clinical application of CPET in heart failure, based on contemporary scientific knowledge and technical advances: the focus is on clinical indications, issues of standardization, and interpretative strategies for CPET.
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Agostoni P, Cattadori G, Bussotti M, Apostolo A. Cardiopulmonary interaction in heart failure. Pulm Pharmacol Ther 2006; 20:130-4. [PMID: 16702004 DOI: 10.1016/j.pupt.2006.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 03/17/2006] [Indexed: 01/12/2023]
Abstract
In heart failure lung dysfunction is frequent and is greater the greater the heart failure severity. It can be evaluated in terms of lung mechanics and gas diffusion. Indeed heart-lung interaction is related to heart dimensions and lung fluid content; furthermore heart-lung interaction is influenced by the body position. Lung diffusion is also altered in patients with chronic heart failure, and a low gas diffusion is associated with a reduced performance. During exercise, heart-lung interaction becomes more evident. Heart failure patients show an abnormal hyperventilation due to a progressively increased respiratory rate, and a lower tidal volume; hyperventilation is due to different causes including enhanced responses from chemo- and metabolo-receptors, increased CO(2) production and increased dead space ventilation. Several drugs affect the ventilatory pattern in heart failure patients: ACE-inhibitors and anti-aldosteronic drugs improve lung diffusion and ventilatory efficiency during exercise; beta-blockers reduce exercise-induced hyperventilation. Furthermore, ultrafiltration improves lung mechanics, both at rest and during exercise, through body fluid content reduction.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, via Parea 4, 20138 Milan, Italy.
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Snyder EM, Johnson BD, Beck KC. An open-circuit method for determining lung diffusing capacity during exercise: comparison to rebreathe. J Appl Physiol (1985) 2005; 99:1985-91. [PMID: 16024523 DOI: 10.1152/japplphysiol.00348.2005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To avoid limitations associated with the use of single-breath and rebreathe methods for assessing the lung diffusing capacity for carbon monoxide (DlCO) during exercise, we developed an open-circuit technique. This method does not require rebreathing or alterations in breathing pattern and can be performed with little cognition on the part of the patient. To determine how this technique compared with the traditional rebreathe (DlCO,RB) method, we performed both the open-circuit (DlCO,OC) and the DlCO,RBmethods at rest and during exercise (25, 50, and 75% of peak work) in 11 healthy subjects [mean age = 34 yr (SD 11)]. Both DlCO,OCand DlCO,RBincreased linearly with cardiac output and external work. There was a good correlation between DlCO,OCand DlCO,RBfor rest and exercise (mean of individual r2= 0.88, overall r2= 0.69, slope = 0.97). DlCO,OCand DlCO,RBwere similar at rest and during exercise [e.g., rest = 27.2 (SD 5.8) vs. 29.3 (SD 5.2), and 75% peak work = 44.0 (SD 7.0) vs. 41.2 ml·min−1·mmHg−1(SD 6.7) for DlCO,OCvs. DlCO,RB]. The coefficient of variation for repeat measurements of DlCO,OCwas 7.9% at rest and averaged 3.9% during exercise. These data suggest that the DlCO,OCmethod is a reproducible, well-tolerated alternative for determining DlCO, particularly during exercise. The method is linearly associated with cardiac output, suggesting increased alveolar-capillary recruitment, and values were similar to the traditional rebreathe method.
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Affiliation(s)
- Eric M Snyder
- Department of Internal Medicine, Division of Cardiovascular Disease, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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Palermo P, Cattadori G, Bussotti M, Apostolo A, Contini M, Agostoni P. Lateral Decubitus Position Generates Discomfort and Worsens Lung Function in Chronic Heart Failure. Chest 2005; 128:1511-6. [PMID: 16162751 DOI: 10.1378/chest.128.3.1511] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Lateral decubitus position is poorly tolerated by heart failure patients. STUDY OBJECTIVES To evaluated pulmonary function and lung diffusion in heart failure patients in the following five body positions: sitting, prone, supine, and left and right decubitus. SETTING Heart failure unit of a university hospital. SUBJECTS We studied 14 chronic heart failure patients in New York Heart Association class III and 14 healthy volunteers. MEASUREMENTS AND RESULTS After 15 min of a selected position, subjects were evaluated by a discomfort scale, ear oximetry, and pulmonary function, which included FEV1, FVC, vital capacity (VC), alveolar volume, and diffusing capacity of the lung for carbon monoxide (D(LCO)) with subcomponent membrane resistance (DM) and capillary volume. In healthy subjects, we observed a reduction of D(LCO) and capillary volume in both lateral decubiti. Some discomfort was documented in both lateral decubiti when selected positions were compared with the sitting position. In the sitting position, pulmonary function suggested slight restriction ([mean +/- SD] FVC, 89.8 +/- 22.3% predicted; FEV1, 84.7 +/- 16.9% predicted, VC, 88.6 +/- 21.5% predicted; and FEV1/VC, 74 +/- 7) with low D(LCO) (73 +/- 19% predicted). Compared with sitting, lung mechanics were unchanged in prone and supine positions; FEV1, FVC, and FEV1/VC were lower when patients were lying on their side, with unchanged alveolar volume and VC. D(LCO) was similar when comparing sitting, prone, and supine positions, and it was lower in lateral decubitus because of the lower capillary volume (vs sitting) and DM (vs prone and supine). Body position-related FVC and D(LCO) reduction were greatest in the largest hearts (deltaFVC and deltaD(LCO) vs left ventricle diastolic volume R = 0.524, p < 0.05 and R = 0.630, p < 0.02, respectively; deltaFVC and deltaD(LCO) vs cardiothoracic index R = 0.539, p < 0.05 and R = 0.685, p < 0.01, respectively). CONCLUSIONS In heart failure, lateral decubitus airway obstruction and lung diffusion impairment become greater as heart dimensions increase.
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Affiliation(s)
- Pietro Palermo
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology, University of Milan, 20138 Milan, Italy
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Agostoni P, Magini A, Andreini D, Contini M, Apostolo A, Bussotti M, Cattadori G, Palermo P. Spironolactone improves lung diffusion in chronic heart failure. Eur Heart J 2004; 26:159-64. [PMID: 15618072 DOI: 10.1093/eurheartj/ehi023] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate whether anti-aldosteronic treatment influences lung diffusion (DLCO) in chronic heart failure (HF) patients. Spironolactone improves clinical conditions and prognosis in chronic HF and reduces connective tissue matrix turnover; DLCO abnormalities in chronic HF are related to increase in fibrosis and connective tissue derangement. METHODS AND RESULTS Thirty stable chronic HF patients, with reduced DLCO (<80% of predicted), were randomly assigned to active treatment (25 mg spironolactone daily) or placebo in addition to conventional anti-failure treatment. They were evaluated by quality of life questionnaire, laboratory investigations, cardiopulmonary exercise test, and pulmonary function test, which included DLCO and membrane diffusing capacity (DM). The evaluation was done before treatment and 6 months after. Quality of life score and standard pulmonary function tests were not significantly affected by spironolactone, while active treatment increased DLCO due to an increase of DM (DLCO: 18.3+/-3.9 vs. 19.9+/-5.5 mL/min/mmHg; DM: 28.1+/-7.7 vs. 33.3+/-8.6 mL/min/mmHg) and peak oxygen consumption (peak VO2 16.8+/-1.9 vs.18.6+/-2.2 mL/min/kg). Increments of DLCO and peak VO2 were linearly related (R=0.849, P<0.001). CONCLUSION These data show a positive effect of spironolactone on gas diffusion and exercise capacity suggesting a novel mechanism by which anti-aldosteronic drugs improve HF clinical condition and prognosis.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, via Parea 4, 20138 Milan, Italy.
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Bussotti M, Andreini D, Agostoni P. Exercise-induced changes in exhaled nitric oxide in heart failure. Eur J Heart Fail 2004; 6:551-4. [PMID: 15302001 DOI: 10.1016/j.ejheart.2003.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2003] [Revised: 06/20/2003] [Accepted: 08/28/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In heart failure abnormalities of pulmonary function are frequently observed as shown by hyperpnea, reduced lung compliance, reduced alveolar-capillary gas diffusion, positive methacholine challenge and, during exercise, early expiratory flow limitation. Nitric oxide (NO) might be related to all the above abnormalities. AIMS We evaluated whether a correlation between exhaled NO (eNO) and lung function exists at rest and during exercise in heart failure. METHODS We studied 33 chronic heart failure patients and 11 healthy subjects with: (a) standard pulmonary function, (b) lung diffusion for carbon monoxide (DLco) including its subcomponents, capillary volume and membrane resistance and eNO both at rest and during light exercise, (c) maximal cycloergometer cardiopulmonary exercise test. RESULTS Forced expiratory volume in 1 s (FEV(1)) was reduced in heart failure patients (83+/-17% of predicted), as was DLco (75+/-18% of predicted) due to reduced membrane resistance (32.6+/-10.3 ml mmHg(-1) min(-1) vs. 39.9+/-6.9 in patients vs. controls, P<0.02). Exhaled NO was lower in patients vs. controls (9.7+/-5.4 ppm vs. 14.4+/-6.4, P<0.05) and was, during exercise, constant in patients and reduced in controls. No significant correlation was found between eNO and lung function. Vice-versa eNO changes during exercise were correlated with peak exercise oxygen consumption (r=0.560, P<0.001). CONCLUSIONS The hypothesis of a link between eNO and lung function in heart failure was not proved. The correlation between eNO changes during exercise and peak V(O(2)) might be due to hemoglobin oxygenation, which binds NO to hemoglobin.
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Affiliation(s)
- Maurizio Bussotti
- Centro Cardiologico Monzino IRCCS, Istituto di Cardiologia Università di Milano, via Parea 4, 20138 Milan, Italy
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Abstract
Background—
In heart failure (HF) patients, exercise may increase pulmonary capillary hydrostatic pressure and thereby generate pulmonary edema. If pulmonary edema developed, alveolar-capillary membrane conductance (D
m
), measured immediately after exercise, would decrease. To test this hypothesis, we measured D
m
before and at 2 and 60 minutes after exercise.
Methods and Results—
We studied 10 HF patients with exercise-induced periodic breathing, 10 with peak V̇
o
2
≤15 mL · min
−1
· kg
−1
(severe HF), 10 with V̇
o
2
=15 to 20 mL · min
−1
· kg
−1
(moderate HF), and 10 normal subjects (control). Using the Roughton-Forster technique, we measured carbon monoxide diffusion capacity (DL
co
) and its components, capillary blood volume (V
c
) and D
m
, at rest and 2 and 60 minutes after exercise. At rest, DL
co
and D
m
were lowest in periodic breathing and highest in control subjects. D
m
decreased in periodic breathing, severe HF, and moderate HF (−7.83±3.98, −5.57±2.03, and −3.85±3.53 mL · min
−1
· mm Hg
−1
, respectively;
P
<0.01) at 2 minutes after exercise but not in control subjects. V
c
increased in all groups at 2 minutes and remained elevated at 60 minutes only in periodic breathing. D
m
/V
c
was decreased in periodic breathing, severe HF, and moderate HF at 2 minutes but not in control subjects. D
m
and D
m
/V
c
remained low at 60 minutes only in periodic breathing.
Conclusions—
D
m
decreases after exercise in HF patients but not in control subjects, which suggests a decrease in conductance across the alveolar-capillary barrier, as with pulmonary edema. The reductions were most marked in HF patients with periodic breathing and less reduced in less severe HF.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, Via Parea 4, 20138 Milan, Italy.
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Ventilation, Autonomic Function, Sleep and Erythropoietin. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2003. [DOI: 10.1007/978-1-4419-8997-0_12] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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