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Girault A, Leprêtre PM, Trachsel LD, Besnier F, Boidin M, Lalongé J, Juneau M, Bherer L, Nigam A, Gayda M. Determinants of V̇+O2peak Changes After Aerobic Training in Coronary Heart Disease Patients. Int J Sports Med 2024; 45:532-542. [PMID: 38267005 DOI: 10.1055/a-2253-1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This study aimed to highlight the ventilatory and circulatory determinants of changes in ˙VO2peak after exercise-based cardiac rehabilitation (ECR) in patients with coronary heart disease (CHD). Eighty-two CHD patients performed, before and after a 3-month ECR, a cardiopulmonary exercise testing (CPET) on a bike with gas exchanges measurements (˙VO2peak, minute ventilation, i. e., ˙VE), and cardiac output (Q˙c). The arteriovenous difference in O2 (C(a-v¯)O2) and the alveolar capillary gradient in O2 (PAi-aO2) were calculated using Fick's laws. Oxygen uptake efficiency slope (OUES) was calculated. A 5.0% cut off was applied for differentiating non- (NR: ˙VO2<0.0%), low (LR: 0.0≤ ∆˙VO2<5.0%), moderate (MR: 5.0≤∆˙VO2 < 10.0%), and high responders (HR: ∆˙VO2≥10.0%) to ECR. A total of 44% of patients were HR (n=36), 20% MR (n=16), 23% LR (n=19), and 13% NR (n=11). For HR, the ˙VO2peak increase (p<0.01) was associated with increases in ˙VE (+12.8±13.0 L/min, p<0.01), (+1.0±0.9 L/min, p<0.01), and C(a-v¯)O2 (+2.3±2.5 mLO2/100 mL, p<0.01). MR patients were characterized by+6.7±19.7 L/min increase in ˙VE (p=0.04) and+0.7±1.0 L/min of Q˙c (p<0.01). ECR induced decreases in ˙VE (p=0.04) and C(a-v¯)O2 (p<0.01) and a Q˙c increase in LR and NR patients (p<0.01). Peripheral and ventilatory responses more than central adaptations could be responsible for the ˙VO2peak change with ECR in CHD patients.
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Affiliation(s)
- Axel Girault
- Preventive medicine and physical activity Center (ÉPIC), Montreal Heart Institute, Université de Montréal, Montréal, Canada
- Unit Research Physiological Adaptations to Exercise and Physical Rehabilitation, Université de Picardie Jules Verne, Amiens, France
| | - Pierre-Marie Leprêtre
- Unit Research Physiological Adaptations to Exercise and Physical Rehabilitation, Université de Picardie Jules Verne, Amiens, France
- Unit of Cardiac Rehabilitation, Hospital Center of Corbie, Corbie, France
| | - Lukas-Daniel Trachsel
- University Clinic for Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Florent Besnier
- Preventive medicine and physical activity Center (ÉPIC), Montreal Heart Institute, Université de Montréal, Montréal, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Maxime Boidin
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Julie Lalongé
- Preventive medicine and physical activity Center (ÉPIC), Montreal Heart Institute, Université de Montréal, Montréal, Canada
| | - Martin Juneau
- Preventive medicine and physical activity Center (ÉPIC), Montreal Heart Institute, Université de Montréal, Montréal, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Louis Bherer
- Preventive medicine and physical activity Center (ÉPIC), Montreal Heart Institute, Université de Montréal, Montréal, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Anil Nigam
- Preventive medicine and physical activity Center (ÉPIC), Montreal Heart Institute, Université de Montréal, Montréal, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Mathieu Gayda
- Preventive medicine and physical activity Center (ÉPIC), Montreal Heart Institute, Université de Montréal, Montréal, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada
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Kirsch M, Vitiello D, Trachsel LD, Boidin M, Lalongé J, Juneau M, Bherer L, Nigam A, Gayda M. Cardiac hemodynamics phenotypes and individual responses to training in coronary heart disease patients. Scand J Med Sci Sports 2024; 34:e14633. [PMID: 38650385 DOI: 10.1111/sms.14633] [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] [Received: 10/03/2023] [Revised: 01/18/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND In patients with coronary heart disease (CHD), individualized exercise training (ET) programs are strongly recommended to optimize peak oxygen uptake (V ̇ $$ \dot{\mathrm{V}} $$ O2peak) improvement and prognosis. However, the cardiac hemodynamic factors responsible for a positive response to training remain unclear. The aim of this study was to compare cardiac hemodynamic changes after an ET program in responder (R) versus non-responder (NR) CHD patients. METHODS A total of 72 CHD patients completed a 3-month ET program and were assessed by cycle ergometer cardiopulmonary exercise test (CPET:V ̇ $$ \dot{\mathrm{V}} $$ O2peak assessment) with impedance cardiography (ICG) for hemodynamic measurements before and after training. Cardiac hemodynamics (e.g., CO, CI, SV, ESV, EDV, and SVR) were measured by ICG during CPET. The R and NR groups were classified using the median change inV ̇ $$ \dot{\mathrm{V}} $$ O2peak (>the median for R and ≤the median for NR). RESULTS In the R group,V ̇ $$ \dot{\mathrm{V}} $$ O2peak (+17%, p < 0.001), CO, CI, SV, and HR increased by 17%, 17%, 13%, and 5%, respectively (p < 0.05) after the training program. In the NR group,V ̇ $$ \dot{\mathrm{V}} $$ O2peak, CO, CI, and SV increased by 0.5%, 5%, 8%, and 6%, respectively (p < 0.01). The SVR decreased in both groups (-19% in R and -11% in NR, p < 0.001). CONCLUSION Among CHD patients, the R group showed a better improvement in peak cardiac output via an increase in peak stroke volume and heart rate and a reduced systemic vascular resistance than the NR group. Different cardiac phenotype adaptations and clinical individual responses were identified in CHD patients according to the aerobic fitness responder's status.
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Affiliation(s)
- Marine Kirsch
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Université Paris Cité, Institut des Sciences du Sport Santé de Paris (I3SP), URP 3625, Paris, France
| | - Damien Vitiello
- Université Paris Cité, Institut des Sciences du Sport Santé de Paris (I3SP), URP 3625, Paris, France
| | - Lukas-Daniel Trachsel
- University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maxime Boidin
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Julie Lalongé
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
| | - Martin Juneau
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Louis Bherer
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Anil Nigam
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Mathieu Gayda
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
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Kirsch M, Iliou MC, Vitiello D. Hemodynamic Response to Exercise Training in Heart Failure With Reduced Ejection Fraction Patients. Cardiol Res 2024; 15:18-28. [PMID: 38464706 PMCID: PMC10923260 DOI: 10.14740/cr1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/27/2023] [Indexed: 03/12/2024] Open
Abstract
Background Supervised exercise training decreases total and cardiac mortality and increases quality of life of heart failure with reduced ejection fraction (HFrEF) patients. However, response to training is variable from one patient to another and factors responsible for a positive response to training remain unclear. The aims of the study were to compare cardiac hemodynamic changes after an exercise training program in responders (R) versus non-responders (NR) HFrEF patients, and to compare different discriminators used to assess response to training. Methods Seventy-six HFrEF patients (86% males, 57 ± 12 years) completed an exercise training program for 4 weeks. Patients underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer before and after training. Cardiac hemodynamics were measured by impedance cardiography during CPET. The R and NR groups were classified using the median change in peak oxygen uptake (V̇O2peak). Results There were statistically significant differences in V̇O2peak (+35% vs. -1%, P < 0.0001) and in peaks of ventilation (+30% vs. +2%, P < 0.0001), cardiac output (COpeak) (+25% vs. +4%, P < 0.01), systolic blood pressure (+12% vs. +2%, P < 0.05), diastolic blood pressure (+9% vs. +4%, P < 0.05) and heart rate (+8% vs. +1%, P < 0.01) between R and NR after the training program. V̇O2peak was the best discriminator between R and NR (receiver operating characteristic (ROC) area under the curve (AUC) = 0.83, P < 0.0001), followed by COpeak (ROC AUC = 0.77, P < 0.0001). Conclusion V̇O2peak is the best discriminator between HFrEF R and NR patients after the training program. Responders showed improvements in peak hemodynamic parameters. These results pave the way for other studies to determine how the individualization of exercise training programs and peak hemodynamic parameters potentially linked to a better positive response status.
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Affiliation(s)
- Marine Kirsch
- Institut des Sciences du Sport Sante de Paris (I3SP), URP 3625, Universite Paris Cite, Paris 75015, France
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hopital Corentin Celton, APHP Centre, France
| | - Damien Vitiello
- Institut des Sciences du Sport Sante de Paris (I3SP), URP 3625, Universite Paris Cite, Paris 75015, France
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Højlund J, Petersen DR, Agerskov M, Foss NB. "The peripheral perfusion index discriminates haemodynamic responses to induction of general anaesthesia". J Clin Monit Comput 2023; 37:1533-1540. [PMID: 37289351 PMCID: PMC10651705 DOI: 10.1007/s10877-023-01035-z] [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] [Received: 01/04/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
Induction of general anaesthesia is often accompanied by hypotension. Standard haemodynamic monitoring during anaesthesia relies on intermittent blood pressure and heart rate. Continuous monitoring systemic blood pressure requires invasive or advanced modalities creating a barrier for obtaining important information of the circulation. The Peripheral Perfusion Index (PPI) is obtained non-invasively and continuously by standard photoplethysmography. We hypothesized that different patterns of changes in systemic haemodynamics during induction of general anaesthesia would be reflected in the PPI. Continuous values of PPI, stroke volume (SV), cardiac output (CO), and mean arterial pressure (MAP) were evaluated in 107 patients by either minimally invasive or non-invasive means in a mixed population of surgical patients. 2 min after induction of general anaesthesia relative changes of SV, CO, and MAP was compared to the relative changes of PPI. After induction total cohort mean(± st.dev.) MAP, SV, and CO decreased to 65(± 16)%, 74(± 18)%, and 63(± 16)% of baseline values. In the 38 patients where PPI decreased MAP was 57(± 14)%, SV was 63(± 18)%, and CO was 55(± 18)% of baseline values 2 min after induction. In the 69 patients where PPI increased the corresponding values were MAP 70(± 15)%, SV 80(± 16)%, and CO 68(± 17)% (all differences: p < 0,001). During induction of general anaesthesia changes in PPI discriminated between the degrees of reduction in blood pressure and algorithm derived cardiac stroke volume and -output. As such, the PPI has potential to be a simple and non-invasive indicator of the degree of post-induction haemodynamic changes.
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Affiliation(s)
- Jakob Højlund
- Department of Anaesthesiology, Hvidovre University Hospital, Capital Region, Denmark.
| | - David René Petersen
- Department of Anaesthesiology, Hvidovre University Hospital, Capital Region, Denmark
- Currently Department of Anaesthesiology, CKO, Rigshospitalet, Capital Region, Denmark
| | - Marianne Agerskov
- Department of Anaesthesiology, Hvidovre University Hospital, Capital Region, Denmark
| | - Nicolai Bang Foss
- Department of Anaesthesiology, Hvidovre University Hospital, Capital Region, Denmark
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Sugita Y, Ito K, Yoshioka Y, Kudo A, Arakawa S, Sakai S. Exercise training affects hemodynamics and exercise capacity in cases of heart failure with preserved ejection fraction: a non-randomized controlled trial in individuals aged 65-80 years. Front Cardiovasc Med 2023; 10:1246739. [PMID: 38028475 PMCID: PMC10646767 DOI: 10.3389/fcvm.2023.1246739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Exercise training is an established intervention method for improving exercise capacity and survival rates in patients with heart failure with preserved ejection fraction (HFpEF). However, most reports have focused on European and American patients, with limited data regarding the effects of exercise training on cardiac function, hemodynamics, and exercise capacity in East Asian patients. This study investigated the effects of exercise training on cardiac function, hemodynamics, and exercise capacity in Japanese patients aged 65-80 years with HFpEF. Methods This single-center, open-label, non-randomized, controlled trial prospectively enrolled 99 outpatients. Eligibility criteria for HFpEF patients were an HFA score ≥5 in addition to clinical symptoms of heart failure and left ventricular diastolic dysfunction. Exercise training in the intervention group consisted of aerobic exercise and strength training thrice weekly for 5 months. Patients in the control group continued the usual treatment for 5 months. Resting cardiac function was evaluated using echocardiography. Peak oxygen uptake (peakVO2), ventilatory equivalent (VE) vs. carbon dioxide output (VCO2) slope, peak cardiac output index, and arteriovenous oxygen difference were calculated using cardiopulmonary exercise testing combined with impedance cardiography. Results After 5 months of exercise training, remarkable interactions were observed, with peakVO2 as the primary outcome. Additionally, significant interactions were observed between hemodynamic indices and some echocardiographic parameters. The mean percentage change in peakVO2 from baseline was 8.3% in the intervention group. Fifteen study participants (30.1%) in the intervention group achieved a clinically meaningful change of 3.0 ml/min/kg (10% improvement) in peakVO2 from baseline. The group with 3.0 ml/min/kg or 10% improvement in peakVO2 from baseline had a considerably lower prevalence of diabetes mellitus and VE vs. VCO2 slope and considerably higher left atrial-global longitudinal strain values than the group without any notable improvements. Conclusions Although exercise training can help improve exercise intolerance in Japanese patients aged 65-80 years with HFpEF, its benefits are limited. Our results suggest that HFpEF, complicated by diabetes mellitus and decreased ventilatory efficiency during exercise, may require reconsideration of intervention strategies. This trial was registered with the University Hospital Medical Information Network, a trial registry in Japan (registration number: UMIN000045474).
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Affiliation(s)
- Yousuke Sugita
- Faculty of Health Sciences, Tsukuba University of Technology, Tsukuba, Japan
| | - Katsuhiko Ito
- Department of Rehabilitation, National Hospital Organization Matsumoto National Hospital, Matsumoto, Japan
| | - Yui Yoshioka
- Department of Rehabilitation, Musashino General Hospital, Kawagoe, Japan
| | - Ayano Kudo
- Faculty of Health Sciences, Tsukuba University of Technology, Tsukuba, Japan
| | - Sota Arakawa
- Faculty of Health Sciences, Tsukuba University of Technology, Tsukuba, Japan
| | - Satoshi Sakai
- Faculty of Health Sciences, Tsukuba University of Technology, Tsukuba, Japan
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Apostolo A, Vignati C, Cittar M, Baracchini N, Mushtaq S, Cattadori G, Sciomer S, Trombara F, Piepoli M, Agostoni P. Determinants of exercise performance in heart failure patients with extremely reduced cardiac output and left ventricular assist device. Eur J Prev Cardiol 2023; 30:ii63-ii69. [PMID: 37819220 DOI: 10.1093/eurjpc/zwad239] [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: 01/11/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 10/13/2023]
Abstract
The evaluation of exercise capacity and cardiac output (QC) is fundamental in the management of patients with advanced heart failure (AdHF). QC and peak oxygen uptake (VO2) have a pivotal role in the prognostic stratification and in the definition of therapeutic interventions, including medical therapies and devices, but also specific treatments such as heart transplantation and left ventricular assist device (LVAD) implantation. Due to the intertwined relationship between exercise capacity and daily activities, exercise intolerance dramatically has impact on the quality of life of patients. It is a multifactorial process that includes alterations in central and peripheral haemodynamic regulation, anaemia and iron deficiency, pulmonary congestion, pulmonary hypertension, and peripheral O2 extraction. This paper aims to review the pathophysiological background of exercise limitations in HF patients and to examine the complex physiology of exercise in LVAD recipients, analysing the interactions between the cardiopulmonary system, the musculoskeletal system, the autonomic nervous system, and the pump. We performed a literature review to highlight the current knowledge on this topic and possible interventions that can be implemented to increase exercise capacity in AdHF patients-including administration of levosimendan, rehabilitation, and the intriguing field of LVAD speed changes. The present paper confirms the role of CPET in the follow-up of this peculiar population and the impact of exercise capacity on the quality of life of AdHF patients.
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Affiliation(s)
- Anna Apostolo
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138, Milano, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138, Milano, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via della Commenda 19, 20122, Milano, Italy
| | - Marco Cittar
- Cardiovascular Department, 'Azienda Sanitaria Universitaria Giuliano-Isontina', Via Costantino Costantinides, 2, 34128, Trieste, Italy
| | - Nikita Baracchini
- Cardiovascular Department, 'Azienda Sanitaria Universitaria Giuliano-Isontina', Via Costantino Costantinides, 2, 34128, Trieste, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138, Milano, Italy
| | - Gaia Cattadori
- Cardio-rehabilitation Unit, Multimedica IRCCS, Via Milanese, 300, 20099, Milano, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, 'Sapienza', Rome University, Viale dell'Università, 37, 00185, Rome, Italy
| | - Filippo Trombara
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138, Milano, Italy
| | - Massimo Piepoli
- Clinical Cardiology, Policlinico San Donato IRCCS, University of Milan, Piazza Edmondo Malan, 2, 20097, Milan, Italy
- Department of Preventive Cardiology, Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wroclaw, Poland
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138, Milano, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via della Commenda 19, 20122, Milano, Italy
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Farina S, Pezzuto B, Vignati C, Laveneziana P, Agostoni P. Intrapulmonary distribution of blood flow during exercise in pulmonary hypertension assessed by a new combination technique. Front Cardiovasc Med 2023; 10:1241379. [PMID: 37745098 PMCID: PMC10515083 DOI: 10.3389/fcvm.2023.1241379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023] Open
Abstract
Background Hyperventilation and inadequate cardiac output (CO) increase are the main causes of exercise limitation in pulmonary hypertension (PH). Intrapulmonary blood flow partitioning between ventilated and unventilated lung zones is unknown. Thoracic impedance cardiography and inert gas rebreathing have been both validated in PH patients for non-invasive measurement of CO and pulmonary blood flow (PBF), respectively. This study sought to evaluate CO behaviour in PH patients during exercise and its partitioning between ventilated and unventilated lung areas, in parallel with ventilation partitioning between ventilated and unventilated lung zones. Methods Eighteen PH patients (group 1 or 4) underwent a cardiopulmonary exercise test (CPET) with a three-step loaded workload protocol. The steps occurred at 0%, 20%, 40%, and 60% of peak workload reached during a preliminary maximum CPET. Ventilatory parameters, arterial blood gases, CO, PBF, and intrapulmonary shunt (calculated as the difference between CO and PBF) were obtained at each step, combining thoracic impedance cardiography and an inert gas rebreathing technique. Results Dead space ventilation observed throughout the exercise was about 40% of total ventilation. A progressive increase of CO from 4.86 ± 1.24 L/min (rest) to 9.41 ± 2.63 L/min (last step), PBF from 3.81 ± 1.41 L/min to 7.21 ± 2.93 L/min, and intrapulmonary shunt from 1.05 ± 0.96 L/min to 2.21 ± 2.28 L/min was observed. Intrapulmonary shunt was approximately 20% of CO at each exercise step. Conclusions Although the study population was small, the combined non-invasive CO measurement seems a promising tool for deepening our knowledge of lung exercise haemodynamics in PH patients. This technique could be applied in future studies to evaluate PH treatment influences on CO partitioning, since a secondary increase of intrapulmonary shunt is undesirable.
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Affiliation(s)
| | | | | | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire APHP-Sorbonne Université, sites Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Lehto T, Zetterman T, Markkula R, Arokoski J, Tikkanen H, Kalso E, Peltonen JE. Cardiac output and arteriovenous oxygen difference contribute to lower peak oxygen uptake in patients with fibromyalgia. BMC Musculoskelet Disord 2023; 24:541. [PMID: 37393269 DOI: 10.1186/s12891-023-06589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/30/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Patients with fibromyalgia (FM) exhibit low peak oxygen uptake ([Formula: see text]O2peak). We aimed to detect the contribution of cardiac output to ([Formula: see text]) and arteriovenous oxygen difference [Formula: see text] to [Formula: see text] from rest to peak exercise in patients with FM. METHODS Thirty-five women with FM, aged 23 to 65 years, and 23 healthy controls performed a step incremental cycle ergometer test until volitional fatigue. Alveolar gas exchange and pulmonary ventilation were measured breath-by-breath and adjusted for fat-free body mass (FFM) where appropriate. [Formula: see text] (impedance cardiography) was monitored. [Formula: see text] was calculated using Fick's equation. Linear regression slopes for oxygen cost (∆[Formula: see text]O2/∆work rate) and [Formula: see text] to [Formula: see text]O2 (∆[Formula: see text]/∆[Formula: see text]O2) were calculated. Normally distributed data were reported as mean ± SD and non-normal data as median [interquartile range]. RESULTS [Formula: see text]O2peak was lower in FM patients than in controls (22.2 ± 5.1 vs. 31.1 ± 7.9 mL∙min-1∙kg-1, P < 0.001; 35.7 ± 7.1 vs. 44.0 ± 8.6 mL∙min-1∙kg FFM-1, P < 0.001). [Formula: see text] and C(a-v)O2 were similar between groups at submaximal work rates, but peak [Formula: see text] (14.17 [13.34-16.03] vs. 16.06 [15.24-16.99] L∙min-1, P = 0.005) and C(a-v)O2 (11.6 ± 2.7 vs. 13.3 ± 3.1 mL O2∙100 mL blood-1, P = 0.031) were lower in the FM group. No significant group differences emerged in ∆[Formula: see text]O2/∆work rate (11.1 vs. 10.8 mL∙min-1∙W-1, P = 0.248) or ∆[Formula: see text]/∆[Formula: see text]O2 (6.58 vs. 5.75, P = 0.122) slopes. CONCLUSIONS Both [Formula: see text] and C(a-v)O2 contribute to lower [Formula: see text]O2peak in FM. The exercise responses were normal and not suggestive of a muscle metabolism pathology. TRIAL REGISTRATION ClinicalTrials.gov, NCT03300635. Registered 3 October 2017-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03300635 .
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Affiliation(s)
- Taneli Lehto
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Mäkelänkatu 47, Urhea-Hall, 00550, Helsinki, Finland.
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
| | - Teemu Zetterman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- City of Vantaa Health Centre, Vantaa, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Ritva Markkula
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Heikki Tikkanen
- Sports and Exercise Medicine, Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Eija Kalso
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- SLEEPWELL Research Programme, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha E Peltonen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Mäkelänkatu 47, Urhea-Hall, 00550, Helsinki, Finland
- Foundation for Sports and Exercise Medicine, Helsinki Sports and Exercise Medicine Clinic, Helsinki, Finland
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Piccirillo G, Moscucci F, Corrao A, Carnovale M, Di Diego I, Lospinuso I, Caltabiano C, Mezzadri M, Rossi P, Magrì D. Noninvasive Hemodynamic Monitoring in Advanced Heart Failure Patients: New Approach for Target Treatments. Biomedicines 2022; 10:biomedicines10102407. [PMID: 36289669 PMCID: PMC9599112 DOI: 10.3390/biomedicines10102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Using bio-impedance to deduce some hemodynamic parameters combined with some short-term ECG temporal dispersion intervals, and measuring myocardial depolarization, intraventricular conduction, and repolarization. A total of 65 in-hospital patients (M/F:35/30) were enrolled, 39 with HFrEF and 26 HFpEF, in New York Heart Association (NYHA) class IV. Stroke volume (SVI), cardiac indexes (CI), left ventricular ejection fraction (LVEFBIO), end diastolic volume (LV-EDV), and other systolic and diastolic parameters were noninvasively obtained at enrollment and at hospital discharge. At the same time, QR, QRS, QT, ST, Tpeak-Tend (Te) interval mean, and standard deviation (SD) from 5 min ECG recordings were obtained. At baseline, HFrEF patients reported significantly lower SVI (p < 0.05), CI (p < 0.05), and LVEF (p < 0.001) than HFpEF patients; moreover, HFrEF patients also showed increased LV-EDV (p < 0.05), QR, QRS, QT, ST, and Te means (p < 0.05) and standard deviations (p < 0.05) in comparison to HFpEF subjects. Multivariable logistic regression analysis reported a significant correlation between hospital mortality and Te mean (odds ratio: 1.03, 95% confidence limit: 1.01−1.06, p: 0.01). Fifty-seven percent of patients were considered responders to optimal medical therapy and, at discharge, they had significantly reduced NT-proBNP, (p < 0.001), heart rate (p < 0.05), and TeSD (p < 0.001). LVEF, obtained by transthoracic echocardiography, and LVEFBIO were significantly related (r: 0.781, p < 0.001), but these two parameters showed a low agreement limit. Noninvasive hemodynamic and ECG-derived parameters were useful to highlight the difference between HFrEF and HFpEF and between responders and nonresponders to the optimal medical therapy. Short-period bioimpedance and electrocardiographic data should be deeply evaluated to determine possible advantages in the therapeutic and prognostic approach in severe CHF.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Federica Moscucci
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
- Correspondence: ; Tel.: +39-06-4997-0118
| | - Andrea Corrao
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Myriam Carnovale
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Ilaria Di Diego
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Ilaria Lospinuso
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Cristina Caltabiano
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Martina Mezzadri
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico n. 155, 00186 Rome, Italy
| | - Pietro Rossi
- Arrhytmology Unit, Cardiology Division, S. Giovanni Calibita, Isola Tiberina, 00186 Rome, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, “Sapienza” University of Rome, 00186 Rome, Italy
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Meijer R, van Hooff M, Papen-Botterhuis NE, Molenaar CJL, Regis M, Timmers T, van de Poll-Franse LV, Savelberg HHCM, Schep G. Estimating VO2peak in 18–90 Year-Old Adults: Development and Validation of the FitMáx©-Questionnaire. Int J Gen Med 2022; 15:3727-3737. [PMID: 35411174 PMCID: PMC8994663 DOI: 10.2147/ijgm.s355589] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Cardiorespiratory fitness (CRF) plays an essential role in health outcomes and quality of life. However, it is often not assessed nor estimated. Objective CRF assessment is costly, labour intensive and not widely available. Patient-reported outcome measures estimate CRF more cost-efficiently, but current questionnaires lack accuracy. The aim of this study is to develop a new self-reported questionnaire to estimate CRF. Materials and Methods The FitMáx©-questionnaire, consisting of only three questions assessing walking, stair climbing, and cycling capacity, was compared with the commonly used Duke Activity Status Index (DASI) and Veterans Specific Activity Questionnaire (VSAQ). These questionnaires were compared to peak oxygen uptake (VO2peak) as measured with cardiopulmonary exercise testing. This study included 759 cardiac, pulmonary and oncologic patients and healthy persons aged 18‒90. Results FitMáx© strongly correlated (r = 0.94 (0.92‒0.95) SEE = 4.14 mL∙kg−1∙min−1) with measured VO2peak. Bias between predicted and measured VO2peak was −0.24 (−9.23‒8.75; 95% limits of agreement) mL·kg−1·min−1. The FitMáx© scored superiorly on correlation and SEE compared with the DASI and VSAQ, r = 0.75 (0.68‒0.80) SEE = 4.62 mL∙kg−1∙min−1 and r = 0.87 (0.83‒0.90) SEE = 6.75 mL∙kg−1∙min−1, respectively. Conclusion FitMáx© is a valid and accessible questionnaire to estimate CRF expressed as VO2peak in clinical practice and shows substantial improvement compared to currently used questionnaires.
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Affiliation(s)
- Renske Meijer
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Correspondence: Renske Meijer, Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands, Tel +31 40 8888 000, Email ; ;
| | - Martijn van Hooff
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | | | - Marta Regis
- Academy, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Mathematics and Computer Science, University of Technology, Eindhoven, the Netherlands
| | - Thomas Timmers
- Department of Research & Development, Interactive Studios, Rosmalen, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Net
herlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Goof Schep
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
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11
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Sugita Y, Ito K, Sakurai S, Sakai S, Kuno S. Epicardial adipose tissue is associated with cardiorespiratory fitness and hemodynamics among Japanese individuals of various ages and of both sexes. PLoS One 2021; 16:e0254733. [PMID: 34260663 PMCID: PMC8279356 DOI: 10.1371/journal.pone.0254733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Epicardial adipose tissue may affect hemodynamics and cardiorespiratory fitness as it is a metabolically active visceral adipose tissue and a source of inflammatory bioactive substances that can substantially modulate cardiovascular morphology and function. However, the associations between epicardial adipose tissue and hemodynamics and cardiorespiratory fitness remain unclear. This cross-sectional study aimed to examine the association between epicardial adipose tissue volume and hemodynamics, and cardiorespiratory fitness among Japanese individuals of various ages and of both sexes. Epicardial adipose tissue volume was measured in 120 participants (age, 21-85 years) by cardiac magnetic resonance imaging. To evaluate cardiorespiratory fitness, peak oxygen uptake was measured by cardiopulmonary exercise testing. Peak cardiac output and arteriovenous oxygen difference were calculated by impedance cardiography. The epicardial adipose tissue volume was significantly increased in middle-aged and older women. The epicardial adipose tissue volume was significantly and negatively correlated to peak cardiac output and peak oxygen uptake, regardless of age and sex; furthermore, epicardial adipose tissue showed a strong negative correlation with peak heart rate. Epicardial adipose tissue and peak cardiac output were significantly associated (β = -0.359, 95% confidence interval, -0.119 to -0.049, p < 0.001), even after multivariate adjustment (R2 = 0.778). However, in the multiple regression analysis with peak oxygen uptake as a dependent variable, the epicardial adipose tissue volume was not an independent predictor. These data suggest that increased epicardial adipose tissue volume may be correlated with decreased peak oxygen uptake, which might have mediated the abnormal hemodynamics among Japanese people of various ages and of both sexes. Interventions targeting epicardial adipose tissue could potentially improve hemodynamics and cardiorespiratory fitness.
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Affiliation(s)
- Yousuke Sugita
- Faculty of Health Sciences, Tsukuba University of Technology, Kasuga, Tsukuba-shi, Ibaraki, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennoudai, Tsukuba-shi, Ibaraki, Japan
| | - Katsuhiko Ito
- Department of Rehabilitation, Saitama National Hospital, Suwa, Wakoh-shi, Saitama, Japan
| | - Shigeki Sakurai
- Department of Cardiology, Sakurai Clinic, Shibasaki, Takasaki-shi, Gunma, Japan
| | - Satoshi Sakai
- Faculty of Health Sciences, Tsukuba University of Technology, Kasuga, Tsukuba-shi, Ibaraki, Japan
| | - Shinya Kuno
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennoudai, Tsukuba-shi, Ibaraki, Japan
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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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13
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Lee SWY, Cheung CHY, Ying MTC, Tam VCW, Khaw ML. Reply to Myers and Leprêtre. J Appl Physiol (1985) 2021; 130:673-674. [DOI: 10.1152/japplphysiol.01018.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Shara W. Y. Lee
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| | - Cara H. Y. Cheung
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| | - Michael T. C. Ying
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| | - Victor C. W. Tam
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| | - May L. Khaw
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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14
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Legendre A, Moatemri F, Kovalska O, Balice-Pasquinelli M, Blanchard JC, Lamar-Tanguy A, Ledru F, Cristofini P, Iliou MC. Responses to exercise training in patients with heart failure. Analysis by oxygen transport steps. Int J Cardiol 2021; 330:120-127. [PMID: 33571565 DOI: 10.1016/j.ijcard.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/09/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Exercise training (ET) increases exercise tolerance, improves quality of life and likely the prognosis in heart failure patients with reduced ejection fraction (HFrEF). However, some patients do not improve, whereas exercise training response is still poorly understood. Measurement of cardiac output during cardiopulmonary exercise test might allow ET response assessment according to the different steps of oxygen transport. METHODS Fifty-three patients with HFrEF (24 with ischemic cardiomyopathy (ICM) and 29 with dilated cardiomyopathy (DCM) had an aerobic ET. Before and after ET program, peak oxygen consumption (VO2peak) and cardiac output using thoracic impedancemetry were measured. Oxygen convection (QO2peak) and diffusion (DO2) were calculated using Fick's principle and Fick's simplified law. Patients were considered as responders if the gain was superior to 10%. RESULTS We found 55% VO2peak responders, 62% QO2peak responders and 56% DO2 responders. Four patients did not have any response. None baseline predictive factor for VO2peak response was found. QO2peak response was related to exercise stroke volume (r = 0.84), cardiac power (r = 0.83) and systemic vascular resistance (SVRpeak) (r = -0.42) responses. Cardiac power response was higher in patients with ICM than in those with DCM (p < 0.05). Predictors of QO2peak response were low baseline exercise stroke volume and ICM etiology. Predictors of DO2 response were higher baseline blood creatinine and prolonged training. CONCLUSION The analysis of the response to training in patients with HFrEF according to the different steps of oxygen transport revealed different phenotypes on VO2peak responses, namely responses in either oxygen convection and/or diffusion.
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Affiliation(s)
- Antoine Legendre
- M3C-Necker, Congenital and Pediatric Cardiology, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Adult Congenital Heart Disease Unit, Cardiology Department, Hôpital Européen Georges Pompidou, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Assistance Publique-Hôpitaux de Paris, Paris, France..
| | - Feriel Moatemri
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Oksana Kovalska
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Maria Balice-Pasquinelli
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Jean-Christophe Blanchard
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Aurelia Lamar-Tanguy
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - François Ledru
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Pascal Cristofini
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
| | - Marie-Christine Iliou
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, APHP Centre University of Paris, Issy les Moulineaux, France
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15
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Spee RF, Niemeijer VM, Thijssen CGE, Hoogeveen A, Wijn PFF, Doevendans PA, Kemps HMC. The utility of the oxygen pulse recovery as a marker of the cardiac output response to exercise in patients with chronic heart failure. Clin Physiol Funct Imaging 2020; 40:328-335. [PMID: 32378304 DOI: 10.1111/cpf.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 01/31/2020] [Accepted: 04/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The cardiac output (CO) response to exercise is a useful marker to grade the prognosis and severity of chronic heart failure (CHF). The recovery of the oxygen pulse (OP) is a non-invasive parameter, which is related to exercise capacity in cardiac patients. However, the relation between OP recovery and the central haemodynamic response to exercise remains to be determined. We hypothesized that an impaired OP recovery is associated with a reduced CO response to exercise in CHF patients. METHODS Sixty one CHF patients performed cardiopulmonary exercise test with simultaneous measurement of CO. Impaired OP recovery was defined as an overshoot during the first minute of recovery or OP at 1-min recovery as a percentage of peak OP (OPRR ). RESULTS An OP overshoot was observed in 9% (n = 5) of patients. In these patients, peak CO and VO2 were significantly lower (peak CO 7.9 ± 0.8 versus 11.2 ± 4.3 L/min and peak VO2 14.1 ± 4.7 versus 19.6 ± 5.8 ml min-1 kg-1 ). Mean relative recovery of OP was 78 ± 20%. Slow OP recovery (negative OPRR ) was seen in 13% (n = 8). Peak CO and VO2 were significantly lower in the negative OPRR group (11 ± 4 versus 8 ± 0.7 L/min and 19.7 ± 5.9 versus 14.6 ± 3.7 ml kg min-1 ). There was a significant relation between OPRR and stroke volume (SV) RR (r = .57), as well as between OPRR and a-v O2 diff RR (rs = .4). CONCLUSION An impaired OP recovery is associated with a reduced CO response to exercise and worse functional status. Therefore, the OP recovery can be used to grade the severity of CHF.
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Affiliation(s)
- Ruud F Spee
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Victor M Niemeijer
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
| | | | - Adwin Hoogeveen
- Department of Sports Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Pieter F F Wijn
- Department of Applied Physics, University of Technology, Eindhoven, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands.,ICIN, Netherlands Heart Institute, Utrecht, The Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
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16
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Stanberry L, Ahmed A, Sorajja P, Cavalcante JL, Gossl M. Invasive versus non-invasive assessment of valvuloarterial impedance in severe aortic stenosis. Open Heart 2020; 7:openhrt-2020-001240. [PMID: 32366520 PMCID: PMC7213872 DOI: 10.1136/openhrt-2020-001240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/03/2020] [Accepted: 03/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background As a measure of the global left ventricular afterload, valvuloarterial impedance (ZVA) can be estimated using transthoracic echocardiography (TTE) and invasive measuring methods. The objective of this study was to compare the performance of TTE in measuring ZVA with invasive haemodynamics, direct Fick and thermodilution (TD), in patients with severe aortic stenosis (AS). Methods This is a retrospective cohort study of 66 patients with severe AS who underwent TTE and bilateral heart catheterisation preaortic valve replacement. ZVA was calculated non-invasively from TTE and invasively using TD and Fick. The differences in measurements were estimated using a generalised estimating equation approach. The exchangeability of the measurements from different methods was evaluated under binary risk stratification rules. Results The mean±SD ZVA by TTE was 4.6±1.4 vs 4.9±1.6 by TD vs 4.3±1.2 mm Hg m2/mL by Fick. From multivariate analyses, ZVA by TTE was 5.9% (95% CI −15.0 to 2.5) lower than by TD and 5.9% (95% CI −1.5 to 12.8) higher than by Fick. At the same time, ZVA by TD was 12.5% (3.0 to 22.9) higher than with Fick. Risk classifications for ZVA-based binary decision rules showed poor agreement between TTE and invasive methods (kappa ≤0.3). Conclusions The differences in ZVA estimates between TTE and invasive standards do not appear to exceed those between the standards. As such TTE-based estimates may be deemed acceptable as a clinical measure of global haemodynamic load. However, TTE-based and invasive measurements may not be interchangeable to identify patients at risk using binary classification rules based on ZVA.
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Affiliation(s)
- Lisa Stanberry
- Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Aisha Ahmed
- Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Joao L Cavalcante
- Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Mario Gossl
- Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA .,Interventional Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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17
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Cheung CHY, Khaw ML, Tam VCW, Ying MTC, Lee SWY. Performance evaluation of a portable bioimpedance cardiac output monitor for measuring hemodynamic changes in athletes during a head-up tilt test. J Appl Physiol (1985) 2020; 128:1146-1152. [DOI: 10.1152/japplphysiol.00822.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The use of impedance cardiography to monitor physiological changes in sports is rarely reported. Using head-up tilt test, we evaluated a portable noninvasive impedance cardiography device (PhysioFlow) by comparing it with a reference Doppler monitor (USCOM). Accuracy in tracking hemodynamic changes deteriorated with higher tilt, implying a gravitational influence on its performance. Stroke volume measurements were overestimated, but the changes were underestimated. Despite its convenient physical features, the suitability of PhysioFlow for sports use is questionable.
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Affiliation(s)
- Cara H. Y. Cheung
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - May L. Khaw
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania
| | - Victor C. W. Tam
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Michael T. C. Ying
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Shara W. Y. Lee
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
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18
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Guirgis L, Khraiche D, Ladouceur M, Iserin L, Bonnet D, Legendre A. Cardiac performance assessment during cardiopulmonary exercise test can improve the management of children with repaired congenital heart disease. Int J Cardiol 2020; 300:121-126. [DOI: 10.1016/j.ijcard.2019.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/03/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022]
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19
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High intensity interval training after cardiac resynchronization therapy: An explorative randomized controlled trial. Int J Cardiol 2020; 299:169-174. [DOI: 10.1016/j.ijcard.2019.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
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20
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Stroke volume and cardiac output measurement in cardiac patients during a rehabilitation program: comparison between tonometry, impedancemetry and echocardiography. Int J Cardiovasc Imaging 2019; 36:447-455. [PMID: 31845049 DOI: 10.1007/s10554-019-01738-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/23/2019] [Indexed: 01/31/2023]
Abstract
Given the increasing use of noninvasive techniques for the assessment of cardiac function in clinical practice, the aim of this study was to evaluate if stroke volume (SV) and cardiac output (CO) measurements obtained by PhysioFlow impedance cardiography or HDI CR-2000 pulse wave analysis (Pulse) are interchangeable with measurements obtained by echocardiography in patients with coronary artery disease (CAD) or heart failure (HF). The study involved 48 men with heart disease (CAD or HF). We compared SV and CO measurements with the three devices at rest, as well as relative changes in SV and CO derived from a rehabilitation program. SV and CO measurements were carried out first by echocardiography and immediately after using tonometry and impedancemetry techniques simultaneously. The Bland-Altman analysis showed a significant bias in the measurement of absolute SV and CO values with Pulse and PhysioFlow. Four quadrant plot and polar plot analysis of relative change SV between Pulse and echocardiography show a rate of concordance of 77% (95% CI 60-88%) and 79% (95% CI 63-89%) respectively. The polar plot analysis showed a mean polar angle of 34° ± 22°, and a 30° radial sector containing 52% of the data points. Both Pulse and PhysioFlow devices overestimate absolute SV and CO values compared to values recorded using echocardiography. Similarly, neither Pulse nor PhysioFlow reliably track SV or CO changes after a rehabilitation program compared with echocardiography.
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Højlund J, Agerskov M, Clemmesen CG, Hvolris LE, Foss NB. The Peripheral Perfusion Index tracks systemic haemodynamics during general anaesthesia. J Clin Monit Comput 2019; 34:1177-1184. [DOI: 10.1007/s10877-019-00420-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/04/2019] [Indexed: 01/09/2023]
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Małek ŁA, Mróz A, Czajkowska A, Kosmol A, Ogonowska-Słodownik A, Molik B, Morgulec-Adamowicz N. Accuracy of Impedance Cardiography for Hemodynamic Assessment During Rest and Exercise in Wheelchair Rugby Players. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2019; 90:336-343. [PMID: 31082312 DOI: 10.1080/02701367.2019.1600651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
Purpose: The aim of the study was to analyze the accuracy of impedance cardiography (ICG) for hemodynamic assessment in wheelchair rugby players during rest and exercise. Method: The study included 21 players (mean age 33.0 ± 5.4, 86% male) with posttraumatic tetraplegia. ECG, echocardiography, and gas exchange analysis during rest and exercise were used to obtain heart rate (HR), stroke volume (SV), and cardiac output (CO) for comparison with PhysioFlow®. Results: There was a good correlation between reference methods and ICG for HR, SV, CO at rest and CO at peak exercise (r = 0.69-0.77, p < .001) and a very good correlation for peak HR (r = 0.91, p < .0001). ICG overestimated SV at rest, CO at rest, and peak CO, which resulted in low intraclass correlation coefficients (ICC = 0.250 and 0.570). Conclusions: ICG can serve as a good estimate of basic hemodynamic parameters during rest and exercise in wheelchair rugby players but overestimates stroke volume and cardiac output.
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Affiliation(s)
- Łukasz A Małek
- a Józef Pilsudski University of Physical Education in Warsaw
| | - Anna Mróz
- a Józef Pilsudski University of Physical Education in Warsaw
| | - Anna Czajkowska
- a Józef Pilsudski University of Physical Education in Warsaw
| | - Andrzej Kosmol
- a Józef Pilsudski University of Physical Education in Warsaw
| | | | - Bartosz Molik
- a Józef Pilsudski University of Physical Education in Warsaw
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Woolstenhulme JG, Guccione AA, Herrick JE, Collins JP, Nathan SD, Chan LE, Keyser RE. Left Ventricular Function Before and After Aerobic Exercise Training in Women With Pulmonary Arterial Hypertension. J Cardiopulm Rehabil Prev 2019; 39:118-126. [PMID: 30624371 PMCID: PMC6452473 DOI: 10.1097/hcr.0000000000000397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a chronic debilitating illness. The effects of vigorous aerobic exercise training (AET) on heart function in PAH are poorly understood. METHODS Eighteen women with PAH (aged 56.2 ± 8.8 yr, body mass index: 28.8 ± 7.3 kg/m) underwent 10 wk of vigorous AET. Cardiac function was observed at rest and peak exercise using bioelectrical impedance cardiography before and after the AET. Cardiac function was observed in a small PAH subset (n = 7) for 10 wk before beginning the AET. A cohort of sedentary women (n = 19) served as healthy controls. RESULTS Left ventricular ejection fraction (48 ± 9.2 vs 61.5 ± 13.3%, P = .034) and the systemic vascular resistance index (2258 ± 419.1 vs 2939 ± 962.4 dyn·sec/cm·m, P = .008) were lower at supine rest in the baseline PAH group versus the healthy group, as were peak exercise heart rate (140 ± 13.3 vs 170 ± 13.8 beats/min, P < .001) and systemic vascular resistance index (828 ± 141.1 vs 824 ± 300.9 dyn·sec/cm·m, P = .050) after controlling for age and heart rate. Systemic vascular resistance index measured at peak exercise decreased in the PAH group after AET (828 ± 141.1 vs 766 ± 139.6 dyn·sec/cm·m, P = .020). Left ventricular early diastolic filling ratio worsened in the PAH subset prior to AET (95.9 ± 19.4 vs 76.2 ± 18.9%, P = .043) and remained unchanged after AET. CONCLUSION Vigorous AET was not associated with significant declines in left ventricular systolic or diastolic function in women with PAH. Aerobic exercise training may be beneficial for reducing afterload and may preserve left ventricular diastolic function.
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Affiliation(s)
- Joshua G. Woolstenhulme
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of HealthBethesda, MD
- The Department of Physical Therapy and Health Care Sciences, The George Washington University, Washington, DC
| | - Andrew A. Guccione
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
| | - Jeffrey E. Herrick
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
| | - John P. Collins
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of HealthBethesda, MD
| | - Steven D. Nathan
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA
| | - Leighton E. Chan
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of HealthBethesda, MD
| | - Randall E. Keyser
- Department of Rehabilitation Science, George Mason University, Fairfax, VA
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of HealthBethesda, MD
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24
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Louvaris Z, Spetsioti S, Andrianopoulos V, Chynkiamis N, Habazettl H, Wagner H, Zakynthinos S, Wagner PD, Vogiatzis I. Cardiac output measurement during exercise in COPD: A comparison of dye dilution and impedance cardiography. CLINICAL RESPIRATORY JOURNAL 2019; 13:222-231. [PMID: 30724023 DOI: 10.1111/crj.13002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/15/2019] [Accepted: 01/26/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Impedance cardiography (IC) derived from morphological analysis of the thoracic impedance signal is now commonly used for noninvasive assessment of cardiac output (CO) at rest and during exercise. However, in Chronic Obstructive Pulmonary Disease (COPD), conflicting findings put its accuracy into question. OBJECTIVES We therefore compared concurrent CO measurements captured by IC (PhysioFlow: COIC ) and by the indocyanine green dye dilution method (CODD ) in patients with COPD. METHODS Fifty paired CO measurements were concurrently obtained using the two methods from 10 patients (FEV1 : 50.5 ± 17.5% predicted) at rest and during cycling at 25%, 50%, 75% and 100% peak work rate. RESULTS From rest to peak exercise COIC and CODD were strongly correlated (r = 0.986, P < 0.001). The mean absolute and percentage differences between COIC and CODD were 1.08 L/min (limits of agreement (LoA): 0.05-2.11 L/min) and 18 ± 2%, respectively, with IC yielding systematically higher values. Bland-Altman analysis indicated that during exercise only 7 of the 50 paired measurements differed by more than 20%. When data were expressed as changes from rest, correlations and agreement between the two methods remained strong over the entire exercise range (r = 0.974, P < 0.001, with no significant difference: 0.19 L/min; LoA: -0.76 to 1.15 L/min). Oxygen uptake (VO2 ) and CODD were linearly related: r = 0.893 (P < 0.001), CODD = 5.94 × VO2 + 2.27 L/min. Similar results were obtained for VO2 and COIC (r = 0.885, P < 0.001, COIC = 6.00 × VO2 + 3.30 L/min). CONCLUSIONS These findings suggest that IC provides an acceptable CO measurement from rest to peak cycling exercise in patients with COPD.
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Affiliation(s)
- Zafeiris Louvaris
- Faculty of Movement and Rehabilitation Sciences, Division of Respiratory Rehabilitation, Department Rehabilitation Sciences KU Leuven, University Hospitals Leuven, Leuven, Belgium.,1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece.,Department of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Spetsioti
- 1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Nikolaos Chynkiamis
- 1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece.,Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle, United Kingdom
| | - Helmut Habazettl
- Institute of Physiology, Charite-University Medicine Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Institute of Anesthesiology, German Heart Institute Berlin, Berlin, Germany
| | - Harrieth Wagner
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Spyros Zakynthinos
- 1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece
| | - Peter D Wagner
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Ioannis Vogiatzis
- 1st Department of Critical Care Medicine and Pulmonary Services, GP Livanos and M Simou Laboratories, Medical School of Athens University, Evangelismos Hospital, Athens, Greece.,Department of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece.,Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle, United Kingdom
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25
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Exercise impedance cardiography reveals impaired hemodynamic responses to exercise in hypertensives with dyspnea. Hypertens Res 2018; 42:211-222. [PMID: 30504821 DOI: 10.1038/s41440-018-0145-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 12/28/2022]
Abstract
Patients with arterial hypertension (AH), especially women, often report exercise intolerance and dyspnea. However, these symptoms are not frequently reflected in standard assessments. The aim of the study was to evaluate the clinical value of impedance cardiography (ICG) in the hemodynamic assessment of patients with AH during exercise, particularly the differences between subgroups based on sex and the presence of dyspnea. Ninety-eight patients with AH (52 women; 54.5 ± 8.2 years of age) were evaluated for levels of N-terminal pro-B-type brain natriuretic peptide (NT-proBNP), exercise capacity (cardiopulmonary exercise testing (CPET) and the 6-min walk test (6MWT)), and exercise ICG. Patients with AH were stratified into the following four subgroups: males without dyspnea (MnD, n = 38); males with dyspnea (MD, n = 8); females without dyspnea (FnD, n = 27); and females with dyspnea (FD, n = 25). In comparison with the MnD subgroup, the FnD subgroup demonstrated significantly higher NT-proBNP levels; lower exercise capacity (shorter 6MWT distance, lower peak oxygen uptake (VO2), lower O2 pulse); higher peak stroke volume index (SVI); and higher SVI at the anaerobic threshold (AT). In comparison with the other subgroups, the FD subgroup walked a shorter distance during the 6MWT distance; had a steeper VE/VCO2 slope; had lower values of peak stroke volume (SV) and peak cardiac output (CO); and had a smaller change in CO from rest to peak. However, no other differences were identified (NT-proBNP, left ventricular diastolic dysfunction, or CPET parameters). Exercise impedance cardiography revealed an impaired hemodynamic response to exercise in hypertensive females with dyspnea. In patients with unexplained exercise intolerance, impedance cardiography may complement traditional exercise tests.
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26
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Kurpaska M, Krzesiński P, Gielerak G, Uziębło-Życzkowska B, Banak M, Piotrowicz K, Stańczyk A. Multiparameter assessment of exercise capacity in patients with arterial hypertension. Clin Exp Hypertens 2018; 41:599-606. [PMID: 30380940 DOI: 10.1080/10641963.2018.1523917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Arterial hypertension (AH) can lead to the development of heart failure. Aim: Evaluating the relationship between parameters of exercise capacity assessed via a six-minute walk test (6MWT) and cardiopulmonary exercise test (CPET), with a hemodynamic assessment via impedance cardiography (ICG), in patients with AH. Methods: Exercise capacity was assessed in 98 hypertensive patients (54.5 ± 8.2 years) by means of oxygen uptake (VO2) get from CPET, 6MWT distance (6MWTd) and hemodynamic parameters measured by ICG: heart rate (HR), stroke volume (SV), cardiac output (CO). Correlations between these parameters at rest, at anaerobic threshold (AT) and at peak of exercise as well as their changes (Δpeak-rest, Δpeak-AT, ΔAT-rest) were evaulated. Results: A large proportion of patients exhibited reduced exercise capacity, with 45.9% not reaching 80% of predicted peak VO2 and 43.9% not reaching predicted 6MWTd. Clinically relevant correlations were noted between the absolute peak values and AT values of VO2 vs HR and VO2 vs CO. Furthermore ΔVO2(peak-AT) correlated with ΔHR(peak-AT), ΔCO(peak-AT) and ΔSV(peak-AT); ΔVO2(peak-rest) with ΔHR(peak-rest) and ΔCO(peak-rest); ΔVO2(AT-rest) with ΔHR(AT-rest) and ΔCO(AT-rest). Stronger correlations between changes in the evaluated parameters were demonstrated in the subgroup of subjects with peak VO2 < 80% of the predicted value; particularly ΔVO2(peak-AT) correlated with ΔSV(peak-AT) and ΔCO(peak-AT). Conclusions: The hemodynamic parameters show significant correlations with more measures of cardiovascular capacity of proven clinical utility. Impedance cardiography is a reliable method for assessing the cardiovascular response to exercise.
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Affiliation(s)
- Małgorzata Kurpaska
- a Department of Cardiology and Internal Medicine, Military Institute of Medicine , Warsaw , Poland
| | - Paweł Krzesiński
- a Department of Cardiology and Internal Medicine, Military Institute of Medicine , Warsaw , Poland
| | - Grzegorz Gielerak
- a Department of Cardiology and Internal Medicine, Military Institute of Medicine , Warsaw , Poland
| | - Beata Uziębło-Życzkowska
- a Department of Cardiology and Internal Medicine, Military Institute of Medicine , Warsaw , Poland
| | - Małgorzata Banak
- a Department of Cardiology and Internal Medicine, Military Institute of Medicine , Warsaw , Poland
| | - Katarzyna Piotrowicz
- a Department of Cardiology and Internal Medicine, Military Institute of Medicine , Warsaw , Poland
| | - Adam Stańczyk
- a Department of Cardiology and Internal Medicine, Military Institute of Medicine , Warsaw , Poland
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27
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Del Torto A, Skattebo Ø, Hallén J, Capelli C. Cardiac output with modified cardio-impedance against inert gas rebreathing during sub-maximal and maximal cycling exercise in healthy and fit subjects. Eur J Appl Physiol 2018; 119:163-170. [PMID: 30328505 DOI: 10.1007/s00421-018-4011-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE We measured cardiac output ([Formula: see text]) during sub-maximal and supra-maximal exercise with inert gas rebreathing ([Formula: see text]) and modified cardio-impedance ([Formula: see text]) and we evaluated the repeatability of the two methods. METHODS [Formula: see text]O2 and [Formula: see text] were measured twice in parallel with the two methods at sub-maximal (50-250 W) and supra-maximal exercise in 7 young subjects (25 ± 1 years; 74.4 ± 5.2 kg; 1.84 ± 0.07 m). RESULTS [Formula: see text] and [Formula: see text] increased by 3.4 L·min-1 and by 5.1 L·min-1 per 1 L·min-1 of increase in [Formula: see text], respectively. Mean [Formula: see text] (23.3 ± 2.5 L·min-1) was 9% lower than [Formula: see text] (25.8 ± 2.2 L·min-1) during supra-maximal exercise. Bland-Altman analysis showed that: (i) bias ([Formula: see text]-[Formula: see text]) was significantly different from zero (- 0.65 ± 2.61 L·min-1) and; (ii) the ratios [Formula: see text] ÷ [Formula: see text] were linearly related with [Formula: see text], indicating that [Formula: see text] tended to overestimate [Formula: see text] in comparison with [Formula: see text] for values ranging from 10.0 to 15.0 L·min-1 and to underestimate it for larger values. The coefficient of variation was similar for sub-maximal values (8.6% vs. 7.7%; 95% CL: ×/÷1.31), but lower for [Formula: see text] (7.6%; 95% CL: ×/÷ 2.05) than for [Formula: see text] (27.7%; 95% CL: ×/÷2.54) at supra-maximal intensity. CONCLUSIONS [Formula: see text] seems to represent a valuable alternative to invasive methods for assessing [Formula: see text] during sub-maximal exercise. The [Formula: see text] underestimation with respect to [Formula: see text] during supra-maximal exercise suggests that [Formula: see text] might be less optimal for supra-maximal intensities.
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Affiliation(s)
- Alessio Del Torto
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy. .,Department of Physical Performance, Norwegian School of Sport Sciences, Sognsveien 220, 0806, Oslo, Norway. .,Department of Medical Area (DAME), University of Udine, Udine, Italy.
| | - Øyvind Skattebo
- Department of Physical Performance, Norwegian School of Sport Sciences, Sognsveien 220, 0806, Oslo, Norway
| | - Jostein Hallén
- Department of Physical Performance, Norwegian School of Sport Sciences, Sognsveien 220, 0806, Oslo, Norway
| | - Carlo Capelli
- Department of Physical Performance, Norwegian School of Sport Sciences, Sognsveien 220, 0806, Oslo, Norway
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28
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Van Iterson EH, Smith JR, Olson TP. Exercise on-transition uncoupling of ventilatory, gas exchange and cardiac hemodynamic kinetics accompany pulmonary oxygen stores depletion to impact exercise intolerance in human heart failure. Acta Physiol (Oxf) 2018; 223:e13063. [PMID: 29575588 DOI: 10.1111/apha.13063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/04/2018] [Accepted: 03/08/2018] [Indexed: 12/16/2022]
Abstract
AIM In contrast to knowledge that heart failure (HF) patients demonstrate peak exercise uncoupling across ventilation, gas exchange and cardiac haemodynamics, whether this dyssynchrony follows that at the exercise on-transition is unclear. This study tested whether exercise on-transition temporal lag for ventilation relative to gas exchange and oxygen pulse (O2 pulse) couples with effects from abnormal pulmonary gaseous oxygen store (O2store ) contributions to V˙O2 to interdependently precipitate persistently elevated ventilatory demand and low oxidative metabolic capacity in HF. METHODS Beat-to-beat HR and breath-to-breath ventilation and gas exchange were continuously acquired in HF (N = 9, ejection fraction = 30 ± 9%) and matched controls (N = 10) during square-wave ergometry at 60% V˙O2peak (46 ± 14 vs 125 ± 54-W, P < .001). Temporal responses across V˙E , V˙O2 and O2 pulse were assessed for the exercise on-transition using single exponential model Phase II on-kinetic time constants (τ = time to reach 63% steady-state rise). Breath-to-breath gas fractions and respiratory flows were used to determine O2stores . RESULTS HF vs controls: τ for V˙E (137 ± 93 vs 74 ± 40-seconds, P = .03), V˙O2 (60 ± 40 vs 23 ± 5-seconds, P = .03) and O2 pulse (28 ± 18 vs 23 ± 15-seconds, P = .59). Within HF, τ for V˙E differed from O2 pulse (P < .02), but not V˙O2 . Exercise V˙E rise (workload indexed) differed in HF vs controls (545 ± 139 vs 309 ± 88-mL min-1 W-1 , P < .001). Exercise on-transition O2store depletion in HF exceeded controls, generally persisting to end-exercise. CONCLUSION These data suggest HF demonstrated exercise on-transition O2store depletion (high O2store contribution to V˙O2 ) coupled with dyssynchronous V˙E , V˙O2 and O2 pulse kinetics-not attributable to prolonged cardiac haemodynamics. Persistent high ventilatory demand and low oxidative metabolic capacity in HF may be precipitated by physiological uncoupling occurring within the exercise on-transition.
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Affiliation(s)
- E. H. Van Iterson
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester MN USA
| | - J. R. Smith
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester MN USA
| | - T. P. Olson
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester MN USA
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29
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Ferrone FA. Targeting HbS Polymerization. Semin Hematol 2018; 55:53-59. [PMID: 30616807 DOI: 10.1053/j.seminhematol.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/21/2018] [Accepted: 04/23/2018] [Indexed: 11/11/2022]
Abstract
The mutation of β6 from glu to val in hemoglobin is responsible for the polymer formation that leads to vaso-occlusion, and a range of severe consequences in sickle cell disease. The treatment of the disease can be addressed in many ways, but the prevention of polymer formation is one of the most fundamental approaches one can take. Such prevention includes affecting the polymer structure, or dilution of the fraction of polymerizable hemoglobin. The latter approach includes (1) induction of HbF, which does not itself, nor in hybrid form, join sickle polymers, or (2) restricting the allosteric change in hemoglobin that occurs in oxygen delivery, and which is required for polymer formation. These approaches will be critically reviewed, as well as the most recent developments that show the benefits of simply swelling the volume of the red cell.
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30
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Woessner MN, Levinger I, Neil C, Smith C, Allen JD. Effects of Dietary Inorganic Nitrate Supplementation on Exercise Performance in Patients With Heart Failure: Protocol for a Randomized, Placebo-Controlled, Cross-Over Trial. JMIR Res Protoc 2018; 7:e86. [PMID: 29625952 PMCID: PMC5910532 DOI: 10.2196/resprot.8865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 01/22/2023] Open
Abstract
Background Chronic heart failure is characterized by an inability of the heart to pump enough blood to meet the demands of the body, resulting in the hallmark symptom of exercise intolerance. Chronic underperfusion of the peripheral tissues and impaired nitric oxide bioavailability have been implicated as contributors to the decrease in exercise capacity in these patients. nitric oxide bioavailability has been identified as an important mediator of exercise tolerance in healthy individuals, but there are limited studies examining the effects in patients with chronic heart failure. Objective The proposed trial is designed to determine the effects of chronic inorganic nitrate supplementation on exercise tolerance in both patients with heart failure preserved ejection fraction (HFpEF) and heart failure reduced ejection fraction (HFrEF) and to determine whether there are any differential responses between the 2 cohorts. A secondary objective is to provide mechanistic insights into the 2 heart failure groups’ exercise responses to the nitrate supplementation. Methods Patients with chronic heart failure (15=HFpEF and 15=HFrEF) aged 40 to 85 years will be recruited. Following an initial screen cardiopulmonary exercise test, participants will be randomly allocated in a double-blind fashion to consume either a nitrate-rich beetroot juice (16 mmol nitrate/day) or a nitrate-depleted placebo (for 5 days). Participants will continue daily dosing until the completion of the 4 testing visits (maximal cardiopulmonary exercise test, submaximal exercise test with echocardiography, vascular function assessment, and vastus lateralis muscle biopsy). There will then be a 2-week washout period after which the participants will cross over to the other treatment and complete the same 4 testing visits. Results This study is funded by National Heart Foundation of Australia and Victoria University. Enrolment has commenced and the data collection is expected to be completed in mid 2018. The initial results are expected to be submitted for publication by the end of 2018. Conclusions If inorganic nitrate supplementation can improve exercise tolerance in patients with chronic heart failure, it has the potential to aid in further refining the treatment of patients in this population. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12615000906550; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368912 (Archived by WebCite at http://www.webcitation.org/6xymLMiFK)
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Affiliation(s)
- Mary N Woessner
- Institute of Health and Sport, Victoria University, Melbourne, Australia.,Western Center for Health and Research Education, Victoria University, St Albans, Australia
| | - Itamar Levinger
- Institute of Health and Sport, Victoria University, Melbourne, Australia.,Australian Institute for Musculoskeletal Science, Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Christopher Neil
- Institute of Health and Sport, Victoria University, Melbourne, Australia.,Department of Medicine-Western Health, University of Melbourne, Melbourne, Australia
| | - Cassandra Smith
- Institute of Health and Sport, Victoria University, Melbourne, Australia.,Australian Institute for Musculoskeletal Science, Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Jason D Allen
- Institute of Health and Sport, Victoria University, Melbourne, Australia.,Western Center for Health and Research Education, Victoria University, St Albans, Australia.,Department of Kinesiology, University of Virginia, Charlottesville, VA, United States
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31
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Legendre A, Bonnet D, Bosquet L. Reliability of Peak Exercise Stroke Volume Assessment by Impedance Cardiography in Patients with Residual Right Outflow Tract Lesions After Congenital Heart Disease Repair. Pediatr Cardiol 2018; 39:45-50. [PMID: 28948370 DOI: 10.1007/s00246-017-1725-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
Global ventricular response to exercise may be useful in follow-up of patients with residual right outflow tract lesions after congenital heart disease repair. In this context, impedance cardiography is considered accurate for stroke volume (SV) measurement during exercise testing, however, to date, only partial assessment of its reliability has been reported. We retrospectively evaluated relative and absolute reliability of peak SV by impedance cardiography during exercise using intraclass correlation (ICC) and standard error of measurement (SEM) in this population. Peak SV was measured in 30 young patients (mean age 14.4 years ± 2.1) with right ventricular outflow tract reconstruction who underwent two cardiopulmonary exercise tests at a mean one-year interval. SV was measured using a signal morphology impedance cardiography analysis device (PhysioFlow®) and was indexed to body surface area. ICC of peak indexed SV measurement was 0.80 and SEM was 10.5%. High heterogeneity was seen when comparing patients according to peak indexed SV; in patients with peak SV < 50 ml/m2 (15 patients), ICC rose to 0.95 and SEM dropped to 2.7%, while in patients with a peak SV > 50 ml/m2 relative and absolute reliability decreased (ICC = 0.45, SEM = 12.2%). Peak exercise SV assessment by a PhysioFlow® device represents a highly reliable method in patients with residual right outflow tract lesions after congenital heart disease repair, especially in patients with peak SV < 50 ml/m2. In this latter group, a peak SV decrease > 7.3% (corresponding to the minimum "true" difference) should be considered a clinically-relevant decrease in global ventricular performance and taken into account when deciding whether to perform residual lesion removal.
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Affiliation(s)
- Antoine Legendre
- Pediatric Cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker Hospital for Sick Children, Assistance publique des Hôpitaux de Paris, Paris, France.
| | - D Bonnet
- Pediatric Cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker Hospital for Sick Children, Assistance publique des Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - L Bosquet
- Faculté des Sciences du Sport, Laboratoire MOVE (EA 6413), Université de Poitiers, Poitiers, France
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32
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Nederend I, Ten Harkel ADJ, Blom NA, Berntson GG, de Geus EJC. Impedance cardiography in healthy children and children with congenital heart disease: Improving stroke volume assessment. Int J Psychophysiol 2017; 120:136-147. [PMID: 28778397 DOI: 10.1016/j.ijpsycho.2017.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/20/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Stroke volume (SV) and cardiac output are important measures in the clinical evaluation of cardiac patients and are also frequently used in research applications. This study was aimed to improve SV scoring derived from spot-electrode based impedance cardiography (ICG) in a pediatric population of healthy volunteers and patients with a corrected congenital heart defect. METHODS 128 healthy volunteers and 66 patients participated. First, scoring methods for ambiguous ICG signals were optimized to improve agreement of B- and X-points with aortic valve opening/closure in simultaneously recorded transthoracic echocardiography (TTE). Building on the improved scoring of B- and X-points, the Kubicek equation for SV estimation was optimized by testing the agreement with the simultaneously recorded SV by TTE. Both steps were initially done in a subset of the sample of healthy children and then validated in the remaining subset of healthy children and in a sample of patients. RESULTS SV assessment by ICG in healthy children strongly improved (intra class correlation increased from 0.26 to 0.72) after replacing baseline thorax impedance (Z0) in the Kubicek equation by an equation (7.337-6.208∗dZ/dtmax), where dZ/dtmax is the amplitude of the ICG signal at the C-point. Reliable SV assessment remained more difficult in patients compared to healthy controls. CONCLUSIONS After proper adjustment of the Kubicek equation, SV assessed by the use of spot-electrode based ICG is comparable to that obtained from TTE. This approach is highly feasible in a pediatric population and can be used in an ambulatory setting.
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Affiliation(s)
- Ineke Nederend
- Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Nico A Blom
- Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Gary G Berntson
- Ohio State University, Department of Psychology, 1835 Neil Avenue, Columbus OH 43210, United States.
| | - Eco J C de Geus
- Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Department of Biological Psychology, Faculty of Behavioral and Movement Sciences, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
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Hirai DM, Zelt JT, Jones JH, Castanhas LG, Bentley RF, Earle W, Staples P, Tschakovsky ME, McCans J, O’Donnell DE, Neder JA. Dietary nitrate supplementation and exercise tolerance in patients with heart failure with reduced ejection fraction. Am J Physiol Regul Integr Comp Physiol 2017; 312:R13-R22. [DOI: 10.1152/ajpregu.00263.2016] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/03/2016] [Accepted: 10/26/2016] [Indexed: 11/22/2022]
Abstract
Endothelial dysfunction and reduced nitric oxide (NO) signaling are key abnormalities leading to skeletal muscle oxygen delivery-utilization mismatch and poor physical capacity in patients with heart failure with reduced ejection fraction (HFrEF). Oral inorganic nitrate supplementation provides an exogenous source of NO that may enhance locomotor muscle function and oxygenation with consequent improvement in exercise tolerance in HFrEF. Thirteen patients (left ventricular ejection fraction ≤40%) were enrolled in a double-blind, randomized crossover study to receive concentrated nitrate-rich (nitrate) or nitrate-depleted (placebo) beetroot juice for 9 days. Low- and high-intensity constant-load cardiopulmonary exercise tests were performed with noninvasive measurements of central hemodynamics (stroke volume, heart rate, and cardiac output via impedance cardiography), arterial blood pressure, pulmonary oxygen uptake, quadriceps muscle oxygenation (near-infrared spectroscopy), and blood lactate concentration. Ten patients completed the study with no adverse clinical effects. Nitrate-rich supplementation resulted in significantly higher plasma nitrite concentration compared with placebo (240 ± 48 vs. 56 ± 8 nM, respectively; P < 0.05). There was no significant difference in the primary outcome of time to exercise intolerance between nitrate and placebo (495 ± 53 vs. 489 ± 58 s, respectively; P > 0.05). Similarly, there were no significant differences in central hemodynamics, arterial blood pressure, pulmonary oxygen uptake kinetics, skeletal muscle oxygenation, or blood lactate concentration from rest to low- or high-intensity exercise between conditions. Oral inorganic nitrate supplementation with concentrated beetroot juice did not present with beneficial effects on central or peripheral components of the oxygen transport pathway thereby failing to improve exercise tolerance in patients with moderate HFrEF.
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Affiliation(s)
- Daniel M. Hirai
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
- Department of Medicine, Respiratory Division, Pulmonary Function and Clinical Exercise Physiology Unit, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Joel T. Zelt
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
| | - Joshua H. Jones
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
| | - Luiza G. Castanhas
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
| | - Robert F. Bentley
- School of Kinesiology and Health Studies, Human Vascular Control Laboratory, Queen’s University, Kingston, Ontario, Canada
| | - Wendy Earle
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, Ontario, Canada; and
| | - Patti Staples
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, Ontario, Canada; and
| | - Michael E. Tschakovsky
- School of Kinesiology and Health Studies, Human Vascular Control Laboratory, Queen’s University, Kingston, Ontario, Canada
| | - John McCans
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, Ontario, Canada; and
| | - Denis E. O’Donnell
- Department of Medicine, Division of Respirology, Respiratory Investigation Unit, Queen’s University, Kingston, Ontario, Canada
| | - J. Alberto Neder
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
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Ebrahim M, Hegde S, Printz B, Abcede M, Proudfoot JA, Davis C. Evaluation of Impedance Cardiography for Measurement of Stroke Volume in Congenital Heart Disease. Pediatr Cardiol 2016; 37:1453-1457. [PMID: 27562130 DOI: 10.1007/s00246-016-1456-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
Noninvasive measurement of cardiac output (CO) and particularly stroke volume (SV) remain difficult but potentially valuable. These variables can be particularly challenging to measure in children with congenital heart disease (CHD). Impedance cardiography (IC) is a technique shown to be accurate in measuring SV in adults and in children with structurally normal hearts. The ease of use and rapidity of SV measurement using IC makes it potentially attractive for young patients with CHD. Advances in IC technology have led to more sophisticated signal-morphology IC (SMIC) devices that may further improve accuracy. We tested the accuracy of SMIC to measure SV in 21 subjects with CHD by comparing measurements with those from cardiac magnetic resonance (CMR) imaging. There was good agreement between SMIC and CMR in measurement of SV: mean difference = 1.7 ml (p = 0.47); r = 0.89. The agreement and correlation persisted when controlling for the differences in blood pressure and heart rate during the two testing methods. We conclude that SMIC is accurate at measuring SV and thus CO when compared to CMR in a variety of forms of CHD.
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Affiliation(s)
- Mohammed Ebrahim
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - Sanjeet Hegde
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - Beth Printz
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - Mark Abcede
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US
| | - James A Proudfoot
- Clinical and Translational Research Institute, University of California San Diego, San Diego, CA, US
| | - Christopher Davis
- Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, US.
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Spee RF, Niemeijer VM, Wijn PF, Doevendans PA, Kemps HM. Effects of high-intensity interval training on central haemodynamics and skeletal muscle oxygenation during exercise in patients with chronic heart failure. Eur J Prev Cardiol 2016; 23:1943-1952. [DOI: 10.1177/2047487316661615] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Ruud F Spee
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
- ICIN, Netherlands Heart Institute, Utrecht, The Netherlands
| | - Victor M Niemeijer
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Pieter F Wijn
- Department of Clinical Physics and Clinical Informatics, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Pieter A Doevendans
- ICIN, Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Hareld M Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
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Payseur JD, Rigney JJ, Turner SL, Wu X, Murphy DJ, Rossman EI. Evaluation of a method utilizing PhysioFlow®, a novel signal morphology-based form of impedance cardiography, to measure cardiac output in the conscious beagle. J Pharmacol Toxicol Methods 2016; 81:115-9. [PMID: 27050559 DOI: 10.1016/j.vascn.2016.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Currently, standard methods for measuring cardiac output are either invasive (i.e. flow probe) or are limited in terms of short measurement intervals and measurement variability (i.e. echocardiography). The ability to reliably measure cardiac output in a non-invasive manner in large animals would provide a valuable tool to expand functional cardiovascular endpoints in preclinical safety studies. PhysioFlow® is a novel method that uses waveform analysis of an impedance signal to measure cardiac output non-invasively. Unlike cardiac impedance techniques in the past, PhysioFlow® is not dependant on thoracic structure or basal thoracic impedance (Z0) and therefore this methodology is transferrable from human to animal models. METHODS Three tool compounds with known effects on cardiac output were administered to conscious beagle dogs to determine if the non-invasive PhysioFlow® system could detect the expected changes in stroke volume and cardiac output as determined by literature references using the current standard methodologies (e.g. aortic blood flow and thermodilution). RESULTS The PhysioFlow® system was able to detect increases in cardiac output when dosed with 20μg/kg of Dobutamine, a decrease in cardiac output when dosed with 0.1mg/kg of Acepromazine, and no significant change in cardiac output when dosed with 2mg/kg of Minoxidil. These results are within expected ranges based on published literature (Stepien et al., 1995; Taylor et al., 2007). DISCUSSION PhysioFlow®, a signal morphology-based impedance cardiography, can be utilized to reliably and non-invasively measure cardiac output in beagle dogs.
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Affiliation(s)
- Jason D Payseur
- Safety Pharmacology, GlaxoSmithKline, 709 Swedeland Rd, King of Prussia, PA 19406, United States
| | - John J Rigney
- Safety Pharmacology, GlaxoSmithKline, 709 Swedeland Rd, King of Prussia, PA 19406, United States
| | - Sandra L Turner
- Safety Pharmacology, GlaxoSmithKline, 709 Swedeland Rd, King of Prussia, PA 19406, United States
| | - XueJun Wu
- Safety Pharmacology, GlaxoSmithKline, 709 Swedeland Rd, King of Prussia, PA 19406, United States
| | - Dennis J Murphy
- Safety Pharmacology, GlaxoSmithKline, 709 Swedeland Rd, King of Prussia, PA 19406, United States
| | - Eric I Rossman
- Safety Pharmacology, GlaxoSmithKline, 709 Swedeland Rd, King of Prussia, PA 19406, United States
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Calibrating Sickle Cell Disease. J Mol Biol 2016; 428:1506-14. [PMID: 26975885 DOI: 10.1016/j.jmb.2016.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/27/2016] [Accepted: 03/02/2016] [Indexed: 11/20/2022]
Abstract
Sickle cell disease is fundamentally a kinetic disorder, in which cells containing the mutated hemoglobin (hemoglobin S; HbS) will cause occlusion if they sickle in the microvasculature, but have minimal (or no) consequences if they sickle in the venous return. Physiologically, sickling always occurs when some ligands are present; nonetheless, the kinetics in the presence of ligands are virtually unstudied. Sickling arises from nucleation-controlled polymer formation, triggered when the HbS loses ligands (e.g., oxygen). Thus, understanding how nucleation responds to the presence of oxygen is the key to understanding how sickling proceeds in a physiological context. We have measured the rate of nucleus formation in HbS partially liganded with NO or CO, which we find have equivalent effects in reducing the nucleation rates. We find that hemoglobin must be in the T (tense) quaternary structure for nucleation, but the presence of ligands inhibits nucleus formation even when the correct quaternary structure is present. From these results, we can predict the fraction of cells that will sickle at any given partial ligand saturations. The ability to make such predictions may prove especially useful in designing future therapies, particularly those where the oxygen affinity is perturbed.
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Spießhöfer J, Fox H, Lehmann R, Efken C, Heinrich J, Bitter T, Körber B, Horstkotte D, Oldenburg O. Heterogenous haemodynamic effects of adaptive servoventilation therapy in sleeping patients with heart failure and Cheyne-Stokes respiration compared to healthy volunteers. Heart Vessels 2015; 31:1117-30. [PMID: 26296413 DOI: 10.1007/s00380-015-0717-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
This study investigated the haemodynamic effects of adaptive servoventilation (ASV) in heart failure (HF) patients with Cheyne-Stokes respiration (CSR) versus healthy controls. Twenty-seven HF patients with CSR and 15 volunteers were ventilated for 1 h using a new ASV device (PaceWave™). Haemodynamics were continuously and non-invasively recorded at baseline, during ASV and after ventilation. Prior to the actual study, a small validation study was performed to validate non-invasive measurement of Stroke volume index (SVI). Non-invasive measurement of SVI showed a marginal overall difference of -0.03 ± 0.41 L/min/m(2) compared to the current gold standard (Thermodilution-based measurement). Stroke volume index (SVI) increased during ASV in HF patients (29.7 ± 5 to 30.4 ± 6 to 28.7 ± 5 mL/m(2), p < 0.05) and decreased slightly in volunteers (50.7 ± 12 to 48.6 ± 11 to 47.9 ± 12 mL/m(2)). Simultaneously, 1 h of ASV was associated with a trend towards an increase in parasympathetic nervous activity (PNA) in HF patients and a trend towards an increase in sympathetic nervous activity (SNA) in healthy volunteers. Blood pressure (BP) and total peripheral resistance response increased significantly in both groups, despite marked inter-individual variation. Effects were independent of vigilance. Predictors of increased SVI during ASV in HF patients included preserved right ventricular function, normal resting BP, non-ischaemic HF aetiology, mitral regurgitation and increased left ventricular filling pressures. This study confirms favourable haemodynamic effects of ASV in HF patients with CSR presenting with mitral regurgitation and/or increased left ventricular filling pressures, but also identified a number of new predictors. This might be mediated by a shift towards more parasympathetic nervous activity in those patients.
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Affiliation(s)
- Jens Spießhöfer
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Henrik Fox
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Roman Lehmann
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Christina Efken
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Jessica Heinrich
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Thomas Bitter
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Britta Körber
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
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Characterization of exercise limitations by evaluating individual cardiac output patterns: a prospective cohort study in patients with chronic heart failure. BMC Cardiovasc Disord 2015; 15:57. [PMID: 26100151 PMCID: PMC4476170 DOI: 10.1186/s12872-015-0057-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 06/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with chronic heart failure (CHF) suffer from exercise intolerance due to impaired central hemodynamics and subsequent alterations in peripheral skeletal muscle function and structure. The relative contribution of central versus peripheral factors in the reduced exercise capacity is still subject of debate. The main purpose was to investigate heterogeneity in the nature of exercise intolerance by evaluating individual cardiac output (Q) patterns. The secondary purpose was to evaluate whether patient and disease characteristics were associated with a central hemodynamic exercise limitation. METHODS Sixty-four stable CHF patients performed a symptom limited incremental exercise test with respiratory gas analysis and simultaneous assessment of Q, using a radial artery pulse contour analysis method. A central hemodynamic exercise limitation was defined as a plateau or decline in Q from 90 to 100 % of exercise duration. RESULTS Data from 61 patients were analyzed. A central hemodynamic exercise limitation was observed in 21 patients (34 %). In these patients, a higher occurrence of a plateau/decrease in oxygen uptake (VO2) (52 % vs 23 %, p = 0.02), stroke volume (SV) (100 % vs. 75 %, p = 0.01) and chronotropic incompetence (31 % vs. 2.5 %, p = 0.01) was observed, while presence of a left bundle branch block (LBBB) occurred significantly less (19 % vs 48 %, p = 0.03) There was no difference in disease characteristics such as etiology, duration, NYHA class, mitral regurgitation or ischemia. CONCLUSIONS The study revealed considerable heterogeneity in the nature of exercise limitations between moderately impaired CHF patients. In one third of the study population a plateau or decrease in Q towards peak exercise was demonstrated, which is indicative of a central hemodynamic exercise limitation. A central hemodynamic exercise limitation was associated with an impairment to augment stroke volume and heart rate.
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Jakovljevic DG, Trenell MI, MacGowan GA. Bioimpedance and bioreactance methods for monitoring cardiac output. Best Pract Res Clin Anaesthesiol 2014; 28:381-94. [DOI: 10.1016/j.bpa.2014.09.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/09/2014] [Accepted: 09/16/2014] [Indexed: 12/18/2022]
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Siebenmann C, Rasmussen P, Sørensen H, Zaar M, Hvidtfeldt M, Pichon A, Secher NH, Lundby C. Cardiac output during exercise: A comparison of four methods. Scand J Med Sci Sports 2014; 25:e20-7. [DOI: 10.1111/sms.12201] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 12/21/2022]
Affiliation(s)
- C. Siebenmann
- Center for Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
| | - P. Rasmussen
- Center for Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
| | - H. Sørensen
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. Zaar
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. Hvidtfeldt
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - A. Pichon
- Laboratoire Réponses Cellulaires et Fonctionnelles à l'Hypoxie; Université Paris 13; Bobigny France
| | - N. H. Secher
- Department of Anesthesia; The Copenhagen Muscle Research Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - C. Lundby
- Center for Integrative Human Physiology; Institute of Physiology; University of Zürich; Zürich Switzerland
- Food & Nutrition & Sport Science; Gothenburg University; Gothenburg Sweden
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Fontecave-Jallon J, Videlier B, Baconnier P, Tanguy S, Calabrese P, Guméry PY. Detecting variations of blood volume shift due to heart beat from respiratory inductive plethysmography measurements in man. Physiol Meas 2013; 34:1085-101. [PMID: 23954865 DOI: 10.1088/0967-3334/34/9/1085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The simultaneous study of the cardiac and respiratory activities and their interactions is of great physiological and clinical interest. For this purpose, we want to investigate if respiratory inductive plethysmography (RIP) can be used for cardiac functional exploration. We propose a system, based on RIP technology and time-scale approaches of signal processing, for the extraction of cardiac information. This study focuses on the monitoring of blood volume shift due to heart beat, noted ▵Vtr_c and investigates RIP for the detection of ▵Vtr_c variations by comparison to stroke volume (SV) variations estimated by impedance cardiography (IMP). We proposed a specific respiratory protocol assumed to induce significant variations of the SV. Fifteen healthy volunteers in the seated and supine positions were asked to alternate rest respiration and maneuvers, consisting in blowing into a manometer. A multi-step treatment including a variant of empirical mode decomposition was applied on RIP signals to extract cardiac volume signals and estimate beat-to-beat ▵Vtr_c. These were averaged in quasi-stationary states at rest and during the respiratory maneuvers, and analysed in view of SV estimations from IMP signals simultaneously acquired. Correlation and statistical tests over the data show that RIP can be used to detect variations of the cardiac blood shift in healthy young subjects.
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Affiliation(s)
- J Fontecave-Jallon
- University Joseph Fourier-Grenoble 1, CNRS, TIMC-IMAG Laboratory CNRS UMR 5525, PRETA team, Grenoble, F-38041, France.
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Elliott AD, Skowno J, Prabhu M, Noakes TD, Ansley L. Evidence of cardiac functional reserve upon exhaustion during incremental exercise to determine VO2max. Br J Sports Med 2013; 49:128-32. [PMID: 23293009 DOI: 10.1136/bjsports-2012-091752] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There remains considerable debate regarding the limiting factor(s) for maximal oxygen uptake (VO2max). Previous studies have shown that the central circulation may be the primary limiting factor for VO2max and that cardiac work increases beyond VO2max. AIM We sought to evaluate whether the work of the heart limits VO2max during upright incremental cycle exercise to exhaustion. METHODS Eight trained men completed two incremental exercise trials, each terminating with exercise at two different rates of work eliciting VO2max (MAX and SUPRAMAX). During each exercise trial we continuously recorded cardiac output using pulse-contour analysis calibrated with a lithium dilution method. Intra-arterial pressure was recorded from the radial artery while pulmonary gas exchange was measured continuously for an assessment of oxygen uptake. RESULTS The workload during SUPRAMAX (mean±SD: 346.5±43.2 W) was 10% greater than that achieved during MAX (315±39.3 W). There was no significant difference between MAX and SUPRAMAX for Q (28.7 vs 29.4 L/min) or VO2 (4.3 vs 4.3 L/min). Mean arterial pressure was significantly higher during SUPRAMAX, corresponding to a higher cardiac power output (8.1 vs 8.5 W; p<0.06). CONCLUSIONS Despite similar VO2 and Q, the greater cardiac work during SUPRAMAX supports the view that the heart is working submaximally at exhaustion during an incremental exercise test (MAX).
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Affiliation(s)
- Adrian D Elliott
- School of Life Sciences, Kingston University, Surrey, UK Discipline of Physiology, University of Adelaide, Adelaide, Australia
| | - Justin Skowno
- The Children's Hospital at Westmead, Sydney, Australiai Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, Australia
| | | | - Timothy David Noakes
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa
| | - Les Ansley
- School of Psychology and Sports Sciences, Northumbria University, Newcastle Upon Tyne, UK
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Fontecave-Jallon J, Guméry PY, Calabrese P, Briot R, Baconnier P. A Wearable Technology Revisited for Cardio-Respiratory Functional Exploration. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2013. [DOI: 10.4018/jehmc.2013010102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The objective of the present study is to extract new information from complex signals generated by Respiratory Inductive Plethysmography (RIP). This indirect cardio-respiratory (CR) measure is a well-known wearable solution. The authors applied time-scale analysis to estimate cardiac activity from thoracic volume variations, witnesses of CR interactions. Calibrated RIP signals gathered from 4 healthy volunteers in resting conditions are processed by Ensemble Empirical Mode Decomposition to extract cardiac volume signals and estimate stroke volumes. Averaged values of these stroke volumes (SVRIP) are compared with averaged values of stroke volumes determined simultaneously by electrical impedance cardiography (SVICG). There is a satisfactory correlation between SVRIP and SVICG (r=0.76, p<0.001) and the limits of agreement between the 2 types of measurements (±23%) satisfies the required criterion (±30%). The observed under-estimation (-58%) is argued. This validates the use of RIP for following stroke volume variations and suggests that one simple transducer can provide a quantitative exploration of both ventilatory and cardiac volumes.
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Affiliation(s)
- Julie Fontecave-Jallon
- University Joseph Fourier-Grenoble 1, CNRS, TIMC-IMAG Laboratory CNRS UMR 5525, PRETA team, Grenoble, F-38041, France
| | - Pierre-Yves Guméry
- University Joseph Fourier-Grenoble 1, CNRS, TIMC-IMAG Laboratory CNRS UMR 5525, PRETA team, Grenoble, F-38041, France
| | - Pascale Calabrese
- University Joseph Fourier-Grenoble 1, CNRS, TIMC-IMAG Laboratory CNRS UMR 5525, PRETA team, Grenoble, F-38041, France
| | - Raphaël Briot
- University Joseph Fourier-Grenoble 1, CNRS, TIMC-IMAG Laboratory CNRS UMR 5525, PRETA team, Grenoble, F-38041, France
| | - Pierre Baconnier
- University Joseph Fourier-Grenoble 1, CNRS, TIMC-IMAG Laboratory CNRS UMR 5525, PRETA team, Grenoble, F-38041, France
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45
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Crisafulli A, Tocco F, Milia R, Angius L, Pinna M, Olla S, Roberto S, Marongiu E, Porcu M, Concu A. Progressive improvement in hemodynamic response to muscle metaboreflex in heart transplant recipients. J Appl Physiol (1985) 2012. [PMID: 23195627 DOI: 10.1152/japplphysiol.01099.2012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise capacity remains lower in heart transplant recipients (HTRs) following transplant compared with normal subjects, despite improved cardiac function. Moreover, metaboreceptor activity in the muscle has been reported to increase. The aim of the present investigation was to assess exercise capacity together with metaboreflex activity in HTR patients for 1 yr following heart transplant, to test the hypothesis that recovery in exercise capacity was paralleled by improvements in response to metaboreflex. A cardiopulmonary test for exercise capacity and Vo(2max) and hemodynamic response to metaboreflex activation obtained by postexercise ischemia were gathered in six HTRs and nine healthy controls (CTL) four times: at the beginning of the study (T0, 42 ± 6 days after transplant), at the 3rd, 6th, and 12th month after TO (T1, T2, and T3). The main results were: 1) exercise capacity and Vo(2max) were seen to progressively increase in HTRs; 2) at T0 and T1, HTRs achieved a higher blood pressure response in response to metaboreflex compared with CTL, and this difference disappeared at T2 and T3; and 3) this exaggerated blood pressure response was the result of a systemic vascular resistance increment. This study demonstrates that exercise capacity progressively improves in HTRs after transplant and that this phenomenon is accompanied by a progressive reduction of the metaboreflex-induced increase in blood pressure and systemic vascular resistance. These facts indicate that, despite improved cardiac function, resetting of cardiovascular regulation in HTRs requires months.
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Affiliation(s)
- Antonio Crisafulli
- Department of Medical Sciences, Sport Physiology Lab., University of Cagliari, Italy.
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46
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Sperandio PA, Oliveira MF, Rodrigues MK, Berton DC, Treptow E, Nery LE, Almeida DR, Neder JA. Sildenafil improves microvascular O2 delivery-to-utilization matching and accelerates exercise O2 uptake kinetics in chronic heart failure. Am J Physiol Heart Circ Physiol 2012; 303:H1474-80. [PMID: 23023868 DOI: 10.1152/ajpheart.00435.2012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nitric oxide (NO) can temporally and spatially match microvascular oxygen (O(2)) delivery (Qo(2mv)) to O(2) uptake (Vo(2)) in the skeletal muscle, a crucial adjustment-to-exercise tolerance that is impaired in chronic heart failure (CHF). To investigate the effects of NO bioavailability induced by sildenafil intake on muscle Qo(2mv)-to-O(2) utilization matching and Vo(2) kinetics, 10 males with CHF (ejection fraction = 27 ± 6%) undertook constant work-rate exercise (70-80% peak). Breath-by-breath Vo(2), fractional O(2)extraction in the vastus lateralis {∼deoxygenated hemoglobin + myoglobin ([deoxy-Hb + Mb]) by near-infrared spectroscopy}, and cardiac output (CO) were evaluated after sildenafil (50 mg) or placebo. Sildenafil increased exercise tolerance compared with placebo by ∼20%, an effect that was related to faster on- and off-exercise Vo(2) kinetics (P < 0.05). Active treatment, however, failed to accelerate CO dynamics (P > 0.05). On-exercise [deoxy-Hb + Mb] kinetics were slowed by sildenafil (∼25%), and a subsequent response "overshoot" (n = 8) was significantly lessened or even abolished. In contrast, [deoxy-Hb + Mb] recovery was faster with sildenafil (∼15%). Improvements in muscle oxygenation with sildenafil were related to faster on-exercise Vo(2) kinetics, blunted oscillations in ventilation (n = 9), and greater exercise capacity (P < 0.05). Sildenafil intake enhanced intramuscular Qo(2mv)-to-Vo(2) matching with beneficial effects on Vo(2) kinetics and exercise tolerance in CHF. The lack of effect on CO suggests that improvement in blood flow to and within skeletal muscles underlies these effects.
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Affiliation(s)
- Priscila A Sperandio
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, Brazil
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47
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Elliott AD, Skowno J, Prabhu M, Ansley L. Measurement of cardiac output during exercise in healthy, trained humans using lithium dilution and pulse contour analysis. Physiol Meas 2012; 33:1691-701. [PMID: 22986506 DOI: 10.1088/0967-3334/33/10/1691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to evaluate the use of pulse contour analysis calibrated with lithium dilution in a single device (LiDCO) for measurement of cardiac output (Q) during exercise in healthy volunteers. We sought to; (a) compare pulse contour analysis (PulseCO) and lithium indicator dilution (LiDCO) for the measurement of Q during exercise, and (b) assess the requirement for recalibration of PulseCO with LiDCO during exercise. Ten trained males performed multi-stage cycling exercise at intensities below and above ventilatory threshold before constant load maximal exercise to exhaustion. Uncalibrated PulseCO Q (Qraw) was compared to that calibrated with lithium dilution at baseline Qbaseline, during submaximal exercise below (Qlow) and above (Qhigh) ventilatory threshold, and at each exercise stage individually (Qexercise). There was a significant difference between Qbaseline and all other calibration methods during exercise, but not at rest. No significant differences were observed between other methods. Closest agreement with Qexercise was observed for Qhigh (bias ± limits of agreement: 4.8 ± 30.0%). The difference between Qexercise and both Qlow and Qraw was characterized by low bias (4-7%) and wide limits of agreement (> ± 40%). Calibration of pulse contour analysis with lithium dilution prior to exercise leads to a systematic overestimation of exercising cardiac output. A single calibration performed during exercise above the ventilatory threshold provided acceptable limits of agreement with an approach incorporating multiple calibrations throughout exercise. Pulse contour analysis may be used for Q measurement during exercise providing the system is calibrated during exercise.
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48
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Ferreira EM, Arakaki JSO, B. Barbosa P, Siqueira ACB, Bravo DM, Kapins CEB, Silva CMC, Nery LE, Alberto Neder J. Signal-morphology impedance cardiography during incremental cardiopulmonary exercise testing in pulmonary arterial hypertension. Clin Physiol Funct Imaging 2012; 32:343-52. [DOI: 10.1111/j.1475-097x.2012.01135.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 03/13/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Eloara M. Ferreira
- Pulmonary Function and Clinical Exercise Physiology Unit; Division of Respiratory Diseases; Department of Medicine; Federal University of Sao Paulo (UNIFESP); São Paulo; São Paulo; Brazil
| | - Jaquelina S. Ota- Arakaki
- Pulmonary Function and Clinical Exercise Physiology Unit; Division of Respiratory Diseases; Department of Medicine; Federal University of Sao Paulo (UNIFESP); São Paulo; São Paulo; Brazil
| | - Priscila B. Barbosa
- Pulmonary Function and Clinical Exercise Physiology Unit; Division of Respiratory Diseases; Department of Medicine; Federal University of Sao Paulo (UNIFESP); São Paulo; São Paulo; Brazil
| | - Ana Cristina B. Siqueira
- Pulmonary Function and Clinical Exercise Physiology Unit; Division of Respiratory Diseases; Department of Medicine; Federal University of Sao Paulo (UNIFESP); São Paulo; São Paulo; Brazil
| | - Daniela M. Bravo
- Pulmonary Function and Clinical Exercise Physiology Unit; Division of Respiratory Diseases; Department of Medicine; Federal University of Sao Paulo (UNIFESP); São Paulo; São Paulo; Brazil
| | - Carlos Eduardo B. Kapins
- Haemodynamic Evaluation Unit; Division of Cardiology; Department of Medicine; Federal University of Sao Paulo (UNIFESP); São Paulo; Brazil
| | - Célia Maria C. Silva
- Haemodynamic Evaluation Unit; Division of Cardiology; Department of Medicine; Federal University of Sao Paulo (UNIFESP); São Paulo; Brazil
| | - Luiz Eduardo Nery
- Pulmonary Function and Clinical Exercise Physiology Unit; Division of Respiratory Diseases; Department of Medicine; Federal University of Sao Paulo (UNIFESP); São Paulo; São Paulo; Brazil
| | - J. Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit; Division of Respiratory Diseases; Department of Medicine; Federal University of Sao Paulo (UNIFESP); São Paulo; São Paulo; Brazil
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49
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Wang L, Poon CCY, Yip G, Yu CM, Zhang YT. Evaluation of a novel cardiac output index on healthy elderly, cardiovascular and heart failure patients during dynamic exercise. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:1515-8. [PMID: 22254608 DOI: 10.1109/iembs.2011.6090365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We have recently proposed a novel CO index, namely pulse time reflection ratio (PTRR), which is extracted from photoplethysmogram and electrocardiogram and measurable from wearable devices, and proved that this index is potentially useful for dynamic CO monitoring in a preliminary study carried out on young, healthy subjects. In this study, we presented an evaluation of this technique against impedance cardiography on 64 subjects undergoing incremental maximal exercise testing, including 15 healthy elderly, 19 cardiovascular patients and 30 heart failure patients. Results showed significant intra-subject correlations (r) between PTRR and reference CO in all subjects (mean r: 0.93, p<0.05) and no significant differences on mean r among subject populations (one-way ANOVA, p=0.48). With further development and testing on mobile subjects, this technique can be applied for long-term CO monitoring at home or in other dynamic situations.
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Affiliation(s)
- L Wang
- Joint Research Centre for Biomedical Engineering, Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong SAR
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50
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Videlier B, Fontecave-Jallon J, Calabrese P, Baconnier P, Gumery PY. Empirical mode decomposition of respiratory inductive plethysmographic signals for stroke volume variations monitoring: respiratory protocol and comparison with impedance cardiography. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2012:2607-2610. [PMID: 23366459 DOI: 10.1109/embc.2012.6346498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We investigate Respiratory Inductive Plethysmography (RIP) to estimate cardiac activity from thoracic volume variations and study cardio-respiratory interactions. The objective of the present study is to evaluate the ability of RIP to monitor stroke volume (SV) variations, with reference to impedance cardiography (IMP). Five healthy volunteers in seated and supine positions were asked to blow into a manometer in order to induce significant SV decreases. Time-scale analysis was applied on calibrated RIP signals to extract cardiac volume signals. Averaged SV values, in quasi-stationary states at rest and during the respiratory maneuvers, were then estimated from these cardiac signals and from IMP signals simultaneously acquired. SV variations between rest and maneuvers were finally evaluated for both techniques. We show that SV values as well as SV variations are correlated between RIP and IMP estimations, suggesting that RIP could be used for SV variations monitoring.
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Affiliation(s)
- Benjamin Videlier
- UJF-Grenoble 1, CNRS, TIMC-IMAG UMR 5525, PRETA Team, Grenoble, F-38041, France
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