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Longobardi I, Prado DMLD, de Andrade DCO, Goessler KF, de Oliveira Júnior GN, de Almeida Azevedo R, Leitão AE, Santos JVP, Pinto ALDS, Gualano B, Roschel H. Cardiorespiratory abnormalities in ICU survivors of COVID-19 with postacute sequelae of SARS-CoV-2 infection are unrelated to invasive mechanical ventilation. Am J Physiol Heart Circ Physiol 2024; 326:H907-H915. [PMID: 38334972 DOI: 10.1152/ajpheart.00073.2024] [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: 02/05/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/10/2024]
Abstract
Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly understood. This single-center, cross-sectional study aimed to gather knowledge on this topic. Fifty-two patients with PASC recruited ∼6 mo after ICU discharge were clustered based on their need for IMV (PASC + IMV, n = 27) or noninvasive support therapy (PASC + NIS, n = 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL, n = 19) comprising individuals of both sexes with similar age, comorbidities, and physical activity levels but without a history of COVID-19 illness. Individuals with PASC, irrespective of support therapy, presented with higher rates of cardiorespiratory abnormalities than CONTROL, especially dysfunctional breathing patterns, dynamic hyperinflation, reduced oxygen uptake and oxygen pulse, and blunted heart rate recovery (all P < 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group (P = 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all P > 0.05). These findings indicate significant involvement of both central and peripheral factors, leading to exertional intolerance in individuals with PASC previously admitted to the ICU, regardless of their need for IMV.NEW & NOTEWORTHY We found cardiorespiratory abnormalities in ICU survivors of severe-to-critical COVID-19 with PASC to be independent of IMV need. Overall, both group of patients experienced dysfunctional breathing patterns, dynamic hyperinflation, lower oxygen uptake and oxygen pulse, and blunted heart rate responses to CPX. PASC seems to impact exertional tolerance and exercise capacity due to ventilatory inefficiency, impaired aerobic metabolism, and potential systolic and autonomic dysfunction, all of these irrespective of support therapy during ICU stay.
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Affiliation(s)
- Igor Longobardi
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Danilo Marcelo Leite do Prado
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Karla Fabiana Goessler
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Gersiel Nascimento de Oliveira Júnior
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Rafael de Almeida Azevedo
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Alice Erwig Leitão
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Jhonnatan Vasconcelos Pereira Santos
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ana Lucia de Sá Pinto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Center of Lifestyle Medicine, Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
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Muller PDT. Ventilatory efficiency (η⩒E) of the exercise: A detailed method report. MethodsX 2023; 11:102412. [PMID: 37860042 PMCID: PMC10582470 DOI: 10.1016/j.mex.2023.102412] [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: 08/09/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Ventilatory efficiency is a combination of the ventilatory-metabolic response stemming from non-invasive analysis of cardiopulmonary exercise testing. Despite being a recognized marker in exercise physiology, this measure presents considerable limitations, including the imprecise designation of "efficiency", broadly recognized, and recently denominated as "excess ventilation". Herein we present a detailed method, with substantial improvements, and new physiological insights, in order to better define the true ventilatory efficiency of the exercise, according to recommendations for physical/physiological processes.•"Ventilatory efficiency" of the exercise is a remarkable physiological index.•Several limitations are currently debated.•We report a new ventilatory efficiency index that match with recommendations.
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Affiliation(s)
- Paulo de Tarso Muller
- Federal University of Mato Grosso do Sul (UFMS)/Maria Aparecida Pedrossian Hospital (HUMAP), Laboratory of Respiratory Pathophysiology (LAFIR), Campo Grande MS, Mato Grosso do Sul, Brazil
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Caruso FR, Goulart CDL, Jr JCB, de Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Predictors of cardiopulmonary exercise testing in COPD patients according to the Weber classification. Heart Lung 2023; 62:95-100. [PMID: 37364368 DOI: 10.1016/j.hrtlng.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Weber classification stratifies cardiac patients based on peak oxygen consumption (V̇O2), the gold-standard measure of exercise capacity. OBJECTIVE To determine if Weber classification is a useful tool to discriminate clinical phenotypes in COPD patients and to evaluate if disease severity and other clinical measures can predict V̇O2peak. METHODS Three hundred and six COPD patients underwent cardiopulmonary exercise testing (CPX) and were divided according to Weber class: 1) Weber A (n = 34); 2) Weber B (n = 88); 3) Weber C (n = 138); and 4) Weber D (n = 46). RESULTS Weber class D patients demonstrated a reduced V̇O2 peak, heart rate (HR), minute ventilation (V̇E), oxygen (O2) pulse, circulatory power (CP), oxygen uptake efficiency slope (OUES), oxygen saturation (SpO2%), delta (Δ)HR and ΔSpO2 when compared to Weber A and B (p<0.05). Moreover, Dyspnea and the V̇E/carbon dioxide production (V̇CO2) slope were higher in Weber D compared with Weber C and A (p<0.001). Hierarchical regression analysis demonstrated significant predictors of V̇O2peak (R2= 0.131; Adj R 2 = 1.25), including HR (β=0.5757; t = 5.7; P<0.001) and forced expiratory volume in one second (FEV1) (β=0.119; t = 2.16; P<0.03). Among the Weber C + D groups, predictors of V̇O2peak (R = 0.78; R2= 0.60; Adj R2 =0.59), dyspnea (β=0.076; t = 1.111; P<0.27) and maximal voluntary ventilation (MVV) (β=0.75; t = 1.14; P<0.00). CONCLUSION Weber classification may be a useful tool to stratify cardiorespiratory fitness in COPD patients. Other clinical measures may be useful in predicting peak V̇O2 in mild-to-severe COPD, moreover different phenotypes may be important tool to improve physical capacity of chronic disease patients.
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Affiliation(s)
- Flávia Rossi Caruso
- Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil
| | | | | | | | | | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Audrey Borghi-Silva
- Physical Therapy Department, Federal University of Sao Carlos, Sao Carlos, Brazil.
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Brito GM, do Prado DML, Rezende DA, de Matos LDNJ, Loturco I, Vieira MLC, de Sá Pinto AL, Alô ROB, de Albuquerque LCA, Bianchini FR, Pinto AJ, Roschel H, Lemes ÍR, Gualano B. The utility of cardiopulmonary exercise testing in athletes and physically active individuals with or without persistent symptoms after COVID-19. Front Med (Lausanne) 2023; 10:1128414. [PMID: 37181373 PMCID: PMC10169680 DOI: 10.3389/fmed.2023.1128414] [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: 12/20/2022] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. Methods Participants' assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis. Results A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO2 slope; p<0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p=0.007), PETCO2 max (p=0.009), and dysfunctional breathing (p=0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing (p=0.008). Discussion A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.
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Affiliation(s)
- Gisele Mendes Brito
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Danilo Marcelo Leite do Prado
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Diego Augusto Rezende
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Irineu Loturco
- Nucleous of High Performance in Sport, São Paulo, Brazil
- Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Ana Lúcia de Sá Pinto
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Ana Jéssica Pinto
- Division of Endocrinology, Metabolism, and Diabetes and Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ítalo Ribeiro Lemes
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, and School of Medicine, University of São Paulo, São Paulo, Brazil
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Das BB. A Systematic Approach for the Interpretation of Cardiopulmonary Exercise Testing in Children with Focus on Cardiovascular Diseases. J Cardiovasc Dev Dis 2023; 10:jcdd10040178. [PMID: 37103057 PMCID: PMC10143216 DOI: 10.3390/jcdd10040178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Abstract
Cardiopulmonary exercise testing (CPET) is the clinical standard for children with congenital heart disease (CHD), heart failure (HF) being assessed for transplantation candidacy, and subjects with unexplained dyspnea on exertion. Heart, lung, skeletal muscle, peripheral vasculature, and cellular metabolism impairment frequently lead to circulatory, ventilatory, and gas exchange abnormalities during exercise. An integrated analysis of the multi-system response to exercise can be beneficial for differential diagnosis of exercise intolerance. The CPET combines standard graded cardiovascular stress testing with simultaneous ventilatory respired gas analysis. This review addresses the interpretation and clinical significance of CPET results with specific reference to cardiovascular diseases. The diagnostic values of commonly obtained CPET variables are discussed using an easy-to-use algorithm for physicians and trained nonphysician personnel in clinical practice.
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Affiliation(s)
- Bibhuti B Das
- Division of Pediatric Cardiology, Department of Pediatrics, McLane Children's Baylor Scott and White Medical Center, Baylor College of Medicine-Temple, Temple, TX 76502, USA
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Lv F, Zhang J, Tao Y. Efficacy and safety of inorganic nitrate/nitrite supplementary therapy in heart failure with preserved ejection fraction. Front Cardiovasc Med 2023; 10:1054666. [PMID: 36818337 PMCID: PMC9932197 DOI: 10.3389/fcvm.2023.1054666] [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: 10/25/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
Background Approximately half of patients with heart failure have a preserved ejection fraction (HFpEF). To date, only SGLT-2i, ARNi, and MRAs treatments have been shown to be effective for HFpEF. Exercise intolerance is the primary clinical feature of HFpEF. The aim of this meta-analysis was to explore the effect of inorganic nitrate/nitrite supplementary therapy on the exercise capacity of HFpEF patients. Methods We searched PubMed, Embase, Cochrane Library, OVID, and Web of Science for eligible studies for this meta-analysis. The primary outcomes were peak oxygen consumption (peak VO2), exercise time, and respiratory exchange ratio (RER) during exercise. The secondary outcomes were cardiac output, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and systemic vascular resistance during rest and exercise, respectively. Results A total of eight randomized-controlled trials were enrolled for this meta-analysis. We found no benefit of inorganic nitrate/nitrite on exercise capacity in patients with HFpEF. Inorganic nitrate/nitrite compared to placebo, did not significantly increased peak VO2 (MD = 0.361, 95% CI = -0.17 to 0.89, p = 0.183), exercise time (MD = 9.74, 95% CI = -46.47 to 65.95, p = 0.734), and respiratory exchange ratio during exercise (MD = -0.003, 95% CI = -0.036 to 0.029, p = 0.834). Among the six diameters reflecting cardiac and artery hemodynamics, inorganic nitrate/nitrite can lower rest SBP, rest/exercise DBP, rest/exercise MAP, and exercise SVR, but has no effect in cardiac output and heart rate for HFpEF patients. Conclusion Our meta-analysis suggested that inorganic nitrate/nitrite supplementary therapy has no benefit in improving the exercise capacity of patients with HFpEF, but can yield a blood pressure lowering effect, especially during exercise.
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Affiliation(s)
- Feng Lv
- Department of Cardiology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou City, Zhejiang Province, China
| | - Junyi Zhang
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou City, Jiangsu Province, China
| | - Yuan Tao
- Department of Cardiology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou City, Zhejiang Province, China,*Correspondence: Yuan Tao,
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Shen T, Liu D, Lin Z, Ren C, Zhao W, Gao W. A Machine Learning Model to Predict Cardiovascular Events during Exercise Evaluation in Patients with Coronary Heart Disease. J Clin Med 2022; 11:jcm11206061. [PMID: 36294382 PMCID: PMC9605581 DOI: 10.3390/jcm11206061] [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: 08/23/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To develop and optimize a machine learning prediction model for cardiovascular events during exercise evaluation in patients with coronary heart disease (CHD). METHODS 16,645 cases of cardiopulmonary exercise testing (CPET) conducted in patients with CHD from January 2016 to September 2019 were retrospectively included. Clinical data before testing and data during exercise were collected and analyzed. RESULTS Cardiovascular events occurred during 505 CPETs (3.0%). No death was reported. Predictive accuracy of the model was evaluated by area under the curve (AUC). AUCs for the SVM, logistic regression, GBDT and XGBoost were 0.686, 0.778, 0.784, and 0.794 respectively. CONCLUSIONS Machine learning methods (especially XGBoost) can effectively predict cardiovascular events during exercise evaluation in CHD patients. Cardiovascular events were associated with age, male, diabetes and duration of diabetes, myocardial infarction history, smoking history, hyperlipidemia history, hypertension history, oxygen uptake, and ventilation efficiency indicators.
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Affiliation(s)
- Tao Shen
- Department of Cardiology, Peking University Third Hospital, National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing 100191, China
| | - Dan Liu
- Department of Cardiology, Peking University Third Hospital, National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing 100191, China
| | - Zi Lin
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100094, China
| | - Chuan Ren
- Department of Cardiology, Peking University Third Hospital, National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing 100191, China
| | - Wei Zhao
- Department of Cardiology, Peking University Third Hospital, National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing 100191, China
- Physical Examination Center, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (W.Z.); (W.G.)
| | - Wei Gao
- Department of Cardiology, Peking University Third Hospital, National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing 100191, China
- Correspondence: (W.Z.); (W.G.)
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A "Bloody" Surprise: When Having Two Lungs Is Providential. Ann Am Thorac Soc 2022; 19:1419-1427. [PMID: 35913460 DOI: 10.1513/annalsats.202203-184cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Pick Your Threshold. Chest 2022; 162:1106-1115. [DOI: 10.1016/j.chest.2022.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/15/2022] [Accepted: 05/04/2022] [Indexed: 01/20/2023] Open
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Shen T, Ren C, Zhao W, Tao L, Xu S, Zhang C, Gao W. Development and Validation of a Prediction Model for Cardiovascular Events in Exercise Assessment of Coronary Heart Disease Patients After Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 9:798446. [PMID: 35557530 PMCID: PMC9086511 DOI: 10.3389/fcvm.2022.798446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to develop a model for predicting cardiovascular events in the exercise assessment of patients with coronary heart disease after percutaneous coronary intervention (PCI) based on multidimensional clinical information. Methods A total of 2,455 post-PCI patients who underwent cardiopulmonary exercise testing (CPET) at the Peking University Third Hospital from January 2016 to September 2019 were retrospectively included in this study; 1,449 post-PCI patients from January 2018 to September 2019 were assigned as the development cohort; and 1,006 post-PCI patients from January 2016 to December 2017 were assigned as the validation cohort. Clinical data of patients before testing and various indicators in the exercise assessment were collected. CPET-related cardiovascular events were also collected, including new-onset angina pectoris, frequent premature ventricular contractions, ventricular tachycardia, atrial tachycardia, and bundle branch block during the examination. A nomogram model for predicting CPET-related cardiovascular events was further developed and validated. Results In the development cohort, the mean age of 1,449 post-PCI patients was 60.7 ± 10.1 years. CPET-related cardiovascular events occurred in 43 cases (2.9%) without fatal events. CPET-related cardiovascular events were independently associated with age, glycosylated hemoglobin, systolic velocity of mitral annulus, ΔVO2/ΔWR slope inflection, and VE/VCO2 slope > 30. The C-index of the nomogram model for predicting CPET-related cardiovascular events was 0.830, and the area under the ROC curve was 0.830 (95% CI: 0.764–0.896). For the validation cohort of 1,006 patients, the area under the ROC curve was 0.807 (95% CI: 0.737–0.877). Conclusion Post-PCI patients with older age, unsatisfactory blood glucose control, impaired left ventricular systolic function, oxygen uptake parameter trajectory inflection, and poor ventilation efficiency have a higher risk of cardiovascular events in exercise assessment. The nomogram prediction model performs well in predicting cardiovascular events in the exercise assessment of post-PCI patients and can provide an individualized plan for exercise risk prediction.
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Affiliation(s)
- Tao Shen
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Chuan Ren
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Wei Zhao
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
- *Correspondence: Wei Zhao,
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Shunlin Xu
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Chengduo Zhang
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Wei Gao
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
- Wei Gao,
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Longobardi I, do Prado DML, Goessler KF, de Oliveira Júnior GN, de Andrade DCO, Gualano B, Roschel H. Benefits of Home-Based Exercise Training Following Critical SARS-CoV-2 Infection: A Case Report. Front Sports Act Living 2022; 3:791703. [PMID: 35088048 PMCID: PMC8787158 DOI: 10.3389/fspor.2021.791703] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023] Open
Abstract
In the current scenario, in which an elevated number of COVID-19 survivors present with severe physical deconditioning, exercise intolerance, persistent symptoms, and other post-acute consequences, effective rehabilitation strategies are of utmost relevance. In this study, we report for the first time the effect of home-based exercise training (HBET) in a survivor patient from critical COVID-19 illness. A 67-year-old woman who had critical COVID-19 disease [71 days of hospitalization, of which 49 days were in the intensive care unit (ICU) with invasive mechanical ventilation due to respiratory failure] underwent a 10-week HBET aiming to recovering overall physical condition. Before and after the intervention, we assessed cardiopulmonary parameters, skeletal muscle strength and functionality, fatigue severity, and self-reported persistent symptoms. At baseline (3 months after discharge), she presented with severe impairment in cardiorespiratory functional capacity (<50% age predicted VO2peak). After the intervention, remarkable improvements in VO2peak (from 10.61 to 15.48 mL·kg-1·min-1, Δ: 45.9%), oxygen uptake efficiency slope (OUES; from 1.0 to 1.3 L·min-1, Δ: 30.1%), HR/VO2 slope (from 92 to 52 bpm·L-1, Δ: -43.5%), the lowest VE/VCO2 ratio (from 35.4 to 32.9 L·min-1, Δ: -7.1%), and exertional dyspnea were observed. In addition, handgrip strength (from 22 to 27 kg, Δ: 22.7%), 30-s Sit-to-Stand (30-STS; from 14 to 16 repetitions, Δ:14.3%), Timed-Up-and-Go (TUG; from 8.25 to 7.01 s, Δ: -15%) performance and post-COVID functional status (PCFS) score (from 4 to 2) were also improved from baseline to post-intervention. Self-reported persistent symptoms were also improved, and Fatigue Severity Scale (FSS) score decreased (from 4 to 2.7) from baseline to post-intervention. This is the first evidence that a semi-supervised, HBET program may be safe and potentially effective in improving cardiorespiratory and physical functionality in COVID-19 survivors. Controlled studies are warranted to confirm these findings.
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Affiliation(s)
- Igor Longobardi
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Danilo Marcelo Leite do Prado
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karla Fabiana Goessler
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gersiel Nascimento de Oliveira Júnior
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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12
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Muller PT, Saraiva EF. Ventilatory inefficiency during graded exercise in COPD: A pragmatic approach. Clin Physiol Funct Imaging 2020; 41:103-109. [PMID: 33112466 DOI: 10.1111/cpf.12674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVE The current approach to measuring ventilatory (in)efficiency (V'E -V'CO2 slope, nadir and intercept) presents critical drawbacks in the evaluation of COPD subjects, owing mainly to mechanical ventilatory constraints. Thus, we aimed to compare the current approach with a new method we have developed for ventilatory efficiency calculation. METHODS The new procedure was based on measuring the amount of CO2 cleared by the lungs (V'CO2 , L/min) plotted against a predefined range of increase in minute ventilation (V'E ) (ten-fold increase based on semilog scale) during incremental exercise to symptom-limited maximum tolerance. This value was compared to a hypothetical predicted maximum CO2 output at the predicted maximal voluntary ventilation, defining ventilatory efficiency (ηV'E , %). The results were used to compare 30 subjects with COPD (II-IV Global Initiative for Chronic Obstructive Lung Disease, GOLD) and 10 non-COPD smokers, to establish the best discriminative physiological variable for disease severity through logistic multinomial regression. RESULTS The new approach was more sensitive to progressive deterioration of airway obstruction, resulting in worse ηV'E as lung function worsens throughout the GOLD panel (ηV'E (%), p < .001), when compared with V'E -V'CO2 slope (p = .715) or V'E -V'CO2 nadir (p = .070), besides showing the best model based on the logistic regression approach. CONCLUSION Although requiring more complex calculations compared to the current procedure, the new approach is highly sensitive to true ventilatory/gas-exchange deterioration, even throughout more severe pulmonary lung function in COPD subjects.
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Affiliation(s)
- Paulo T Muller
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul (UFMS)/Maria Aparecida Pedrossian Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Erlandson F Saraiva
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul (UFMS)/Maria Aparecida Pedrossian Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil.,Biostatistical Department, Mathematical Institute (INMA), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
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13
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Barrett NA, Hart N, Camporota L. In-vitro performance of a low flow extracorporeal carbon dioxide removal circuit. Perfusion 2019; 35:227-235. [PMID: 31441365 DOI: 10.1177/0267659119865115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Extracorporeal gas exchange requires the passage of oxygen and carbon dioxide (CO2) across an artificial membrane. Current European Union regulations do not require the transfer to be assessed in models using clinically relevant haemoglobin, making it difficult for clinicians to understand the CO2 clearance of a membrane, and how it changes in relation to sweep gas flow through the membrane. The characteristics of membrane CO2 clearance are described using a single membrane at different sweep gas flows in an in vitro model with clinically relevant haemoglobin concentrations using three separate methods of calculating CO2 clearance. METHODS To define the CO2 removal characteristics of the extra-corporeal CO2 removal (ECCO2R) device, we devised an in-vitro gas exchange circuit formed by a dedicated ECCO2R circuit (ALung, Pittsburgh, USA) in series with two membrane oxygenators. The system was primed with donated expired human red cells provided by the local blood bank. The experimental set-up allowed constant CO2 input (via one membrane oxygenator) with variable removal from a portion of the blood in a manner which was analogous to that seen in vivo. Blood gases were measured from different ports in the circuit in order to measure the experimental membrane CO2 clearance (VCO2). RESULTS Results demonstrate that the relationship between VCO2 and gas flow at a constant blood flow of 0.4 L/minute with a haemoglobin of 7 g/dL increases sharply from a gas flow of 0 to 2 L/min but plateaus at gas flows >4 L/minute. VCO2, calculated using three different methods, showed a strong linear correlation with minimal bias. CONCLUSIONS The CO2 clearance of the membrane used in this bench test is non-linear. This has implications for clinical practice, especially during the weaning phase of the device.
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Affiliation(s)
- Nicholas A Barrett
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Nicholas Hart
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.,Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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14
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Heart or Lungs? Uncovering the Causes of Exercise Intolerance in a Patient with Chronic Cardiopulmonary Disease. Ann Am Thorac Soc 2018; 15:1096-1104. [PMID: 30168743 DOI: 10.1513/annalsats.201802-073cc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Sayegh ALC, Santos MRD, Oliveira PD, Fernandes F, Rondon E, Souza FRD, Salemi VMC, Alves MJDNN, Mady C. Characterization of Cardiopulmonary Exercise Testing Variables in Patients with Endomyocardial Fibrosis after Endocardial Resection. Arq Bras Cardiol 2018; 109:533-540. [PMID: 29364349 PMCID: PMC5783434 DOI: 10.5935/abc.20170179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/21/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Endomyocardial fibrosis (EMF) is a rare disease, characterized by diastolic dysfunction which leads to reduced peak oxygen consumption (VO2). Cardiopulmonary exercise testing (CPET) has been proved to be a fundamental tool to identify central and peripheral alterations. However, most studies prioritize peak VO2 as the main variable, leaving aside other important CPET variables that can specify the severity of the disease and guide the clinical treatment. OBJECTIVE The aim of this study was to evaluate central and peripheral limitations in symptomatic patients with EMF by different CPET variables. METHODS Twenty-six EMF patients (functional class III, NYHA) were compared with 15 healthy subjects (HS). Functional capacity was evaluated using CPET and diastolic and systolic functions were evaluated by echocardiography. RESULTS Age and gender were similar between EMF patients and HS. Left ventricular ejection fraction was normal in EMF patients, but decreased compared to HS. Peak heart rate, peak workload, peak VO2, peak oxygen (O2) pulse and peak pulmonary ventilation (VE) were decreased in EMF compared to HS. Also, EMF patients showed increased Δ heart rate /Δ oxygen uptake and Δ oxygen uptake /Δ work rate compared to HS. CONCLUSION Determination of the aerobic capacity by noninvasive respiratory gas exchange during incremental exercise provides additional information about the exercise tolerance in patients with EMF. The analysis of different CPET variables is necessary to help us understand more about the central and peripheral alterations cause by both diastolic dysfunction and restrictive pattern.
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Affiliation(s)
- Ana Luiza C Sayegh
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Marcelo R Dos Santos
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Patricia de Oliveira
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Fábio Fernandes
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Eduardo Rondon
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Francis R de Souza
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Vera M C Salemi
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | | | - Charles Mady
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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16
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Kim CH, Van Iterson EH, Hansen JE, MacCarter DJ, Johnson BD. Streamlining cardiopulmonary exercise testing for use as a screening and tracking tool in primary care. Pulm Circ 2018; 8:2045894018776489. [PMID: 29693481 PMCID: PMC5987906 DOI: 10.1177/2045894018776489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/20/2018] [Indexed: 11/16/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) using a spectrum of different approaches demonstrates usefulness for objectively assessing patient disease severity in clinical and research settings. Still, an absence of trained specialists and/or improper data interpretation techniques can pose major limitations to the effective use of CPET for the clinical classification of patients. This study aimed to test an automated disease likelihood scoring algorithm system based on cardiopulmonary responses during a simplified step-test protocol. For patients with heart failure (HF), pulmonary hypertension (PAH), obstructive lung disease (OLD), or restrictive lung disease (RLD), we compared patient scores stratified into one of four "silos" generated from our novel algorithm system against patient evaluations provided by expert clinicians. Patients with HF (n = 12), PAH (n = 9), OLD (n = 16), or RLD (n = 10) performed baseline pulmonary function testing followed by submaximal step-testing. Breath-by-breath measures of ventilation and gas exchange, in addition to oxygen saturation and heart rate were collected continuously throughout testing. The algorithm demonstrated close alignment with patient assessments provided by clinical specialists: HF (r = 0.89, P < 0.01); PAH (r = 0.88, P < 0.01); OLD (r = 0.70, P < 0.01); and RLD (r = 0.88, P < 0.01). Furthermore, the algorithm was capable of differentiating major disease from other disease pathologies. Thus, in a clinically relevant manner, these data suggest this simplified automated disease algorithm scoring system used during step-testing to identify the likelihood that patients have HF, PAH, OLD, or RLD closely correlates with patient assessments conducted by trained clinicians.
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Affiliation(s)
- Chul-Ho Kim
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - James E. Hansen
- Respiratory and critical care physiology and medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Dean J. MacCarter
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Bruce D. Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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17
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Kim CH, Hansen JE, MacCarter DJ, Johnson BD. Algorithm for Predicting Disease Likelihood From a Submaximal Exercise Test. Clin Med Insights Circ Respir Pulm Med 2017; 11:1179548417719248. [PMID: 28757799 PMCID: PMC5513526 DOI: 10.1177/1179548417719248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/04/2017] [Indexed: 12/13/2022] Open
Abstract
We developed a simplified automated algorithm to interpret noninvasive gas exchange in healthy subjects and patients with heart failure (HF, n = 12), pulmonary arterial hypertension (PAH, n = 11), chronic obstructive lung disease (OLD, n = 16), and restrictive lung disease (RLD, n = 12). They underwent spirometry and thereafter an incremental 3-minute step test where heart rate and SpO2 respiratory gas exchange were obtained. A custom-developed algorithm for each disease pathology was used to interpret outcomes. Each algorithm for HF, PAH, OLD, and RLD was capable of differentiating disease groups (P < .05) as well as healthy cohorts (n = 19, P < .05). In addition, this algorithm identified referral pathology and coexisting disease. Our primary finding was that the ranking algorithm worked well to identify the primary referral pathology; however, coexisting disease in many of these pathologies in some cases equally contributed to the cardiorespiratory abnormalities. Automated algorithms will help guide decision making and simplify a traditionally complex and often time-consuming process.
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Affiliation(s)
- Chul-Ho Kim
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - James E Hansen
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Dean J MacCarter
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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18
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da Costa CH, da Silva KM, Maiworm A, Raphael Y, Parnayba J, Da Cal M, Figueira B, Condesso D, Rufino R. Can we use the 6-minute step test instead of the 6-minute walking test? An observational study. Physiotherapy 2015; 103:48-52. [PMID: 27012823 DOI: 10.1016/j.physio.2015.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/02/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To verify whether or not heart rate is maintained below the calculated submaximal level in healthy, sedentary subjects when they perform the 6-minute step test (6MST) and the 6-minute walking test (6MWT), and to compare the maximal heart rate achieved by the subjects at the end of each test. DESIGN Observational, cross-sectional study. SETTING One tertiary centre. PARTICIPANTS Two hundred and fifty-three participants from a pool of 330 healthy and sedentary subjects between 20 and 80 years of age. INTERVENTIONS Both the 6MWT and the 6MST were performed in accordance with the American Thoracic Society's statement. Dyspnoea, blood pressure, oxygen saturation and heart rate were measured before and after each test. RESULTS Mean heart rate immediately after the 6MST was significantly higher than mean heart rate immediately after the 6MWT {125 [standard deviation (SD) 19] vs 111 (SD 17) beats/minute; mean difference 13 (95% confidence interval of the difference 10 to 16); P<0.001}. Moreover, mean heart rate during (3minutes after commencement) the 6MST [118 (SD 18) beats/minute] was statistically higher than mean heart rate at the end of the 6MWT [111 (SD 18) beats/minute; P<0.001]. None of the subjects achieved the calculated submaximal heart rate. CONCLUSIONS The 6MST and 6MWT are safe and produce submaximal effort in healthy participants. However, they are not interchangeable, and the 6MST requires more energy than the 6MWT.
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Affiliation(s)
- C H da Costa
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| | - K M da Silva
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - A Maiworm
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Y Raphael
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - J Parnayba
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - M Da Cal
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - B Figueira
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - D Condesso
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - R Rufino
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
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19
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Exercise Intolerance in Pulmonary Arterial Hypertension. The Role of Cardiopulmonary Exercise Testing. Ann Am Thorac Soc 2015; 12:604-12. [DOI: 10.1513/annalsats.201412-558cc] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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20
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Sperling MPR, Caruso FCR, Mendes RG, Dutra DB, Arakelian VM, Bonjorno JC, Catai AM, Arena R, Borghi-Silva A. Relationship between non-invasive haemodynamic responses and cardiopulmonary exercise testing in patients with coronary artery disease. Clin Physiol Funct Imaging 2014; 36:92-8. [DOI: 10.1111/cpf.12197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/11/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Milena Pelosi Rizk Sperling
- Programa de Pós-graduação Interunidades Bioengenharia (EESC/FMRP/IQSC); Universidade de São Paulo, USP; São Carlos SC Brasil
- Laboratório de Fisioterapia Cardiopulmonar; Universidade Federal de São Carlos, UFSCar; São Carlos SP Brasil
| | | | - Renata Gonçalves Mendes
- Laboratório de Fisioterapia Cardiopulmonar; Universidade Federal de São Carlos, UFSCar; São Carlos SP Brasil
| | - Daniela Bassi Dutra
- Laboratório de Fisioterapia Cardiopulmonar; Universidade Federal de São Carlos, UFSCar; São Carlos SP Brasil
| | - Vivian Maria Arakelian
- Laboratório de Fisioterapia Cardiopulmonar; Universidade Federal de São Carlos, UFSCar; São Carlos SP Brasil
| | - José Carlos Bonjorno
- Programa de Pós-graduação Interunidades Bioengenharia (EESC/FMRP/IQSC); Universidade de São Paulo, USP; São Carlos SC Brasil
| | - Aparecida Maria Catai
- Laboratório de Fisioterapia Cardiopulmonar; Universidade Federal de São Carlos, UFSCar; São Carlos SP Brasil
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory; College of Applied Health Sciences; University of Illinois Chicago; Chicago IL USA
| | - Audrey Borghi-Silva
- Programa de Pós-graduação Interunidades Bioengenharia (EESC/FMRP/IQSC); Universidade de São Paulo, USP; São Carlos SC Brasil
- Laboratório de Fisioterapia Cardiopulmonar; Universidade Federal de São Carlos, UFSCar; São Carlos SP Brasil
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21
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Zhuang XD, Long M, Li F, Hu X, Liao XX, Du ZM. PDE5 inhibitor sildenafil in the treatment of heart failure: A meta-analysis of randomized controlled trials. Int J Cardiol 2014; 172:581-7. [DOI: 10.1016/j.ijcard.2014.01.102] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/30/2013] [Accepted: 01/19/2014] [Indexed: 12/15/2022]
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