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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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Gayda M, Gremeaux V, Bherer L, Juneau M, Drigny J, Dupuy O, Lapierre G, Labelle V, Fortier A, Nigam A. Cognitive function in patients with stable coronary heart disease: Related cerebrovascular and cardiovascular responses. PLoS One 2017; 12:e0183791. [PMID: 28937981 PMCID: PMC5609740 DOI: 10.1371/journal.pone.0183791] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/08/2017] [Indexed: 11/18/2022] Open
Abstract
Chronic exercise has been shown to prevent or slow age-related decline in cognitive functions in otherwise healthy, asymptomatic individuals. We sought to assess cognitive function in a stable coronary heart disease (CHD) sample and its relationship to cerebral oxygenation-perfusion, cardiac hemodynamic responses, and V˙O2 peak compared to age-matched and young healthy control subjects. Twenty-two young healthy controls (YHC), 20 age-matched old healthy controls (OHC) and 25 patients with stable CHD were recruited. Cognitive function assessment included short term—working memory, perceptual abilities, processing speed, cognitive inhibition and flexibility and long-term verbal memory. Maximal cardiopulmonary function (gas exchange analysis), cardiac hemodynamic (impedance cardiography) and left frontal cerebral oxygenation-perfusion (near-infra red spectroscopy) were measured during and after a maximal incremental ergocycle test. Compared to OHC and CHD, YHC had higher V˙O2 peak, maximal cardiac index (CI max), cerebral oxygenation-perfusion (ΔO2 Hb, ΔtHb: exercise and recovery) and cognitive function (for all items) (P<0.05). Compared to OHC, CHD patients had lower V˙O2 peak, CI max, cerebral oxygenation-perfusion (during recovery) and short term—working memory, processing speed, cognitive inhibition and flexibility and long-term verbal memory (P<0.05). V˙O2 peak and CI max were related to exercise cerebral oxygenation-perfusion and cognitive function (P<0.005). Cerebral oxygenation-perfusion (exercise) was related to cognitive function (P<0.005). Stable CHD patients have a worse cognitive function, a similar cerebral oxygenation/perfusion during exercise but reduced one during recovery vs. their aged-matched healthy counterparts. In the all sample, cognitive functions correlated with V˙O2 peak, CI max and cerebral oxygenation-perfusion.
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Affiliation(s)
- Mathieu Gayda
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Research Center, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Vincent Gremeaux
- INSERM - U1093 “Cognition, Action, et Plasticité Sensorimotrice”, Dijon, France
| | - Louis Bherer
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Research Center, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Martin Juneau
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Research Center, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Joffrey Drigny
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Olivier Dupuy
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- PERFORM Centre, Department of Psychology, Concordia University, Montreal, Quebec, Canada
- Research Centre, Institut Universitaire de Gériatrie de Montreal, Montreal, Quebec, Canada
- Laboratory, MOVE (EA6314), Faculty of Sport Sciences, Université de Poitiers, Poitiers, France
| | - Gabriel Lapierre
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Research Center, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Véronique Labelle
- Research Centre, Institut Universitaire de Gériatrie de Montreal, Montreal, Quebec, Canada
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, A Division of the Montreal Heart Institute, Montreal, Quebec, Canada
| | - Anil Nigam
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Research Center, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- * E-mail:
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Thorin-Trescases N, Hayami D, Yu C, Luo X, Nguyen A, Larouche JF, Lalongé J, Henri C, Arsenault A, Gayda M, Juneau M, Lambert J, Thorin E, Nigam A. Exercise Lowers Plasma Angiopoietin-Like 2 in Men with Post-Acute Coronary Syndrome. PLoS One 2016; 11:e0164598. [PMID: 27736966 PMCID: PMC5063321 DOI: 10.1371/journal.pone.0164598] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/27/2016] [Indexed: 12/11/2022] Open
Abstract
Pro-inflammatory angiopoietin-like 2 (angptl2) promotes endothelial dysfunction in mice and circulating angptl2 is higher in patients with cardiovascular diseases. We previously reported that a single bout of physical exercise was able to reduce angptl2 levels in coronary patients. We hypothesized that chronic exercise would reduce angptl2 in patients with post-acute coronary syndrome (ACS) and endothelial dysfunction. Post-ACS patients (n = 40, 10 women) were enrolled in a 3-month exercise-based prevention program. Plasma angptl2, hs-CRP, and endothelial function assessed by scintigraphic forearm blood flow, were measured before and at the end of the study. Exercise increased VO2peak by 10% (p<0.05), but did not significantly affect endothelial function, in both men and women. In contrast, exercise reduced angptl2 levels only in men (-26±7%, p<0.05), but unexpectedly not in women (+30±16%), despite similar initial levels in both groups. Exercise reduced hs-CRP levels in men but not in women. In men, levels of angptl2, but not of hs-CRP, reached at the end of the training program were negatively correlated with VO2peak (r = -0.462, p = 0.012) and with endothelial function (r = -0.419, p = 0.033) measured at baseline: better initial cardiopulmonary fitness and endothelial function correlated with lower angptl2 levels after exercise. Pre-exercise angptl2 levels were lower if left ventricular ejection time was long (p<0.05) and the drop in angptl2 induced by exercise was greater if the cardiac output was high (p<0.05). In conclusion, in post-ACS men, angptl2 levels are sensitive to chronic exercise training. Low circulating angptl2 reached after training may reflect good endothelial and cardiopulmonary functions.
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Affiliation(s)
| | - Doug Hayami
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Carol Yu
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Departments of Pharmacology and Surgery, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Xiaoyan Luo
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Albert Nguyen
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Departments of Pharmacology and Surgery, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jean-François Larouche
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Julie Lalongé
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Christine Henri
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
| | - André Arsenault
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Montreal Behavioral Medicine Centre, Montreal, Quebec, Canada
| | - Mathieu Gayda
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Martin Juneau
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Jean Lambert
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Eric Thorin
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Departments of Pharmacology and Surgery, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- * E-mail:
| | - Anil Nigam
- Montreal Heart Institute, Research Center, University of Montreal, Montreal, Quebec, Canada
- Cardiac Rehabilitation and Prevention Center (EPIC) of the Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
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Gayda M, Desjardins A, Lapierre G, Dupuy O, Fraser S, Bherer L, Juneau M, White M, Gremeaux V, Labelle V, Nigam A. Cerebral Hemodynamics During Exercise and Recovery in Heart Transplant Recipients. Can J Cardiol 2016; 32:539-46. [DOI: 10.1016/j.cjca.2015.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/17/2015] [Accepted: 07/17/2015] [Indexed: 11/24/2022] Open
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Cardiovascular changes occurring with occlusion of a mature arteriovenous fistula. J Vasc Access 2015; 16:459-66. [DOI: 10.5301/jva.5000336] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study was to evaluate the relationship between Qa, cardiovascular parameters and symptomatic cardiac disease. Methods A prospective cohort study of 100 patients dialysing via an arteriovenous fistula (AVF) was performed. Qa was measured using pulsed Doppler ultrasound. Cardiovascular parameters were measured using thoracic bioimpedance technique (Medis, GmbH). Measurement of cardiovascular parameters was undertaken pre- and post-occlusion of the AVF. Results Mean age was 57.1 years (range: 19-83); 51% male. Mean values pre-occlusion: mean arterial blood pressure (MABP) 89.6 ± 16.9 mmHg; stroke volume index (SVI) 39.3 ± 4.6 mL; cardiac index (CI) 3.7 ± 0.8 L/min/m2; systemic vascular resistance index (SVRI) 585.5 ± 67.8 dyn/sec/cm−5/m2; oxygen delivery (DO2I) 607.1 ± 116.8 mL/min/m2. A total of 12% of patients had CI>4.5 L/min/m2 pre-occlusion. There was no difference in heart rate (HR), MABP and SVI following occlusion of AVF. Mean CI reduced post-AVF occlusion (∆CI: -0.42 L/min/m2; p<0.001), as did DO2I (∆ DO2I: 45.5 mL/min/m2; p<0.001). SVRI increased (∆SVRI: 170.1 dyn/sec/cm−5/m2; p<0.001). The drop in CI which occurred post-AVF occlusion was greater in patients with Qa >2000 mL/min (-2.79 ± 0.34 vs. -0.24 ± 0.48 L/min/m2; p<0.001). There was a non-significant trend towards symptomatic heart failure in those patients with a greater ∆CI following AVF occlusion (NYHA 1: -0.1 ± 0.1 L/min/m2; NHYA 2: -0.3 ± 0.7 L/min/m2; NYHA 3: -0.7 ± 1.0 L/min/m2; p = 0.06). Conclusions The relationship between AVF blood flow, cardiac output and symptomatic cardiac disease is complex. Occlusion of an AVF leads to reduced cardiac output and improved oxygen delivery, even in asymptomatic patients. This difference is most marked in patients with high-flow AVF (>2000 mL/min). High-flow AVF with large ∆CI may lead to high cardiac output state, which is reversible on occlusion of the AVF.
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