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Boulmpou A, Boutou AK, Pella E, Sarafidis P, Papadopoulos CE, Vassilikos V. Cardiopulmonary Exercise Testing in Heart Failure With Preserved Ejection Fraction: Technique Principles, Current Evidence, and Future Perspectives. Cardiol Rev 2023; 31:299-317. [PMID: 36723460 DOI: 10.1097/crd.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a multifactorial clinical syndrome involving a rather complex pathophysiologic substrate and quite a challenging diagnosis. Exercise intolerance is a major feature of HFpEF, and in many cases, diagnosis is suspected in subjects presenting with exertional dyspnea. Cardiopulmonary exercise testing (CPET) is a noninvasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic functions during maximal or submaximal exercise. The assessment is based on the principle that system failure typically occurs when the system is under stress, and thus, CPET is currently considered to be the gold standard for identifying exercise intolerance, allowing the differential diagnosis of underlying causes. CPET is used in observational studies and clinical trials in HFpEF; however, in most cases, only a few from a wide variety of CPET parameters are examined, while the technique is largely underused in everyday cardiology practice. This article discusses the basic principles and methodology of CPET and studies that utilized CPET in patients with HFpEF, in an effort to increase awareness of CPET capabilities among practicing cardiologists.
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Affiliation(s)
- Aristi Boulmpou
- From the Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Eva Pella
- Department of Nephrology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- From the Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- From the Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hamazaki N, Kamiya K, Nozaki K, Yamashita M, Uchida S, Noda T, Maekawa E, Meguro K, Yamaoka-Tojo M, Matsunaga A, Ako J. Correlation between respiratory muscle weakness and frailty status as risk markers for poor outcomes in patients with cardiovascular disease. Eur J Cardiovasc Nurs 2022; 21:782-790. [PMID: 35259240 DOI: 10.1093/eurjcn/zvac014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/18/2021] [Accepted: 02/25/2022] [Indexed: 12/29/2022]
Abstract
AIMS Although the developmental mechanism of respiratory muscle weakness (RMW) and frailty are partly similar in patients with cardiovascular disease (CVD), their relationship remains unclear. This study aimed to investigate the correlation between RMW and frailty and its impact on clinical outcomes in patients with CVD. METHODS AND RESULTS In this retrospective observational study, consecutive 1217 patients who were hospitalized for CVD treatment were enrolled. We assessed frailty status by using the Fried criteria and respiratory muscle strength by measuring the maximal inspiratory pressure (PImax) at hospital discharge, with RMW defined as PImax <70% of the predicted value. The endpoint was a composite of all-cause death and/or readmission for heart failure. We examined the prevalence of RMW and frailty and their correlation. The relationships of RMW with the endpoint for each presence or absence of frailty were also investigated. Respiratory muscle weakness and frailty were observed in 456 (37.5%) and 295 (24.2%) patients, respectively, and 149 (12.2%) patients had both statuses. Frailty was detected as a significant indicator of RMW [odds ratio: 1.84, 95% confidence interval (CI): 1.39-2.44]. Composite events occurred in 282 patients (23.2%). Respiratory muscle weakness was independently associated with an increased incidence of events in patients with both non-frailty [hazard ratio (HR): 1.40, 95% CI: 1.04-1.88] and frailty (HR: 1.68, 95% CI: 1.07-2.63). CONCLUSIONS This is the first to demonstrate a correlation between RMW and frailty in patients with CVD, with 12.2% of patients showing overlap. RMW was significantly associated with an increased risk of poor outcomes in patients with CVD and frailty.
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Affiliation(s)
- Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0375, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0375, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
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Li H, Tao L, Huang Y, Li Z, Zhao J. Inspiratory muscle training in patients with heart failure: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:993846. [PMID: 36337890 PMCID: PMC9626810 DOI: 10.3389/fcvm.2022.993846] [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: 07/18/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To explore the effect of inspiratory muscle training (IMT) on patients with heart failure and further explore the impact of IMT on patients with heart failure with preserved ejection fraction. Methods PubMed, EMBASE, Cochrane Library, CNKI, Wanfang and VIP databases were systematically searched. Randomized controlled trials of inspiratory muscle training in patients with heart failure were included. Revman 5.3 software was used to calculate the weighted mean difference (MD) of the combined effect size. The effects of IMT on the maximum oxygen uptake (peakVO2), maximum inspiratory pressure (PImax), ventilation efficiency (VE/VCO2), six-minute walking distance (6MWD), forced expiratory volume (FEV1), forced vital capacity (FVC) and quality of life in patients with heart failure were compared and analyzed. Results After systematic retrieval and screening, 17 studies were included in this study, and the quality of the included studies was good. The results showed that IMT could increase peakVO2 (MD 2.53; 95% CI 1. 54, 3. 51; P < 0.0001) and PImax (MD 17.25; 95% CI 13. 75, 20. 75; P < 0.00001); improve the VE/VCO2 (MD −4.22; 95% CI −6.78, −1.66; P = 0.001) and significantly improve the quality of life in patients with heart failure (MD −13.34; 95% CI −20.42, −6.26; P = 0.0002). However, the effect of IMT on 6MWD in patients with heart failure was not statistically significant (MD 74.45; 95% CI −12.88,161.79; P = 0.09), and the effect on lung function (FEV1 and FVC) was also not statistically significant (P = 0.08; P = 0.86). IMT had a more significant positive effect on peakVO2 (MD 2.98; 95% CI 1.63, 4.34; P < 0.0001) and quality of life (MD −14.52; 95% CI −18.53, −10.52; P < 0.00001) in patients with heart failure with preserved ejection fraction. Descriptive analysis suggested that IMT may positively affect dyspnoea in patients with heart failure. In addition, the choice of evaluation scale may affect the evaluation results of quality of life and dyspnoea. Conclusion IMT has a significant positive effect on respiratory status in patients with heart failure, but different dyspnoea and quality of life evaluation scales can affect the final evaluation results.
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Affiliation(s)
- Hui Li
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingling Tao
- Department of Ultrasound, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuewi Huang
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyang Li
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ziyang Li
| | - Jianrong Zhao
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jianrong Zhao
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Deaton C. The Emperor-Preserved trial: what will change for patients with heart failure with preserved ejection fraction? Eur J Cardiovasc Nurs 2021; 21:293-294. [PMID: 34718524 DOI: 10.1093/eurjcn/zvab093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK
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Unraveling the Role of Respiratory Muscle Metaboloreceptors under Inspiratory Training in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041697. [PMID: 33578776 PMCID: PMC7916511 DOI: 10.3390/ijerph18041697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 12/15/2022]
Abstract
Exercise intolerance may be considered a hallmark in patients who suffer from heart failure (HF) syndrome. Currently, there is enough scientific evidence regarding functional and structural deterioration of skeletal musculature in these patients. It is worth noting that muscle weakness appears first in the respiratory muscles and then in the musculature of the limbs, which may be considered one of the main causes of exercise intolerance. Functional deterioration and associated atrophy of these respiratory muscles are related to an increased muscle metaboreflex leading to sympathetic–adrenal system hyperactivity and increased pulmonary ventilation. This issue contributes to increased dyspnea and/or fatigue and decreased aerobic function. Consequently, respiratory muscle weakness produces exercise limitations in these patients. In the present review, the key role that respiratory muscle metaboloreceptors play in exercise intolerance is accurately addressed in patients who suffer from HF. In conclusion, currently available scientific evidence seems to affirm that excessive metaboreflex activity of respiratory musculature under HF is the main cause of exercise intolerance and sympathetic–adrenal system hyperactivity. Inspiratory muscle training seems to be a useful personalized medicine intervention to reduce respiratory muscle metaboreflex in order to increase patients’ exercise tolerance under HF condition.
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Baral N, Changezi HU, Khan MR, Adhikari G, Adhikari P, Khan HMW, Poudyal A, Abdelazeem B, Sigdel S, Champine A. Inspiratory Muscle Training in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis. Cureus 2020; 12:e12260. [PMID: 33510978 PMCID: PMC7826245 DOI: 10.7759/cureus.12260] [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] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives To explore the role of inspiratory muscle training (IMT) in improving cardiorespiratory fitness of stable heart failure with preserved ejection fraction (HFpEF) patients. Background There is a paucity of data on the role of IMT in patients with HFpEF. HFpEF is a growing problem in the developed world, especially in the aging population. Methods We conducted a systematic literature search for English studies in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. We searched databases using terms relating to or describing breathing exercise, IMT, and HFpEF. RevMan 5.4 (The Cochrane Collaboration, 2020) was used for data analysis, and two independent investigators performed literature retrieval and data extraction. Results We identified three randomized controlled trials (RCTs) and one prospective study on the role of IMT in HFpEF. We calculated the pooled mean difference of peak oxygen consumption (Peak VO2) and six-min walk distance (6MWD) between the IMT and standard care (SC) groups. Our meta-analysis showed that compared with SC, IMT could significantly improve peak VO2 with a mean difference (MD) of 2.82 ml/kg/min, 95% CI [1.90, 3.74] P < 0.00001 and improve 6MWD with MD of 83.97 meters, 95% CI [59.18, 108.76] P< 0.00001 to improve cardiorespiratory fitness at 12 weeks of IMT and improve peak VO2 with MD of 2.18 ml/kg/min, 95% CI [0.38, 3.99] P < 0.00001 at 24 weeks of therapy. Conclusion IMT should be further studied as a possible treatment option to improve cardiorespiratory fitness for patients with stable HFpEF.
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Affiliation(s)
- Nischit Baral
- Internal Medicine, McLaren Flint/Michigan State University (MSU), Flint, USA
| | - Hameem U Changezi
- Cardiovascular Medicine, McLaren Flint/Michigan State University (MSU), Flint, USA
| | - Mahin R Khan
- Cardiology, McLaren Flint/Michigan State University (MSU), Flint, USA
| | | | - Prakash Adhikari
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | | | | | - Basel Abdelazeem
- Internal Medicine, McLaren Flint/Michigan State University (MSU), Flint, USA
| | - Shashi Sigdel
- Internal Medicine, Rochester Regional Health, Rochester, USA
| | - Andrew Champine
- Behavioral Health/Family Medicine/Internal Medicine, McLaren Flint/Michigan State University (MSU), Flint, USA
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Shoemaker MJ, Cahalin LP, Dias KJ, Heick JD, Davenport TE, Severin R, Collins SM. On "Going beyond clinical practice guidelines." Jette AM. Phys Ther. 2020;100:1-2. Phys Ther 2020; 100:1419. [PMID: 32383732 DOI: 10.1093/ptj/pzaa090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Michael J Shoemaker
- Department of Physical Therapy, Grand Valley State University, 301 Michigan NE, Suite 200, Grand Rapids, MI, 49503 (USA)
| | - Lawrence P Cahalin
- Department of Physical Therapy, Plymouth State University, Plymouth, New Hampshire
| | - Konrad J Dias
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida
| | - John D Heick
- Department of Physical Therapy, Maryville University of Saint Louis, Saint Louis, Missouri
| | - Todd E Davenport
- Department of Physical Therapy, Northern Arizona University, Flagstaff, Arizona
| | - Richard Severin
- Department of Physical Therapy and Athletic Training, University of the Pacific, Stockton, California
| | - Sean M Collins
- Department of Physical Therapy, University of Illinois at Chicago, College of Applied Health Sciences, Chicago, Illinois
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Fernandez-Rubio H, Becerro-de-Bengoa-Vallejo R, Rodríguez-Sanz D, Calvo-Lobo C, Vicente-Campos D, Chicharro JL. Inspiratory Muscle Training in Patients with Heart Failure. J Clin Med 2020; 9:jcm9061710. [PMID: 32498445 PMCID: PMC7356942 DOI: 10.3390/jcm9061710] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Prior systematic reviews and meta-analysis addressed that inspiratory muscle training (IMT) improved inspiratory muscle weakness, cardiorespiratory fitness and quality of life similar to conventional exercise training as a first alternative in deconditioned patients with heart failure (HF) lead to a better adaptation to posterior exercise training. The heterogeneity and variability in a wide range of new studies about this topic led to the necessity of an updated and comprehensive narrative review. The present review aimed to analyze and update the most relevant studies about IMT in patients who suffer from HF. Methods: A narrative review was carried out about IMT in HF patients including 26 experimental studies divided into 21 clinical trials and 5 quasi-experimental studies identified through database searching in PubMed, Cochrane and PEDro. Results: There is enough evidence to state that IMT produces improvements in functional capacity of patients with HF. Nevertheless, there is not enough evidence to support that IMT could improve cardiovascular parameters, blood biomarkers or quality of life in these patients. Conclusions: Thus, IMT may be recommended to improve functional capacity in patients who suffer from HF; nevertheless, more evidence is needed regarding cardiovascular parameters, biomarkers and quality of life. Furthermore, mortality or HF hospitalization was not evaluated and most studies were not longer than 3 months. According to IMT protocols and study designs heterogeneity and mid-term follow-up, further investigations through high-quality long-term randomized clinical trials should be performed to achieve systematic reviews and meta-analysis to support strong evidence for IMT in HF patients.
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Affiliation(s)
- Hugo Fernandez-Rubio
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
- Correspondence: ; Tel.: +34-913-941-532
| | - Davinia Vicente-Campos
- Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - J. L. Chicharro
- Grupo FEBIO, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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