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Santana EJ, Christle JW, Cauwenberghs N, Peterman JE, Busque V, Gomes B, Bagherzadeh SP, Moneghetti K, Kuznetsova T, Wheeler M, Ashley E, Harber MP, Arena R, Kaminsky LA, Myers J, Haddad F. Improving Reporting of Exercise Capacity Across Age Ranges Using Novel Workload Reference Equations. Am J Cardiol 2024; 215:32-41. [PMID: 38301753 DOI: 10.1016/j.amjcard.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/03/2024]
Abstract
Exercise capacity (EC) is an important predictor of survival in the general population and in subjects with cardiopulmonary disease. Despite its relevance, considering the percent-predicted workload (%pWL) given by current equations may overestimate EC in older adults. Therefore, to improve the reporting of EC in clinical practice, our main objective was to develop workload reference equations (pWL) that better reflect the relation between workload and age. Using the Fitness Registry and the Importance of Exercise National Database (FRIEND), we analyzed a reference group of 6,966 apparently healthy participants and 1,060 participants with heart failure who underwent graded treadmill cardiopulmonary exercise testing. For the first group, the mean age was 44 years (18 to 79); 56.5% of participants were males and 15.4% had obesity. Peak oxygen consumption was 11.6 ± 3.0 METs in males and 8.5 ± 2.4 METs in females. After partition analysis, we first developed sex-specific pWL equations to allow comparisons to a healthy weight reference. For males, pWL (METs) = 14.1-0.9×10-3×age2 and 11.5-0.87×10-3×age2 for females. We used those equations as denominators of %pWL, and based on their distribution, we determined thresholds for EC classification, with average EC defined by the range corresponding to 85% to 115%pWL. Compared with %pWL using current equations, the new equations yielded better-calibrated %pWL across different age ranges. We also derived body mass index-adjusted pWL equations that better assessed EC in subjects with heart failure. In conclusion, the novel pWL equations have the potential to impact the report of EC in practice.
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Affiliation(s)
- Everton J Santana
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University, Stanford, California; Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
| | - Jeffrey W Christle
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University, Stanford, California; Stanford Sports Cardiology, Department of Medicine, Stanford University, Stanford, California
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - James E Peterman
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana
| | - Vincent Busque
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Bruna Gomes
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University, Stanford, California; Department of Cardiology, Pneumology and Angiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Shadi P Bagherzadeh
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Kegan Moneghetti
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Matthew Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Euan Ashley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Department of Genetics, Stanford University School of Medicine, Stanford, California; Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, Indiana
| | - Ross Arena
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, Illinois; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinios
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana; Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, Indiana; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinios
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinios; Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, California.
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University, Stanford, California; Stanford Diabetes Research Center, Stanford University, Stanford, California; Wu Tsai Performance Alliance, Stanford University, Stanford, California.
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Kuznetsova T, Daels Y, Ntalianis E, Santana EJ, Sabovčik F, Haddad F, Cauwenberghs N. Clinical and biochemical predictors of longitudinal changes in left atrial structure and function: A general population study. Echocardiography 2024; 41:e15780. [PMID: 38372342 DOI: 10.1111/echo.15780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE There is a need for better understanding the factors that modulate left atrial (LA) dysfunction. Therefore, we determined associations of clinical and biochemical biomarkers with serial changes in echocardiographic indexes of LA function in the general population. METHODS We measured LA maximal and minimal volume indexes (LAVImax and LAVImin) by echocardiography and LA reservoir strain (LARS) by two-dimensional speckle-tracking in 627 participants (mean age 50.8 years, 51.2% women) at baseline and after 4.8 years. RESULTS During follow-up, LARS decreased significantly in men (-.90%, P = .033) but not in women (-.23%, P = .60). In stepwise regression analysis, stronger decrease in LARS over time was associated with male sex, a higher age, body mass index (BMI), mean arterial pressure (MAP) and serum insulin at baseline and with a greater increase in BMI and MAP over time (P ≤ .018). Similarly, an increased risk of developing or retaining abnormal LARS was observed in older participants, in subjects with a higher baseline BMI, MAP, heart rate (HR), troponin T and ΔMAP, and in those who used β-blockers at baseline. Both LAVImax and LAVImin increased significantly over time (P ≤ .0007). This increase was associated with a higher baseline age, pulse pressure and a lower HR at baseline and a greater increase in pulse pressure over time (P ≤ .029). Higher serum insulin and D-dimer were independently associated with a stronger increase in LAVImin (P ≤ .0034). CONCLUSION Subclinical worsening in LA dysfunction was associated with older age, hypertension, obesity, insulin resistance and troponin T levels. Cardiovascular risk management strategies may delay LA deterioration.
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Affiliation(s)
- Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yne Daels
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Evangelos Ntalianis
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Everton J Santana
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Francois Haddad
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Sanchez PA, O’Donnell CT, Francisco N, Santana EJ, Moore AR, Pacheco-Navarro A, Roque J, Lebold KM, Parmer-Chow CM, Pienkos SM, Celestin BE, Levitt JE, Collins WJ, Lanspa MJ, Ashley EA, Wilson JG, Haddad F, Rogers AJ. Right Ventricular Dysfunction Patterns among Patients with COVID-19 in the Intensive Care Unit: A Retrospective Cohort Analysis. Ann Am Thorac Soc 2023; 20:1465-1474. [PMID: 37478340 PMCID: PMC10559129 DOI: 10.1513/annalsats.202303-235oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023] Open
Abstract
Rationale: Right ventricular (RV) dysfunction is common among patients hospitalized with coronavirus disease (COVID-19); however, its epidemiology may depend on the echocardiographic parameters used to define it. Objectives: To evaluate the prevalence of abnormalities in three common echocardiographic parameters of RV function among patients with COVID-19 admitted to the intensive care unit (ICU), as well as the effect of RV dilatation on differential parameter abnormality and the association of RV dysfunction with 60-day mortality. Methods: We conducted a retrospective cohort study of ICU patients with COVID-19 between March 4, 2020, and March 4, 2021, who received a transthoracic echocardiogram within 48 hours before to at most 7 days after ICU admission. RV dysfunction and dilatation, respectively, were defined by guideline thresholds for tricuspid annular plane systolic excursion (TAPSE), RV fractional area change, RV free wall longitudinal strain (RVFWS), and RV basal dimension or RV end-diastolic area. Association of RV dysfunction with 60-day mortality was assessed through logistic regression adjusting for age, prior history of congestive heart failure, invasive ventilation at the time of transthoracic echocardiogram, and Acute Physiology and Chronic Health Evaluation II score. Results: A total of 116 patients were included, of whom 69% had RV dysfunction by one or more parameters, and 36.3% of these had RV dilatation. The three most common patterns of RV dysfunction were the presence of three abnormalities, the combination of abnormal RVFWS and TAPSE, and isolated TAPSE abnormality. Patients with RV dilatation had worse RV fractional area change (24% vs. 36%; P = 0.001), worse RVFWS (16.3% vs. 19.1%; P = 0.005), higher RV systolic pressure (45 mm Hg vs. 31 mm Hg; P = 0.001) but similar TAPSE (13 mm vs. 13 mm; P = 0.30) compared with those with normal RV size. After multivariable adjustment, 60-day mortality was significantly associated with RV dysfunction (odds ratio, 2.91; 95% confidence interval, 1.01-9.44), as was the presence of at least two parameter abnormalities. Conclusions: ICU patients with COVID-19 had significant heterogeneity in RV function abnormalities present with different patterns associated with RV dilatation. RV dysfunction by any parameter was associated with increased mortality. Therefore, a multiparameter evaluation may be critical in recognizing RV dysfunction in COVID-19.
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Affiliation(s)
| | | | - Nadia Francisco
- Echocardiography Imaging Center, Cardiovascular Heath, Stanford Health Care, and
| | | | | | | | | | - Katherine M. Lebold
- Department of Emergency Medicine, Stanford University, Stanford, California; and
| | | | | | | | | | | | - Michael J. Lanspa
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
| | | | - Jennifer G. Wilson
- Department of Emergency Medicine, Stanford University, Stanford, California; and
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Ichimura K, Santana EJ, Kuznetsova T, Cauwenberghs N, Sabovčik F, Chun L, Francisco NLC, Kheyfets VO, Salerno M, Zamanian RT, Spiekerkoetter E, Haddad F. Novel left ventricular mechanical index in pulmonary arterial hypertension. Pulm Circ 2023; 13:e12216. [PMID: 37063750 PMCID: PMC10103585 DOI: 10.1002/pul2.12216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/13/2023] [Accepted: 03/25/2023] [Indexed: 04/18/2023] Open
Abstract
Ventricular interdependence plays an important role in pulmonary arterial hypertension (PAH). It can decrease left ventricular (LV) longitudinal strain (LVLS) and lead to a leftward displacement ("transverse shortening") of the interventricular septum (sTS). For this study, we hypothesized the ratio of LVLS/sTS would be a sensitive marker of systolic ventricular interactions in PAH. In a cross-sectional cohort of patients with PAH (n = 57) and matched controls (n = 57), we quantified LVLS and septal TS in the amplitude and time domain. We then characterized LV phenotypes using upset plots, ventricular interactions using network analysis, and longitudinal analysis in a representative cohort of 45 patients. We also measured LV metrics in mice subjected to pulmonary arterial banding (PAB) using a 7 T magnetic resonance imaging at baseline, Week 1, and Week 7 post-PAB (N = 9). Patients with PAH had significantly reduced absolute LVLS (15.4 ± 3.4 vs. 20.1 ± 2.3%, p < 0.0001), higher sTS (53.0 ± 12.2 vs. 28.0 ± 6.2%, p < 0.0001) and lower LVLS/sTS (0.30 ± 0.09 vs. 0.75 ± 0.16, p < 0.0001) compared to controls. Reduced LVLS/sTS was observed in 89.5% of patients, while diastolic dysfunction, impaired LVLS (<16%), and LV atrophy were observed in 73.7%, 52.6%, and 15.8%, respectively. In the longitudinal cohort, changes in LVLS/sTS were closely associated with changes in N-terminal pro B-type natriuretic peptide (r = 0.73, p < 0.0001) as well as survival. Mice subjected to PAB showed significant RV systolic dysfunction and decreased LVLS/sTS compared to sham animals. We conclude that in PAH, LVLV/sTS is a simple ratio that can reflect ventricular systolic interactions.
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Affiliation(s)
- Kenzo Ichimura
- Department of Medicine, Division of Pulmonary, Allergy and Critical CareStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center of Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
| | - Everton J. Santana
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
| | - František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
| | - Lindsey Chun
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
| | | | - Vitaly O. Kheyfets
- Pediatric Critical Care Medicine; Developmental Lung Biology and CVP Research Laboratories, School of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Michael Salerno
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Roham T. Zamanian
- Department of Medicine, Division of Pulmonary, Allergy and Critical CareStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center of Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Edda Spiekerkoetter
- Department of Medicine, Division of Pulmonary, Allergy and Critical CareStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center of Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
| | - Francois Haddad
- Vera Moulton Wall Center of Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
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