1
|
Stewart GM, Fermoyle CC, Wheatley-Guy CM, Robach P, Tiller NB, Taylor BJ, Ziegler B, Schwartz J, Gavet A, Chabridon L, Murdock RW, Constantini K, Johnson BD. Effect of Ultra-Marathon Trail Running at Sea Level and Altitude on Alveolar-Capillary Function and Lung Diffusion. Med Sci Sports Exerc 2024:00005768-990000000-00500. [PMID: 38595212 DOI: 10.1249/mss.0000000000003448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Endurance exercise at altitude can increase cardiac output and pulmonary vascular pressure to levels that may exceed the stress-tolerability of the alveolar-capillary unit. This study examined the effect of ultra-marathon trail racing at different altitudes (ranging from <1000 m to between 1500 - 2700 m) on alveolar-capillary recruitment and lung diffusion. METHODS Cardiac and lung function were examined before and after an ultra-marathon in 67 runners (age:41 ± 9y, BMI:23 ± 2 kg/m2, 10 females), and following 12-24 h of recovery in a subset (n = 27). Cardiac biomarkers (cTnI & BNP) were assessed from whole blood, while lung fluid accumulation (comet tails), stroke volume (SV) and cardiac output (Q) were quantified via echocardiography. Lung diffusing capacity for carbon monoxide (DLco) and its components, alveolar membrane conductance (Dm) and capillary blood volume (Vc), were determined via a single-breath method at rest and during three stages of submaximal semi-recumbent cycling (20, 30, & 40 W). RESULTS Average race time was 25 ± 12 h. From pre- to post-race, there was an increase in cardiac biomarkers (cTnI: 0.04 ± .02 vs 0.13 ± .03 ng/ml; BNP: 20 ± 2 vs 112 ± 21 pg/ml, p < 0.01) and lung comet tails (2 ± 1 vs 7 ± 6, p < 0.01), a decrease in resting and exercise SV (76 ± 2 vs 69 ± 2 ml; 40 W: 93 ± 2 vs 88 ± 2 ml, p < 0.01), and an elevation in Q at rest (4.1 ± 0.1 vs 4.6 ± 0.2 l/min, p < 0.01; 40 W: 7.3 ± 0.2 vs 7.4 ± 0.3 l/min, p = 0.899). Resting DLco and Vc decreased after the race (p < 0.01), while Dm was unchanged (p = 0.465); however, during the three stages of exercise DLco, Vc and Dm were all reduced from pre- to post-race (40 W: 36.3 ± 0.9 vs 33.0 ± 0.8 mL/min/mmHg; 83 ± 3 vs 73 ± 2 mL; 186 ± 6 vs 170 ± 7 mL/min/mmHg, respectively, p < 0.01). When corrected for alveolar volume and Q, DLco decreased from pre- to post-race (p < 0.01), and changes in DLco were similar for all ultra-marathon events (p > 0.05). CONCLUSIONS Competing in an ultra-marathon leads to a transient increase in cardiac injury biomarkers, mild lung-fluid accumulation, and impairments in lung diffusion. Reductions in DLco are predominantly caused by a reduced Vc and possible pulmonary capillary de-recruitment at rest. However, impairments in alveolar-capillary recruitment and Dm both contribute to a fall in exertional DLco following an ultra-marathon. Perturbations in lung diffusion were evident across a range of event distances and varying environmental exposures.
Collapse
Affiliation(s)
| | | | | | - Paul Robach
- Ecole Nationale des Sports de Montagne, Chamonix, FRANCE
| | - Nicholas B Tiller
- Institute of Respiratory Medicine and Exercise Physiology, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrence, CA
| | - Bryan J Taylor
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL
| | - Briana Ziegler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Jesse Schwartz
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Alice Gavet
- Ecole Nationale des Sports de Montagne, Chamonix, FRANCE
| | - Loïc Chabridon
- Ecole Nationale des Sports de Montagne, Chamonix, FRANCE
| | - Robert W Murdock
- Department of Cardiac Electrophysiology, Los Angeles Medical Center, Los Angeles, CA
| | - Keren Constantini
- School of public health, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, Tel-Aviv University, Tel Aviv, ISRAEL
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| |
Collapse
|
2
|
Chou H, Arthur K, Shaw E, Schaber C, Boyle B, Allsworth M, Kelley EF, Stewart GM, Wheatley CM, Schwartz J, Fermoyle CC, Ziegler BL, Johnson KA, Robach P, Basset P, Johnson BD. Metabolic insights at the finish line: deciphering physiological changes in ultramarathon runners through breath VOC analysis. J Breath Res 2024; 18:026008. [PMID: 38290132 DOI: 10.1088/1752-7163/ad23f5] [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] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/30/2024] [Indexed: 02/01/2024]
Abstract
Exhaustive exercise can induce unique physiological responses in the lungs and other parts of the human body. The volatile organic compounds (VOCs) in exhaled breath are ideal for studying the effects of exhaustive exercise on the lungs due to the proximity of the breath matrix to the respiratory tract. As breath VOCs can originate from the bloodstream, changes in abundance should also indicate broader physiological effects of exhaustive exercise on the body. Currently, there is limited published data on the effects of exhaustive exercise on breath VOCs. Breath has great potential for biomarker analysis as it can be collected non-invasively, and capture real-time metabolic changes to better understand the effects of exhaustive exercise. In this study, we collected breath samples from a small group of elite runners participating in the 2019 Ultra-Trail du Mont Blanc ultra-marathon. The final analysis included matched paired samples collected before and after the race from 24 subjects. All 48 samples were analyzed using the Breath Biopsy Platform with GC-Orbitrap™ via thermal desorption gas chromatography-mass spectrometry. The Wilcoxon signed-rank test was used to determine whether VOC abundances differed between pre- and post-race breath samples (adjustedP-value < .05). We identified a total of 793 VOCs in the breath samples of elite runners. Of these, 63 showed significant differences between pre- and post-race samples after correction for multiple testing (12 decreased, 51 increased). The specific VOCs identified suggest the involvement of fatty acid oxidation, inflammation, and possible altered gut microbiome activity in response to exhaustive exercise. This study demonstrates significant changes in VOC abundance resulting from exhaustive exercise. Further investigation of VOC changes along with other physiological measurements can help improve our understanding of the effect of exhaustive exercise on the body and subsequent differences in VOCs in exhaled breath.
Collapse
Affiliation(s)
- Hsuan Chou
- Owlstone Medical, Cambridge, United Kingdom
| | | | - Elen Shaw
- Owlstone Medical, Cambridge, United Kingdom
| | | | | | | | - Eli F Kelley
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Glenn M Stewart
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Courtney M Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Jesse Schwartz
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Caitlin C Fermoyle
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
- Utah Vascular Research Laboratory, Salt Lake City, UT, United States of America
| | - Briana L Ziegler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Kay A Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| | - Paul Robach
- Ecole Nationale des Sports de Montagne, Chamonix, France
| | | | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States of America
| |
Collapse
|
3
|
Aitken CR, Pathangey G, Stamos M, Kim CH, Johnson BD, Stewart GM. Reproducibility and responsiveness of airway impedance measures derived from the forced oscillation technique across different operating lung volumes. Respir Physiol Neurobiol 2024; 320:104200. [PMID: 38036081 DOI: 10.1016/j.resp.2023.104200] [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] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The forced oscillation technique (FOT) enables non-invasive measurement of respiratory system impedance. Limited data exists on how changes in operating lung volume (OLV) impact FOT-derived measures of airway resistance (Rrs) and reactance (Xrs). OBJECTIVES This study examined the reproducibility and responsiveness of FOT-derived measures of Rrs and Xrs during simulated changes in OLV. METHODS Participants simulated breathing at six OLVs: total lung capacity (TLC), ∼50% of inspiratory reserve volume (IRV50), ∼two-times tidal volume (VT2), tidal volume (VT), ∼50% of expiratory reserve volume (ERV50), and residual volume (RV), on a commercially available FOT device. Each simulated OLV manuever was performed in triplicate and in random order. Total Rrs and Xrs were recorded at 5, 11, and 19 Hz. RESULTS Twelve healthy participants (2 female) completed the study (weight: 76.5 ± 13.6 kg, height: 178.6 ± 9.7 cm, body mass index: 23.9 ± 3.1 kg/m2). Reproducibility of Rrs and Xrs at VT, VT2 and IRV50 was good to excellent (Range: ICC: 0.89-0.98, 95% confidence interval (CI): 0.70-0.98), while reproducibility at TLC, RV, and ERV50 was poor to excellent (Range: ICC: 0.60-0.98, 95% CI: 0.36-0.97). Rrs and Xrs were not different between VT and VT2 at any frequency (P > .05). With lung hyperinflation from VT to TLC, Rrs and Xrs decreased at all three frequencies (e.g., At 5 Hz Rrs: mean difference (MD): - 0.89, 95%CI: - 0.03 to - 1.75, P = .04; Xrs: MD: - 0.56, 95%CI: - 0.25 to - 0.86, P < .01). With lung hypoinflated from VT to RV, Rrs increased, and Xrs decreased for all frequencies (e.g., MD at 5 Hz, Rrs: MD: 2.31, 95%CI: 0.94-3.67, P < .01; Xrs: MD: -2.53, 95%CI: -4.02 to -1.04, P < .01). CONCLUSION FOT-derived measures of airway Rrs and Xrs are reproducible across a range of OLV's, and are responsive to hyper- and hypo-inflation of the lung. To further understand the impact of lung hyper- and hypo-inflation on FOT-derived airway impedance additional study is required in individuals with pathological variations in operating lung volume.
Collapse
Affiliation(s)
- Craig R Aitken
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | | | - Mathew Stamos
- Depatment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Chul-Ho Kim
- Depatment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Bruce D Johnson
- Depatment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Glenn M Stewart
- Depatment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Charles Perkins Centre and School of Medicine, Faculty of Medicine and Health, University of Sydney, Camberdown, NSW, Australia.
| |
Collapse
|
4
|
Parks JK, Wheatley-Guy CM, Stewart GM, Fermoyle CC, Taylor BJ, Schwartz J, Ziegler B, Johnson K, Gavet A, Chabridon L, Robach P, Johnson BD. Lung "Comet Tails" in Healthy Individuals: Accumulation or Clearance of Extravascular Lung Water? High Alt Med Biol 2023; 24:230-233. [PMID: 37722011 DOI: 10.1089/ham.2022.0114] [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] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Parks, Jordan K, Courtney M. Wheatley-Guy, Glenn M. Stewart, Caitlin C. Fermoyle, Bryan J. Taylor, Jesse Schwartz, Briana Ziegler, Kay Johnson, Alice Gavet, Loïc Chabridon, Paul Robach, and Bruce D. Johnson. Lung "Comet Tails" in healthy individuals: accumulation or clearance of extravascular lung water? High Alt Med Biol. 24:230-233, 2023-Ultrasound lung comet tails (or B-lines) tend to be limited in number (<5) or absent under ultrasound examination, and the appearance of diffuse B-lines with lung sliding has been suggested to identify pulmonary edema. Clinical evaluation of B-lines has been utilized as a bedside test to assess pulmonary congestion in patients with heart failure. Exposure to altitude or prolonged exercise can alter fluid regulation and can lead to pulmonary congestion or edema. As such, B-lines have been utilized in the field to monitor for pathological lung fluid accumulation. However, ultrasound lung comet lines might not be as reliable for identifying extravascular lung water (EVLW) as previously thought in healthy individuals exercising at altitude where an increase in the number of ultrasound lung comets would reflect fluid buildup in the interstitial space of the alveoli and pulmonary capillaries. This report will focus on reviewing the literature and our data from a group of ultraendurance runners that completed the Ultra Trail Mont Blanc race that demonstrates that lung comet tails may not always be evidence of pathological fluid accumulation in healthy individuals and as such should be used to assess EVLW in concert with other diagnostic testing.
Collapse
Affiliation(s)
- Jordan K Parks
- Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Glenn M Stewart
- Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
| | - Caitlin C Fermoyle
- Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
| | - Bryan J Taylor
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Jesse Schwartz
- Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
| | - Briana Ziegler
- Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
| | - Kay Johnson
- Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
| | - Alice Gavet
- Ecole Nationale des Sports de Montagne, site de l'Ecole Nationale de Ski et d'Alpinisme, Chamonix, France
| | - Loïc Chabridon
- Ecole Nationale des Sports de Montagne, site de l'Ecole Nationale de Ski et d'Alpinisme, Chamonix, France
| | - Paul Robach
- Ecole Nationale des Sports de Montagne, site de l'Ecole Nationale de Ski et d'Alpinisme, Chamonix, France
| | - Bruce D Johnson
- Division of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
| |
Collapse
|
5
|
McKeown DJ, Stewart GM, Kavanagh JJ. The severity of acute hypoxaemia determines distinct changes in intracortical and spinal neural circuits. Exp Physiol 2023; 108:1203-1214. [PMID: 37548581 PMCID: PMC10988465 DOI: 10.1113/ep091224] [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] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
The purpose of this study was to examine how two common methods of continuous hypoxaemia impact the activity of intracortical circuits responsible for inhibition and facilitation of motor output, and spinal excitability. Ten participants were exposed to 2 h of hypoxaemia at 0.13 fraction of inspired oxygen (F I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol) and 80% of peripheral capillary oxygen saturation (S p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol) using a simulating altitude device on two visits separated by a week. Using transcranial magnetic and peripheral nerve stimulation, unconditioned motor evoked potential (MEP) area, short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF), and F-wave persistence and area were assessed in the first dorsal interosseous (FDI) muscle before titration, after 1 and 2 h of hypoxic exposure, and at reoxygenation. The clamping protocols resulted in differing reductions inS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ by 2 h (S p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol: 81.9 ± 1.3%,F I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol: 90.6 ± 2.5%). Although unconditioned MEP peak to peak amplitude and area did not differ between the protocols, SICI duringF I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping was significantly lower at 2 h compared toS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping (P = 0.011) and baseline (P < 0.001), whereas ICF was higher throughout theF I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping compared toS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping (P = 0.005). Furthermore, a negative correlation between SICI andS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ (rrm = -0.56, P = 0.002) and a positive correlation between ICF andS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ (rrm = 0.69, P = 0.001) were determined, where greater reductions inS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ correlated with less inhibition and less facilitation of MEP responses. Although F-wave area progressively increased similarly throughout the protocols (P = 0.037), persistence of responses was reduced at 2 h and reoxygenation (P < 0.01) during theS p O 2 ${S_{{\mathrm{p}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol compared to theF I O 2 ${F_{{\mathrm{I}}{{\mathrm{O}}_{\mathrm{2}}}}}$ clamping protocol. After 2 h of hypoxic exposure, there is a reduction in the activity of intracortical circuits responsible for inhibiting motor output, as well as excitability of spinal motoneurones. However, these effects can be influenced by other physiological responses to hypoxia (i.e., hyperventilation and hypocapnia). NEW FINDINGS: What is the central question of this study? How do two common methods of acute hypoxic exposure influence the excitability of intracortical networks and spinal circuits responsible for motor output? What is the main finding and its importance? The excitability of spinal circuits and intracortical networks responsible for inhibition of motor output was reduced during severe acute exposure to hypoxia at 2 h, but this was not seen during less severe exposure. This provides insight into the potential cause of variance seen in motor evoked potential responses to transcranial magnetic stimulation (corticospinal excitability measures) when exposed to hypoxia.
Collapse
Affiliation(s)
- Daniel J. McKeown
- Neural Control of Movement LaboratoryMenzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- Department of PsychologyFaculty of Society and DesignBond UniversityGold CoastQueenslandAustralia
| | - Glenn M. Stewart
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- Allied Health Research CollaborativeThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Justin J. Kavanagh
- Neural Control of Movement LaboratoryMenzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| |
Collapse
|
6
|
Aitken CR, Stewart GM, Walsh JR, Palmer T, Adams L, Sabapathy S, Morris NR. Exertional dyspnea responses to the Dyspnea Challenge in heart failure: Comparison to chronic obstructive pulmonary disease. Heart Lung 2023; 58:108-115. [PMID: 36455422 DOI: 10.1016/j.hrtlng.2022.11.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In heart failure (HF), exertional dyspnea is a common symptom, but validated field-based tests for its measurement are limited. The Dyspnea Challenge is a two-minute uphill treadmill walk designed to measure exertional dyspnea in cardiopulmonary disease. OBJECTIVES The purpose of this study was to establish the test-retest reliability of the Dyspnea Challenge in HF and to compare the exercise responses to a group with chronic obstructive pulmonary disease (COPD). METHODS The study was an experimental, single-blind, randomized, multi-site project that recruited individuals with HF (New York Heart Association I-III) and COPD (Global Initiative for Chronic Obstructive Lung Disease II-IV). Participants completed two visits. On the first visit, participants performed two six-minute walk tests (6MWT), followed by two to three Dyspnea Challenges to calculate treadmill speed and gradient. At Visit Two, participants performed two separate Dyspnea Challenges, with one including measures of pulmonary gas exchange and central hemodynamics. RESULTS Twenty-one individuals with HF (10 female; 66±11years; ejection fraction:45.3 ± 6.1%; six-minute distance(6MWD) 520 ± 97 m), and 25 COPD (11 female; 68 ± 10 yr; forced expiratory volume in 1 s:47.6 ± 11.5%; 6MWD: 430 ± 101 m). Intraclass correlation coefficients demonstrated excellent test-retest reliability for HF (0.94, P<.01) and COPD (0.95, P<.01). While achieving similar end-exercise exertional dyspnea intensities (P=.60), the HF group walked at a higher average speed (4.2 ± 0.8 vs. 3.5 ± 0.8km·h-1) and gradient (10.3 ± 2.8 vs. 9.6 ± 2.8%) and a greater oxygen uptake (P<.01) and ventilation (P<.01) than those with COPD. While achieving similar cardiac outputs (P=.98), stroke volumes (P=.97), and heart rates (P=.83), those with HF displayed a larger arteriovenous oxygen difference (P<.01), while those with COPD exhibited greater decreases in inspiratory capacity (P=.03), arterial oxygen saturation (P=.02), and breathing reserve (P<.01). CONCLUSIONS The Dyspnea Challenge is a reliable test-retest measure of exertional dyspnea in HF. Typical to their pathologies, HF seemed limited by an inadequate modulation of cardiac output, while ventilatory constraints hampered those with COPD.
Collapse
Affiliation(s)
- Craig R Aitken
- School of Health Sciences and Social Work, Southport, QLD. Australia; Allied Health Research Collaborative. The Prince Charles Hospital. Brisbane. QLD. Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane. QLD. Australia.
| | - Glenn M Stewart
- School of Health Sciences and Social Work, Southport, QLD. Australia; Allied Health Research Collaborative. The Prince Charles Hospital. Brisbane. QLD. Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane. QLD. Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD. Australia
| | - James R Walsh
- School of Health Sciences and Social Work, Southport, QLD. Australia; Allied Health Research Collaborative. The Prince Charles Hospital. Brisbane. QLD. Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane. QLD. Australia
| | - Tanya Palmer
- School of Health Sciences and Social Work, Southport, QLD. Australia
| | - Lewis Adams
- School of Health Sciences and Social Work, Southport, QLD. Australia
| | - Surendran Sabapathy
- School of Health Sciences and Social Work, Southport, QLD. Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD. Australia
| | - Norman R Morris
- School of Health Sciences and Social Work, Southport, QLD. Australia; Allied Health Research Collaborative. The Prince Charles Hospital. Brisbane. QLD. Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane. QLD. Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD. Australia
| |
Collapse
|
7
|
Tiller NB, Wheatley-Guy CM, Fermoyle CC, Robach P, Ziegler B, Gavet A, Schwartz JC, Taylor BJ, Constantini K, Murdock R, Johnson BD, Stewart GM. Sex-Specific Physiological Responses to Ultramarathon. Med Sci Sports Exerc 2022; 54:1647-1656. [PMID: 35653262 DOI: 10.1249/mss.0000000000002962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Despite a growing body of literature on the physiological responses to ultramarathon, there is a paucity of data in females. This study assessed the female physiological response to ultramarathon and compared the frequency of perturbations to a group of race- and time-matched males. METHODS Data were collected from 53 contestants of an ultramarathon trail race at the Ultra-Trail du Mont-Blanc (UTMB®) in 2018/19. Before and within 2 h of the finish, participants underwent physiological assessments, including blood sampling for biomarkers (creatine kinase-MB isoenzyme [CK-MB], cardiac troponin I [cTnI], brain natriuretic peptide [BNP], and creatinine [Cr]), pulmonary function testing (spirometry, exhaled NO, diffusing capacities, and mouth pressures), and transthoracic ultrasound (lung comet tails, cardiac function). Data from eight female finishers (age = 36.6 ± 6.9 yr; finish time = 30:57 ± 11:36 h:min) were compared with a group of eight time-matched males (age = 40.3 ± 8.3 yr; finish time = 30:46 ± 10:32 h:min). RESULTS Females exhibited significant pre- to postrace increases in BNP (25.8 ± 14.6 vs 140.9 ± 102.7 pg·mL -1 ; P = 0.007) and CK-MB (3.3 ± 2.4 vs 74.6 ± 49.6 IU·L -1 ; P = 0.005), whereas males exhibited significant pre- to postrace increases in BNP (26.6 ± 17.5 vs 96.4 ± 51.9 pg·mL -1 ; P = 0.002), CK-MB (7.2 ± 3.9 vs 108.8 ± 37.4 IU·L -1 ; P = 0.002), and Cr (1.06 ± 0.19 vs 1.23 ± 0.24 mg·dL -1 ; P = 0.028). Lung function declined in both groups, but males exhibited additional reductions in lung diffusing capacities (DL CO = 34.4 ± 5.7 vs 29.2 ± 6.9 mL⋅min -1 ⋅mm Hg -1 , P = 0.004; DL NO = 179.1 ± 26.2 vs 152.8 ± 33.4 mL⋅min -1 ⋅mm Hg -1 , P = 0.002) and pulmonary capillary blood volumes (77.4 ± 16.7 vs 57.3 ± 16.1 mL; P = 0.002). Males, but not females, exhibited evidence of mild postrace pulmonary edema. Pooled effect sizes for within-group pre- to postrace changes, for all variables, were generally larger in males versus females ( d = 0.86 vs 0.63). CONCLUSIONS Ultramarathon negatively affects a range of physiological functions but generally evokes more frequent perturbations, with larger effect sizes, in males compared to females with similar race performances.
Collapse
Affiliation(s)
- Nicholas B Tiller
- Institute of Respiratory Medicine and Exercise Physiology, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | | | | | - Paul Robach
- Ecole Nationale des Sports de Montagne, Chamonix, FRANCE
| | - Briana Ziegler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Alice Gavet
- Ecole Nationale des Sports de Montagne, Chamonix, FRANCE
| | - Jesse C Schwartz
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Bryan J Taylor
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL
| | - Keren Constantini
- School of Public Health, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, Tel-Aviv University, ISRAEL
| | | | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
8
|
Tiller NB, Johnson BD, Fermoyle CC, Wheatley-Guy CM, Robach P, Gavet A, Constantini K, Schwartz JC, Ziegler B, Johnson K, Murdock R, Bassett P, Taylor BJ, Stewart GM. Sex-specific Physiological Responses To Ultramarathon. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000877536.67257.8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
9
|
Aitken CR, Walsh JR, Sabapathy S, Adams L, Morris NR, Stewart GM. Optimising the Dyspnoea Challenge: exertional dyspnoea responses to changing treadmill gradients. Respir Physiol Neurobiol 2022; 302:103915. [PMID: 35500885 DOI: 10.1016/j.resp.2022.103915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/12/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Dyspnoea Challenge is a two-minute treadmill walk designed to measure exertional dyspnoea(ED). To efficiently individualise workload, we aimed to assess; 1) whether the Dyspnoea Challenge is responsive to 1% changes in treadmill gradient and 2) the minimum gradient variation necessary to generate a clinically meaningful change in ED (≥1 modified Borg scale). METHODS Thirty individuals with COPD(GOLD II-IV) (age: 69.2 ± 9.2 years; FEV1: 49.3 ± 19.1%) completed six Dyspnoea Challenges at a fixed treadmill speed of 3 km·h-1 and at a gradient of between 3% and 8%, performed in random order. ED intensity and leg fatigue were measured using the 0-10 modified Borg scale. Heart rate(HR) and oxygen saturation(SpO2) were monitored continuously. A multidimensional dyspnoea profile(MDP) was used to quantify the discomfort, physical, e.g., work/effort and breathing frequency, and emotional components of ED. RESULTS Higher treadmill gradients generated stronger intensities of ED (3%:2.6 ± 1.8; 4%:2.8 ± 2.2; 5%:3.2 ± 2.2; 6%:3.4 ± 2.2; 7%:3.7 ± 1.8; 8%:4.0 ± 2.1units). Statistical changes were observed in ED(e.g.,3 vs. 5%: P = .03) and the MDP discomfort data(e.g.,4 vs. 6%: P = .04) at ≥ a 2% variation in treadmill gradient. Linear regression found a 4% variation in treadmill gradient corresponded to a rise in ED ≥ 1unit. Increases in ED intensity corresponded to heightened sensations of work/effort(P < .01) and breathing frequency(P < .01). There were no changes in emotional constructs(P = .27). While there was an increase in HR with increasing gradient(P < .01), no differences were observed in end-exercise SpO2(P = .79) or leg fatigue(P = .06). CONCLUSION To significantly change ED, the treadmill gradient must be manipulated by ≥ 2%, with a ≥ 4% change in gradient required to induce a clinically meaningful change in ED.
Collapse
Affiliation(s)
- Craig R Aitken
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia; Heart Lung Institute, The Prince Charles Hospital Brisbane, QLD, Australia.
| | - James R Walsh
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia; Heart Lung Institute, The Prince Charles Hospital Brisbane, QLD, Australia
| | - Surendran Sabapathy
- School of Health Sciences and Social Work, Southport, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| | - Lewis Adams
- School of Health Sciences and Social Work, Southport, QLD, Australia
| | - Norman R Morris
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia; Heart Lung Institute, The Prince Charles Hospital Brisbane, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| | - Glenn M Stewart
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia; Heart Lung Institute, The Prince Charles Hospital Brisbane, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| |
Collapse
|
10
|
Aitken CR, Walsh JR, Stewart GM, Sabapathy S, Adams L, Morris NR. Exertional Dyspnoea responses reported in the Dyspnoea Challenge and measures of disease severity in COPD. Respir Physiol Neurobiol 2022; 304:103941. [PMID: 35777721 DOI: 10.1016/j.resp.2022.103941] [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] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Dyspnoea Challenge has been developed to facilitate the field-based measure of exertional dyspnoea(ED). To further validate the test, we aimed to; investigate the relationship between end-exercise ED, generated by a fixed-intensity Dyspnoea Challenge(DCFIX), and measures of disease severity (Forced expiratory volume in 1 s(FEV1), six-minute walk distance(6MWD), breathing reserve(V̇E/MVV), modified medical research council dyspnoea scale (mMRC), Body-mass index, airflow Obstruction, Dyspnoea, and Exercise (BODE index) and compare the physiological response of the DCFIX to a six-minute walk test(6MWT). METHODS Thirty-two individuals (15 female) with COPD (GOLD II-IV) (age: 69.7 ± 9.4 yrs; FEV1: 49.1 ± 18.2 %) performed 2×6MWT and 2xDCFIX at a treadmill speed of 3 km h-1 and gradient of 4 %. The intensity of ED was measured using the modified Borg dyspnoea scale at baseline and end-exercise with heart rate (HR) and oxygen saturation (SpO2) monitored continuously. During 1×6MWT and 1xDCFIX pulmonary gas exchange, cardiac output (Q̇) and dynamic hyperinflation were measured. RESULTS End-exercise ED measured during the DCFIX was not correlated to FEV1, but moderately correlated to; 6MWD(rs = -0.54, P < .01), V̇E/MVV (rs = 0.46, P = .02), mMRC(rs = 0.45, P = .01), and the BODE index(rs = 0.53, P < .01). When comparing the DCFIX and 6MWT, participants walked to comparable levels of oxygen consumption(P = .38), ventilation(P = .37), Q̇(P = .20), V̇E/MVV(P = .83), maximum HR percentages(P = .67) and dynamically hyperinflated to a similar degree(P = .37). CONCLUSIONS The Dyspnoea Challenge is correlated to different parameters of disease severity and produces a similar physiological and ED response to that of the 6MWT with the added benefit of being appropriate for longitudinal assessment of ED.
Collapse
Affiliation(s)
- Craig R Aitken
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia; Heart Lung Institute, The Prince Charles Hospital Brisbane, QLD, Australia.
| | - James R Walsh
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia; Heart Lung Institute, The Prince Charles Hospital Brisbane, QLD, Australia
| | - Glenn M Stewart
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia; Heart Lung Institute, The Prince Charles Hospital Brisbane, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| | - Surendran Sabapathy
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| | - Lewis Adams
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
| | - Norman R Morris
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia; Heart Lung Institute, The Prince Charles Hospital Brisbane, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| |
Collapse
|
11
|
Aitken CR, Sharma P, Louis M, Walsh J, Stewart GM, Sabapathy S, Adams L, Morris NR. Examining the repeatability of a novel test to measure exertional dyspnoea in chronic obstructive pulmonary disease. Respir Physiol Neurobiol 2021; 296:103826. [PMID: 34864520 DOI: 10.1016/j.resp.2021.103826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Exertional dyspnoea(ED) is a hallmark of chronic obstructive pulmonary disease(COPD). We examined the repeatability and face validity of the end-exercise ED(EDend) response during the Dyspnoea Challenge and compared those to the six-minute walk test (6MWT) in COPD. METHODS Twenty-six individuals with COPD(13 Females, age:69 ± 5.5yrs, FEV1:63.4 ± 11.9 %) completed 2 × 6MWTs and 4 x Dyspnoea Challenges on three occasions. The challenge consisted of a two-minute treadmill walk at 80 % of 6MWT speed(3.9 ± 0.5 km·hr-1) at either a low(LIDC:5.3 ± 2%) or high angle of incline(HIDC:9.5 ± 3%). Dyspnoea(0-10 scale), heart rate(HR) and oxygen saturation(SpO2) were monitored continuously. RESULTS Mean 6MWT distance was 488 ± 58 m. End-exercise ED and HR were higher in the HIDC(EDend 6.2 ± 2.0; HR: 123 ± 17beats·min-1) compared to the LIDC(EDend 4.2 ± 2.0; HR: 119 ± 15beats·min-1) and the 6MWT(EDend 4.3 ± 2.0; HR: 115 ± 16beats·min-1)(P < 0.01). SpO2 was not different between 6MWT, LIDC or HIDC(P = 0.34). The intraclass correlation coefficient(ICC) for each intensity was excellent (HIDC, ICC = 0.88, LIDC, ICC = 0.93, P < 0.001) with neither reporting bias(HIDC, P = 0.63; LIDC, P = 0.94). CONCLUSIONS The Dyspnoea Challenge is a simple measure of ED that appears to have both repeatability and face validity. With further optimisation, this test may enhance the field-based clinical assessment of ED.
Collapse
Affiliation(s)
- Craig R Aitken
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative. The Prince Charles Hospital Brisbane, QLD, Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane, QLD, Australia.
| | - Pramod Sharma
- School of Health Sciences and Social Work, Southport, QLD, Australia
| | - Menaka Louis
- School of Health Sciences and Social Work, Southport, QLD, Australia
| | - James Walsh
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative. The Prince Charles Hospital Brisbane, QLD, Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane, QLD, Australia
| | - Glenn M Stewart
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative. The Prince Charles Hospital Brisbane, QLD, Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| | - Surendran Sabapathy
- School of Health Sciences and Social Work, Southport, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| | - Lewis Adams
- School of Health Sciences and Social Work, Southport, QLD, Australia
| | - Norman R Morris
- School of Health Sciences and Social Work, Southport, QLD, Australia; Allied Health Research Collaborative. The Prince Charles Hospital Brisbane, QLD, Australia; Heart Lung Institute. The Prince Charles Hospital Brisbane, QLD, Australia; Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| |
Collapse
|
12
|
Fermoyle CC, Stewart GM, Borlaug BA, Johnson BD. Simultaneous Measurement of Lung Diffusing Capacity and Pulmonary Hemodynamics Reveals Exertional Alveolar-Capillary Dysfunction in Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2021; 10:e019950. [PMID: 34369164 PMCID: PMC8475049 DOI: 10.1161/jaha.120.019950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hemodynamic perturbations in heart failure with preserved ejection fraction (HFpEF) may alter the distribution of blood in the lungs, impair gas transfer from the alveoli into the pulmonary capillaries, and reduce lung diffusing capacity. We hypothesized that impairments in lung diffusing capacity for carbon monoxide (DLCO) in HFpEF would be associated with high mean pulmonary capillary wedge pressures during exercise. Methods and Results Rebreathe DLCO and invasive hemodynamics were measured simultaneously during exercise in patients with exertional dyspnea. Pulmonary pressure waveforms and breath‐by‐breath pulmonary gas exchange were recorded at rest, 20 W, and symptom‐limited maximal exercise. Patients with HFpEF (n=20; 15 women, aged 65±11 years, body mass index 36±8 kg/m2) achieved a lower symptom‐limited maximal workload (52±27 W versus 106±42 W) compared with controls with noncardiac dyspnea (n=10; 7 women, aged 55±10 years, body mass index 30±5 kg/m2). DLCO was lower in patients with HFpEF compared with controls at rest (DLCO 10.4±2.9 mL/min per mm Hg versus 16.4±6.9 mL/min per mm Hg, P<0.01) and symptom‐limited maximal exercise (DLCO 14.6±4.7 mL/min per mm Hg versus 23.8±10.8 mL/min per mm Hg, P<0.01) because of a lower alveolar‐capillary membrane conductance in HFpEF (rest 16.8±6.6 mL/min per mm Hg versus 28.4±11.8 mL/min per mm Hg, P<0.01; symptom‐limited maximal exercise 25.0±6.7 mL/min per mm Hg versus 45.5±22.2 mL/min per mm Hg, P<0.01). DLCO was lower in HFpEF for a given mean pulmonary artery pressure, mean pulmonary capillary wedge pressure, pulmonary arterial compliance, and transpulmonary gradient. Conclusions Lung diffusing capacity is lower at rest and during exercise in HFpEF due to impaired gas conductance across the alveolar‐capillary membrane. DLCO is impaired for a given pulmonary capillary wedge pressure and pulmonary arterial compliance. These data provide new insight into the complex relationships between hemodynamic perturbations and gas exchange abnormalities in HFpEF.
Collapse
Affiliation(s)
- Caitlin C Fermoyle
- Mayo Clinic Graduate School of Biomedical SciencesMayo Clinic Rochester MN
| | - Glenn M Stewart
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Barry A Borlaug
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Bruce D Johnson
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| |
Collapse
|
13
|
Kelley EF, Whealtey-Guy CM, Stewart GM, Schwartz JC, Fermoyle C, Ziegler BL, Johnson K, Robach P, Basset P, Schaber C, Shaw E, Arthur K, Johnson BD. The Relationship Between Exhaled Volatile Organic Compounds And Respiratory Function In Response To Ultra-endurance Exercise. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760256.26087.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
14
|
Stewart GM, Cross TJ, Joyner MJ, Chase SC, Curry T, Lehrer-Graiwer J, Dufu K, Vlahakis NE, Johnson BD. Impact of Pharmacologically Left Shifting the Oxygen-Hemoglobin Dissociation Curve on Arterial Blood Gases and Pulmonary Gas Exchange During Maximal Exercise in Hypoxia. High Alt Med Biol 2021; 22:249-262. [PMID: 34152867 DOI: 10.1089/ham.2020.0159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stewart, Glenn M., Troy J. Cross, Michael J. Joyner, Steven C. Chase, Timothy Curry, Josh Lehrer-Graiwer, Kobina Dufu, Nicholas E. Vlahakis, and Bruce D. Johnson. Impact of pharmacologically left shifting the oxygen-hemoglobin dissociation curve on arterial blood gases and pulmonary gas exchange during maximal exercise in hypoxia. High Alt Med Biol. 22:249-262, 2021. Introduction: Physiological and pathological conditions, which reduce the loading of oxygen onto hemoglobin (Hb), can impair exercise capacity and cause debilitating symptoms. Accordingly, this study examined the impact of pharmacologically left shifting the oxygen-hemoglobin dissociation curve (ODC) on arterial oxygen saturation (SaO2) and exercise capacity. Methods: Eight healthy subjects completed a maximal incremental exercise test in hypoxia (FIO2: 0.125) and normoxia (FIO2: 0.21) before (Day 1) and after (Day 15) daily ingestion of 900 mg of voxelotor (an oxygen/Hb affinity modulator). Pulmonary gas exchange and arterial blood gases were assessed throughout exercise and at peak. Data for a 1,500 mg daily drug dose are reported in a limited cohort (n = 3). Results: Fourteen days of drug administration left shifted the ODC (p50 measured under standard conditions, Day 1: 28.0 ± 2.1 mmHg vs. Day 15: 26.1 ± 1.8 mmHg, p < 0.05). Throughout incremental exercise in hypoxia, SaO2 was systematically higher after drug (peak exercise SaO2 on Day 1: 71 ± 2 vs. Day 15: 81% ± 2%, p < 0.001), whereas oxygen extraction (Ca-vO2 diff) and consumption (VO2) were similar (peak exercise Ca-vO2 diff on Day 1: 11.5 ± 1.7 vs. Day 15: 11.0 ± 1.8 ml/100 ml blood, p = 0.417; peak VO2 on Day 1: 2.59 ± 0.39 vs. Day 15: 2.47 ± 0.43 l/min, p = 0.127). Throughout incremental exercise in normoxia, SaO2 was systematically higher after drug, whereas peak VO2 was reduced (peak exercise SaO2 on Day 1: 93.9 ± 1.8 vs. Day 15: 95.8% ± 1.0%, p = 0.008; peak VO2 on Day 1: 3.62 ± 0.55 vs. Day 15: 3.26 ± 52 l/min, p = 0.001). Conclusion: Pharmacologically increasing the affinity of Hb for oxygen improved SaO2 during hypoxia without impacting exercise capacity; however, left shifting the ODC in healthy individuals appears detrimental to exercise capacity in normoxia. Left shifting the ODC to different magnitudes and under more chronic forms of hypoxia warrants further study.
Collapse
Affiliation(s)
- Glenn M Stewart
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Troy J Cross
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Michael J Joyner
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven C Chase
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy Curry
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kobina Dufu
- Global Blood Therapeutics, South San Francisco, California, USA
| | | | - Bruce D Johnson
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
15
|
Reddy YNV, Stewart GM, Obokata M, Koepp KE, Borlaug BA. Peripheral and pulmonary effects of inorganic nitrite during exercise in heart failure with preserved ejection fraction. Eur J Heart Fail 2021; 23:814-823. [PMID: 33421267 DOI: 10.1002/ejhf.2093] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 01/06/2023] Open
Abstract
AIMS To determine whether inorganic nitrite improves peripheral and pulmonary oxygen (O2 ) transport during exercise in heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS Data from two invasive, randomized, double-blind, placebo-controlled trials with matched workload exercise of inhaled and intravenous sodium nitrite were pooled for this analysis (n = 51). Directly measured O2 consumption (VO2 ) and blood gas data were used to evaluate the effect of nitrite on skeletal muscle O2 conductance (Dm), VO2 kinetics, alveolar capillary membrane O2 conductance (DL ), and O2 utilization during submaximal exercise. As compared to placebo, treatment with nitrite resulted in an improvement in Dm (+4.9 ± 6.5 vs. -0.9 ± 4.3 mL/mmHg*min, P = 0.0008) as well as VO2 kinetics measured by mean response time (-5.0 ± 6.9 vs. -0.6 ± 6.0 s, P = 0.03), with preserved O2 utilization despite increased convective O2 delivery through cardiac output (+0.4 ± 0.7 vs. -0.3 ± 0.9 L/min, P = 0.02). Nitrite improved DL (+2.5 ± 6.3 vs. -2.0 ± 9.0 mL/mmHg*min, P = 0.05) with exercise, which was associated with lower pulmonary capillary pressures (r = -0.34, P = 0.02), and reduced pulmonary dead space ventilation fraction (-0.01 ± 0.05 vs. +0.02 ± 0.05, P = 0.02). CONCLUSION Sodium nitrite enhances skeletal muscle Dm during exercise as well as pulmonary O2 diffusion, optimizing O2 kinetics in tandem with increased convective O2 delivery through cardiac output augmentation. The favourable combined pulmonary, cardiac and peripheral effects of nitrite may improve exercise tolerance in people with HFpEF and requires further investigation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID NCT01932606 and NCT02262078.
Collapse
Affiliation(s)
- Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Glenn M Stewart
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Katlyn E Koepp
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
16
|
Abstract
Regular physical activity decreases the risk of cardiovascular disease, type II diabetes, obesity, certain cancers, and all-cause mortality. Nevertheless, there is mounting evidence that extreme exercise behaviors may be detrimental to human health. This review collates several decades of literature on the physiology and pathophysiology of ultra-marathon running, with emphasis on the cardiorespiratory implications. Herein, we discuss the prevalence and clinical significance of postrace decreases in lung function and diffusing capacity, respiratory muscle fatigue, pulmonary edema, biomarkers of cardiac injury, left/right ventricular dysfunction, and chronic myocardial remodeling. The aim of this article is to inform risk stratification for ultra-marathon and to edify best practice for personnel overseeing the events (i.e., race directors and medics).
Collapse
Affiliation(s)
- Nicholas B Tiller
- Institute of Respiratory Medicine and Exercise Physiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Glenn M Stewart
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Camilla R Illidi
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, UNITED KINGDOM
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
17
|
Balmain BN, Sabapathy S, Yamada A, Shiino K, Chan J, Haseler LJ, Kavanagh JJ, Morris NR, Stewart GM. Cardiac perturbations after high-intensity exercise are attenuated in middle-aged compared with young endurance athletes: diminished stress or depleted stimuli? Am J Physiol Heart Circ Physiol 2020; 320:H159-H168. [PMID: 33124881 DOI: 10.1152/ajpheart.00427.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Strenuous exercise elicits transient functional and biochemical cardiac imbalances. Yet, the extent to which these responses are altered owing to aging is unclear. Accordingly, echocardiograph-derived left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) and high-sensitivity cardiac troponin I (hs-cTnI) were assessed before (pre) and after (post) a 60-min high-intensity cycling race intervention (CRIT60) in 11 young (18-30 yr) and 11 middle-aged (40-65 yr) highly trained male cyclists, matched for cardiorespiratory fitness. LV and RV GLS were measured at rest and during a semirecumbent exercise challenge performed at the same intensity (young: 93 ± 10; middle-aged: 85 ± 11 W, P = 0.60) pre- and post-CRIT60. Augmentation (change from rest-to-exercise challenge) of LV GLS (pre: -2.97 ± 0.65; post: -0.82 ± 0.48%, P = 0.02) and RV GLS (pre: -2.08 ± 1.28; post: 3.08 ± 2.02%, P = 0.01) was attenuated and completely abolished, in the young following CRIT60, while augmentation of LV GLS (pre: -3.21 ± 0.41; post: -3.99 ± 0.55%, P = 0.22) and RV GLS (pre: -3.47 ± 1.44; post: -1.26 ± 1.00%, P = 0.27) was preserved in middle-aged following CRIT60. While serum hs-cTnI concentration increased followingCRIT60 in the young (pre: 7.3 ± 1.6; post: 17.7 ± 1.6 ng/L, P < 0.01) and middle-aged (pre: 4.5 ± 0.6; post: 10.7 ± 2.0 ng/L, P < 0.01), serum hs-cTnI concentration increased to a greater extent in the young than in the middle-aged following CRIT60 (P < 0.01). These findings suggest that functional and biochemical cardiac perturbations induced by high-intensity exercise are attenuated in middle-aged relative to young individuals. Further study is warranted to determine whether acute exercise-induced cardiac perturbations alter the adaptive myocardial remodeling response.NEW & NOTEWORTHY High-intensity endurance exercise elicits acute cardiac imbalances that may be an important stimulus for adaptive cardiac remodeling. This study highlights that following a bout of high-intensity exercise that is typical of routine day-to-day cycling training, exercise-induced autonomic, biochemical, and functional cardiac imbalances are attenuated in middle-aged relative to young well-trained cyclists. These findings suggest that aging may alter exercise-induced stress stimulus response that initiates cardiac remodeling in athlete's heart.
Collapse
Affiliation(s)
- Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas.,Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | | | - Akira Yamada
- Department of Cardiology, Fujita Health University, Nagoya, Japan
| | - Kenji Shiino
- Department of Cardiology, Fujita Health University, Nagoya, Japan
| | - Jonathan Chan
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,Cardiology Division, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Luke J Haseler
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Justin J Kavanagh
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Norman R Morris
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Glenn M Stewart
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
18
|
Fermoyle CC, Stewart GM, Borlaug BA, Johnson BD. Effects of exercise on thoracic blood volumes, lung fluid accumulation, and pulmonary diffusing capacity in heart failure with preserved ejection fraction. Am J Physiol Regul Integr Comp Physiol 2020; 319:R602-R609. [PMID: 32936678 DOI: 10.1152/ajpregu.00192.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) experience symptoms of exertional dyspnea that may be related to lung fluid accumulation during exercise. A computed tomography (CT)-based method was used to measure exercise-induced changes in extravascular lung fluid content and thoracic blood volumes and to determine the effect of lung fluid on lung diffusing capacity for carbon monoxide (DLCO) in stable subjects with HFpEF and healthy controls. Nine subjects with HFpEF (age = 68 ± 8 yr; body mass index = 32.1 ± 2.6 kg/m2) and eight healthy controls (62 ± 9 yr, 23.8 ± 2.4 kg/m2) performed triplicate rebreathe DLCO/DLNO (lung diffusing capacity for nitric oxide) tests in a supine position at rest and duplicate measurements during two 5-min submaximal exercise stages (15W and 35W) and recovery. Subjects subsequently performed a 5-min exercise bout (35W) inside a CT scanner, and extravascular lung fluid content and thoracic blood volumes were quantified at rest and immediately following exercise from thoracic and contrast perfusion scans, respectively. Subjects with HFpEF had a higher lung fluid content at rest compared with controls (means ± SD, HFpEF: 14.4 ± 1.7%, control: 12.8 ± 1.7%, P = 0.043) and a higher lung fluid content following exercise (15.2 ± 2.0% vs. 12.6 ± 1.5%, P = 0.009). Higher lung fluid content was associated with a lower DLCO and alveolar-capillary membrane conductance (Dm) in subjects with HFpEF (DLCO: R = -0.57, P = 0.022, Dm: R = -0.61, P = 0.012) but not in controls. Pulmonary blood volume was not altered by exercise and was similar between groups. Submaximal exercise elicited a greater accumulation of lung fluid in subjects with HFpEF compared with in controls, and lung fluid content was negatively correlated with lung diffusing capacity and alveolar-capillary membrane conductance in subjects with HFpEF.
Collapse
Affiliation(s)
- Caitlin C Fermoyle
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota
| | - Glenn M Stewart
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
19
|
Fermoyle CC, Stewart GM, Borlaug BA, Johnson BD. Pulmonary Vascular Pressures and Gas Exchange Response to Exercise in Heart Failure With Preserved Ejection Fraction. J Card Fail 2020; 26:1011-1015. [PMID: 32750488 DOI: 10.1016/j.cardfail.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/07/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 11/15/2022]
Abstract
Elevated left ventricular filling pressure (measured as mean pulmonary capillary wedge pressure) at rest or with exercise is diagnostic of heart failure with preserved ejection fraction. However, the capacity of the right ventricle to compensate for a high mean pulmonary capillary wedge pressure and thus maintain an appropriate transpulmonary gradient (TPG) and perfusion of the pulmonary capillaries is likely an important contributor to gas exchange efficiency and exercise capacity. Therefore, this study aimed to determine whether a higher TPG at peak exercise is associated with superior exercise capacity and gas exchange. Gas exchange data from dyspneic patients referred for exercise right heart catheterization were retrospectively analyzed and patients were split into two groups based on TPG. Patients with a higher TPG at peak exercise had a higher peak VO2 (1025 ± 227 vs 823 ± 276, P = .038), end-tidal partial pressure of carbon dioxide (42.2 ± 7.9 vs 38.0 ± 4.7, P = .044), and gas exchange estimates of pulmonary vascular capacitance (408 ± 90 vs 268 ± 108, P = .001). A higher TPG at peak exercise correlated with a higher peak oxygen uptake, O2 pulse, and stroke volume (R = 0.42, 0.44 and 0.42, respectively, all P < 0.05). These findings indicate that a greater TPG with exercise might be important for improving exercise capacity in heart failure with preserved ejection fraction.
Collapse
Affiliation(s)
- Caitlin C Fermoyle
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Glenn M Stewart
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
20
|
Kelley EF, Stewart GM, Wheatley-Guy CM, Schwartz JC, Ziegler BL, Jorgenson CC, Johnson BD. Exhaled Volatile Organic Compounds In Ultra-endurance Runners. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678088.66752.3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
21
|
Fermoyle CC, Stewart GM, Borlaug BA, Johnson BD. Relationship Between Lung Diffusion And Exercise Capacity In Heart Failure With Preserved Ejection Fraction. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000684460.61095.a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
22
|
Stewart GM, Fermoyle CC, Wheatley-Guy CM, Robach P, Constantini K, Tiller NB, Murdoch R, Taylor BJ, Schwartz JC, Ziegler B, Gavet A, Chabridon L, Johnson BD. Extravascular Lung Water And Lung Diffusing Capacity In Response To Ultra-endurance Exercise Performed At Moderate Altitude. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000683640.42837.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
23
|
Stewart GM, Wheatley-Guy CM, Johnson BD, Shen WK, Kim CH. Impact of pulsed electromagnetic field therapy on vascular function and blood pressure in hypertensive individuals. J Clin Hypertens (Greenwich) 2020; 22:1083-1089. [PMID: 32401418 DOI: 10.1111/jch.13877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/07/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022]
Abstract
The present study investigated the impact of 12 weeks of pulsed electromagnetic field (PEMF) therapy on peripheral vascular function, blood pressure (BP), and nitric oxide in hypertensive individuals. Thirty hypertensive individuals (SBP > 130 mm Hg and/or MAP > 100 mm Hg) were assigned to either PEMF group (n = 15) or control group (n = 15). During pre-assessment, participants underwent measures of flow-mediated dilation (FMD), BP, and blood draw for nitric oxide (NO). Subsequently, they received PEMF therapy 3x/day for 12 weeks and, at conclusion, returned to the laboratory for post-assessment. Fifteen participants from the PEMF group and 11 participants from the control group successfully completed the study protocol. After therapy, the PEMF group demonstrated significant improvements in FMD and FMDNOR (normalized to hyperemia), but the control group did not (P = .05 and P = .04, respectively). Moreover, SBP, DBP, and MAP were reduced, but the control group did not (P = .04, .04, and .03, respectively). There were no significant alterations in NO in both groups (P > .05). Twelve weeks of PEMF therapy may improve BP and vascular function in hypertensive individuals. Additional studies are needed to identify the mechanisms by which PEMF affects endothelial function.
Collapse
Affiliation(s)
- Glenn M Stewart
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | | | - Bruce D Johnson
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Win K Shen
- Department of Cardiovascular Disease, Mayo Clinic, Phoenix, Arizona
| | - Chul-Ho Kim
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
24
|
Stewart GM, Chase S, Cross TJ, Wheatley-Guy CM, Joyner MJ, Curry T, Lehrer-Graiwer J, Dufu K, Vlahakis NE, Johnson BD. Effects of an allosteric hemoglobin affinity modulator on arterial blood gases and cardiopulmonary responses during normoxic and hypoxic low-intensity exercise. J Appl Physiol (1985) 2020; 128:1467-1476. [PMID: 32324473 DOI: 10.1152/japplphysiol.00185.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Numerous pathophysiological conditions induce hypoxemia-related cardiopulmonary perturbations, decrements in exercise capacity, and debilitating symptoms. Accordingly, this study investigated the efficacy of an allosteric hemoglobin modulator (voxelotor) to enhance arterial oxygen saturation during low-intensity exercise in hypoxia. Eight normal healthy subjects (36 ± 7 yr; 73.8 ± 9.5 kg; 3 women) completed a submaximal cycling test (60 W) under normoxic ([Formula: see text]: 0.21; O2 partial pressure: 144 mmHg) and hypoxic ([Formula: see text]: 0.125; O2 partial pressure: 82 mmHg) conditions before (day 1) and after (day 15) 14 days of oral drug administration. While stationary on a cycle ergometer and during exercise, ratings of perceived exertion (RPE) and dyspnea, oxygen consumption (V̇o2), and cardiac output (Q) were measured noninvasively, while arterial blood pressure (MAP) and blood gases ([Formula: see text], [Formula: see text], and [Formula: see text]) were measured invasively. The 14-day drug administration left shifted the oxygen-hemoglobin dissociation curve (ODC; p50 measured at standard pH and Pco2; day 1: 28.0 ± 2.1 mmHg vs. day 15: 26.1 ± 1.8 mmHg, P < 0.05). RPE, dyspnea, V̇o2, Q, and MAP were not different between day 1 and day 15. [Formula: see text] was similar during normoxia on day 1 and day 15 while stationary but higher during exercise (day 1: 95.2 ± 0.4% vs. day 15: 96.6 ± 0.3%, P < 0.05). [Formula: see text] was higher during hypoxia on day 15 while stationary (day 1: 82.9 ± 3.4% vs. day 15: 90.9 ± 1.8%, P < 0.05) and during exercise (day 1: 73.6 ± 2.5% vs. day 15: 84.8 ± 2.7%, P < 0.01). [Formula: see text] and [Formula: see text]were systematically higher and lower, respectively, after drug (P < 0.01), while the alveolar-arterial oxygen difference was unchanged suggesting hyperventilation contributed to the rise in [Formula: see text]. Oral administration of voxelotor left shifted the ODC and stimulated a mild hyperventilation, leading to improved arterial oxygen saturation without altering V̇o2 and central hemodynamics during rest and low-intensity exercise. This effect was more pronounced during submaximal hypoxic exercise, when arterial desaturation was more evident. Additional studies are needed to determine the effects of voxelotor during maximal exercise and under chronic forms of hypoxia.NEW & NOTEWORTHY In humans, a novel allosteric hemoglobin-oxygen affinity modulator was administered to comprehensively examine the cardiopulmonary consequences of stabilizing a portion of the available hemoglobin in a high-oxygen affinity state during submaximal exercise in normoxia and hypoxia. Oral administration of voxelotor enhanced arterial oxygen saturation during submaximal exercise without altering oxygen consumption and central hemodynamics; however, the partial pressure of arterial carbon dioxide was reduced and the partial pressure of arterial oxygen was increased implying that hyperventilation also contributed to the increase in oxygen saturation. The preservation of arterial oxygen saturation and content was particularly evident during hypoxic submaximal exercise, when arterial desaturation typically occurs, but this did not influence arterial-venous oxygen difference.
Collapse
Affiliation(s)
- Glenn M Stewart
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Steven Chase
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Troy J Cross
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Courtney M Wheatley-Guy
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Michael J Joyner
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy Curry
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Kobina Dufu
- Global Blood Therapeutics, South San Francisco, California
| | | | - Bruce D Johnson
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
25
|
Stewart GM, Johnson BD, Sprecher DL, Reddy YNV, Obokata M, Goldsmith S, Bart B, Oughton A, Fillmore C, Behm DJ, Borlaug BA. Targeting pulmonary capillary permeability to reduce lung congestion in heart failure: a randomized, controlled pilot trial. Eur J Heart Fail 2020; 22:1641-1645. [PMID: 32227554 DOI: 10.1002/ejhf.1809] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/07/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS Lung congestion in patients with heart failure (HF) has traditionally been treated using interventions that reduce pulmonary capillary hydrostatic pressure. The transient receptor potential vanilloid 4 (TRPV4) channel regulates fluid transit across the pulmonary capillary-interface, and represents a novel target to reduce lung water, independent of pulmonary capillary hypertension. This pilot study examined the safety and potential efficacy of TRPV4 blockade as a novel treatment for HF. METHODS AND RESULTS In this randomized, double-blind, placebo-controlled crossover pilot trial, 11 subjects with chronic, compensated HF were treated with a novel TRPV4 antagonist (GSK2798745) or placebo. The primary endpoint was lung diffusing capacity for carbon monoxide (DLCO ) after 7 days of treatment with GSK2798745 as compared to placebo. Secondary endpoints included additional diffusion parameters, spirometry and safety assessments. Compared to placebo, treatment with GSK2798745 resulted in a trend to improvement in DLCO (placebo: -0.336 mL/mmHg/min; GSK2798745: +0.458 mL/mmHg/min; treatment difference: +0.793 mL/mmHg/min; 95% confidence interval: -0.925 to 2.512) that was not statistically significant. GSK2798745 was well-tolerated with no serious adverse events. CONCLUSION In this pilot trial, GSK2798745 was found to be safe and well-tolerated, with a trend toward improved gas transfer. Further investigation is warranted in larger studies to determine whether treatment with TRPV4 antagonists or alternative treatments targeting capillary permeability might be effective to improve lung congestion, pulmonary gas transfer and clinical status in patients with acute or chronic HF.
Collapse
Affiliation(s)
- Glenn M Stewart
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bruce D Johnson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Steven Goldsmith
- Hennepin County Medical Centre, Minneapolis, MI, USA.,University of Minnesota, Minneapolis, MI, USA
| | - Brad Bart
- Hennepin County Medical Centre, Minneapolis, MI, USA.,University of Minnesota, Minneapolis, MI, USA
| | - Anna Oughton
- GlaxoSmithKline Pharmaceutical Ltd., Collegeville, PA, USA
| | | | - David J Behm
- GlaxoSmithKline Pharmaceutical Ltd., Collegeville, PA, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
26
|
Stewart GM, Chan J, Kane GC, Johnson BD, Balmain BN, Yamada A, Shiino K, Haseler LJ, Sabapathy S. Marked Disparity in Regional and Transmural Cardiac Mechanics in the Athlete's Heart. Med Sci Sports Exerc 2020; 52:1908-1914. [PMID: 32175971 DOI: 10.1249/mss.0000000000002336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Regional heterogeneity of the human heart plays an important role in left ventricular (LV) and right ventricular (RV) function and may contribute to enhanced myocardial efficiency in the athlete's heart. PURPOSE This study comprehensively characterized regional and transmural myocardial tissue deformation (strain) in recreationally active (RA) and endurance-trained (ET) men to determine if regional nonuniformity evolves alongside morphological adaptations associated with endurance training. METHODS Echocardiography was used to measure LV and RV global, regional (apical, mid, basal) and transmural (endocardial, epicardial) longitudinal strain in 30 endurance-trained (ET) (age, 31 ± 2 yr; body mass index, 23.1 ± 0.5 kg·m; V˙O2peak, 60.2 ± 6.5 mL·kg·min) and 30 RA (age: 29 ± 2 yr; body mass index, 23.4 ± 0.4 kg·m; V˙O2peak: 42.6 ± 4.6 mL·kg·min). Nonuniformity was characterized using apex-to-base and transmural (endocardial-to-epicardial) strain gradients. RESULTS Global longitudinal strain was similar in ET and RA in the left (-17.4% ± 0.4% vs -17.8% ± 0.5%, P = 0.662) and right ventricle (-25.8% ± 0.8% vs 26.4% ± 1.0%, P = 0.717). The apex-to-base strain gradient was greater in ET than RA in the left (-6.5% ± 0.7% vs -2.7% ± 0.8%, P = 0.001) and right ventricle (-9.6% ± 1.8% vs -3.0% ± 1.6%, P = 0.010). The LV transmural strain gradient was greater than RV in both groups, but similar in ET and RA (-4.7% ± 0.2% vs -4.7% ± 0.2%, P = 0.850), whereas RV transmural strain gradient was greater in ET than RA (-3.4% ± 0.3% vs -1.6% ± 0.4%, P = 0.003). RV apex-to-base and transmural strain gradients correlated with RV end-diastolic area (R = 0.536 & 0.555, respectively, P < 0.01) and V˙O2peak (R = 0.415 & 0.677, respectively, P < 0.01). CONCLUSIONS Transmural nonuniformity is more pronounced in the left ventricle than the RV free wall; however, RV functional nonuniformity develops markedly after endurance training. Differences in myocardial architecture and exercise-induced wall stress in the left and right ventricles are possible explanations for the marked functional nonuniformity throughout the myocardium and in response to endurance exercise training.
Collapse
Affiliation(s)
| | | | - Garvan C Kane
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Bryce N Balmain
- School of Allied Health Sciences, Griffith University, Gold Coast, AUSTRALIA
| | - Akira Yamada
- Department of Cardiology, Fujita Health University, Nagoya, JAPAN
| | - Kenji Shiino
- Department of Cardiology, Fujita Health University, Nagoya, JAPAN
| | - Luke J Haseler
- School of Physiotherapy and Exercise Science, Curtin University, Perth, AUSTRALIA
| | - Surendran Sabapathy
- School of Allied Health Sciences, Griffith University, Gold Coast, AUSTRALIA
| |
Collapse
|
27
|
Stewart GM, Wheatley-Guy CM, Morris NR, Coffman KE, Stepanek J, Carlson AR, Issa A, Schmidt MA, Johnson BD. Myocardial adaptability in young and older-aged sea-level habitants sojourning at Mt Kilimanjaro: are cardiac compensatory limits reached in older trekkers? Eur J Appl Physiol 2020; 120:799-809. [PMID: 32076831 DOI: 10.1007/s00421-020-04319-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION High-altitude ascent induces left (LV) and right (RV) ventricular adaptations secondary to hypoxia-related hemodynamic and myocardial alterations. Since cardiopulmonary decrements observed with aging (e.g., decreased LV compliance and increased pulmonary vascular resistance) may limit cardiac plasticity, this study examined myocardial adaptability throughout an 11 day sojourn to 5893 m in young and older-aged trekkers. METHODS AND RESULTS Echocardiography was performed on 14 young (8 men; 32 ± 5 years) and 13 older-aged (8 men; 59 ± 5 years) subjects on non-trekking days (Day 0: 880 m; Day 3: 3100 m; Day 8: 4800 m; Day 12/post-climb: 880 m). RV systolic pressure (mmHg) was systematically higher in older-aged subjects (p < 0.01) with similar progressive increases observed during ascent for young and older subjects, respectively (Day 0: 18 ± 1 vs 20 ± 2; Day 3: 25 ± 2 vs 29 ± 3; Day 8: 30 ± 2 vs 35 ± 2). Estimates of LV filling pressure (E/E') were systematically higher in older subjects (p < 0.01) with similar progressive decreases observed during ascent for young and older-aged subjects, respectively (Day 0: 5.6 ± 0.3 vs 6.7 ± 0.5; Day 3: 5.1 ± 0.2 vs 6.1 ± 0.3; Day 8: 4.7 ± 0.3 vs 5.4 ± 0.3). Overall, RV end-diastolic and end-systolic area increased at altitude (p < 0.01), while LV end-diastolic and end-systolic volume decreased (p < 0.01). However, all RV and LV morphological measures were similar on Day 3 and Day 8 (p > 0.05), and returned to baseline post-climb (p > 0.05). Excluding mild LV dilatation in some older-aged trekkers on Day 8/Day 12 (p < 0.01), altitude-induced morphological and functional adaptations were similar for all trekkers (p > 0.05). CONCLUSION Altitude-induced myocardial adaptations are chamber specific, secondary to RV and LV hemodynamic alterations. Despite progressive hemodynamic alterations during ascent, morphological and functional cardiac perturbations plateaued, suggesting rapid myocardial adaptation which was mostly comparable in young and older-aged individuals.
Collapse
Affiliation(s)
- Glenn M Stewart
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Scottsdale, MN, 55905, USA.
| | | | - Norman R Morris
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Allied Health Research Collaborative, Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Australia.,Hopkins Centre and Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Kirsten E Coffman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Scottsdale, MN, 55905, USA
| | - Jan Stepanek
- Aerospace Medicine Program, Mayo Clinic, Scottsdale, USA
| | - Alex R Carlson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Scottsdale, MN, 55905, USA
| | - Amine Issa
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Scottsdale, MN, 55905, USA
| | - Michael A Schmidt
- Advanced Pattern Analysis & Countermeasures Group, Boulder, USA.,Sovaris Aerospace, Boulder, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Scottsdale, MN, 55905, USA
| |
Collapse
|
28
|
Dominelli PB, Baker SE, Wiggins CC, Stewart GM, Sajgalik P, Shepherd JRA, Roberts SK, Roy TK, Curry TB, Hoyer JD, Oliveira JL, Foster GE, Joyner MJ. Dissociating the effects of oxygen pressure and content on the control of breathing and acute hypoxic response. J Appl Physiol (1985) 2019; 127:1622-1631. [PMID: 31647724 PMCID: PMC6962610 DOI: 10.1152/japplphysiol.00569.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/16/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022] Open
Abstract
Arterial oxygen tension and oxyhemoglobin saturation (S a O 2 ) decrease in parallel during hypoxia. Distinguishing between changes in oxygen tension and oxygen content as the relevant physiological stimulus for cardiorespiratory alterations remains challenging. To overcome this, we recruited nine individuals with hemoglobinopathy manifesting as high-affinity hemoglobin [HAH; partial pressure at 50% S a O 2 (P50) = 16 ± 0.4 mmHg] causing greater S a O 2 at a given oxygen partial pressure compared with control subjects (n = 12, P50 = 26 ± 0.4 mmHg). We assessed ventilatory and cardiovascular responses to acute isocapnic hypoxia, iso-oxic hypercapnia, and 20 min of isocapnic hypoxia (arterial Po2 = 50 mmHg). Blood gas alterations were achieved with dynamic end-tidal forcing. When expressed as a function of the logarithm of oxygen partial pressure, ventilatory sensitivity to hypoxia was not different between groups. However, there was a significant difference when expressed as a function of S a O 2 . Conversely, the rise in heart rate was blunted in HAH subjects when expressed as a function of partial pressure but similar when expressed as a function of S a O 2 . Ventilatory sensitivity to hypercapnia was not different between groups. During sustained isocapnic hypoxia, the rise in minute ventilation was similar between groups; however, heart rate was significantly greater in the controls during 3 to 9 min of exposure. Our results support the notion that oxygen tension, not content, alters cellular Po2 in the chemosensors and drives the hypoxic ventilatory response. Our study suggests that in addition to oxygen partial pressure, oxygen content may also influence the heart rate response to hypoxia.NEW & NOTEWORTHY We dissociated the effects of oxygen content and pressure of cardiorespiratory regulation studying individuals with high-affinity hemoglobin (HAH). During hypoxia, the ventilatory response, expressed as a function of oxygen tension, was similar between HAH variants and controls; however, the rise in heart rate was blunted in the variants. Our work supports the notion that the hypoxic ventilatory response is regulated by oxygen tension, whereas cardiovascular regulation may be influenced by arterial oxygen content and tension.
Collapse
Affiliation(s)
- Paolo B Dominelli
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sarah E Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Glenn M Stewart
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Pavol Sajgalik
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - John R A Shepherd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shelly K Roberts
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tuhin K Roy
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy B Curry
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - James D Hoyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Oliveira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Glen E Foster
- School of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
29
|
Kim CH, Wheatley-Guy CM, Stewart GM, Yeo D, Shen WK, Johnson BD. The impact of pulsed electromagnetic field therapy on blood pressure and circulating nitric oxide levels: a double blind, randomized study in subjects with metabolic syndrome. Blood Press 2019; 29:47-54. [PMID: 31394939 DOI: 10.1080/08037051.2019.1649591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Regulation of blood pressure (BP) is important in reducing the risk for cardiovascular disease. There is growing interest in non-pharmacological methods to treat BP including a novel approach using pulsed electromagnetic field therapy (PEMF). PEMF therapy has been proposed to impact physiological function at the cellular and tissue level and one possible mechanism is through an impact on endothelial function and nitric oxide (NO) related pathways. The focus of the present study was to evaluate the effect of PEMF on BP and NO in subjects with mild to moderate metabolic syndrome.Materials and methods: For 12 weeks, 23 subjects underwent PEMF therapy and 21 subjects underwent sham therapy. BP was measured at rest and near the end of submaximal exercise pre- and 12 week post-therapy. Additionally, plasma NO was measured at similar time points.Results: The PEMF demonstrated an increase in NO after therapy (p = .04) but SHAM did not (p = .37). For resting BP, there were no differences in systolic BP (SBP), diastolic BP (DBP) or mean arterial pressure (MAP) between groups (p > .05). During exercise, PEMF had a reduction in peak SBP (p = .04), but not SHAM (p = .57). PEMF demonstrated significant relationships between baseline SBP and change in SBP following therapy (r = -0.71, p < .01) and between MAP and change in MAP following therapy (r = -0.60, p < .01), but no such relationships were found in SHAM. Subjects with resting hypertension (SBP ≥140 mmHg) in PEMF (n = 11) had significant reductions in SBP, DBP and MAP when compared to SHAM with hypertension (n = 9) (p < .05). In this sub-group analysis, PEMF demonstrated lowered peak SBP (p = .04) at a given exercise load (p = .40) but SHAM did not (p > .05).Conclusion: PEMF may increase plasma NO availability and improve BP at rest and during exercise. However, this beneficial effect appears to be more pronounced in subjects with existing hypertension.
Collapse
Affiliation(s)
- Chul-Ho Kim
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Glenn M Stewart
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Dongwook Yeo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
30
|
Wheatley CM, Fermoyle CC, Stewart GM, Taylor BJ, Chabridon L, Gavet A, Ziegler BL, Schwartz JC, Robach P, Johnson BD. Lung Function - Ultraendurance Marathon. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562381.31349.f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
31
|
Wheatley CM, Stewart GM, Fermoyle CC, Taylor BJ, Ziegler BL, Schwartz JC, Chabridon L, Gavet A, Robach P, Bouzat P, Johnson BD. Influence of Ultraendurance Event Distance on Lung Heath. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562458.81074.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
32
|
Balmain BN, Jay O, Morris NR, Shiino K, Stewart GM, Jayasinghe R, Chan J, Sabapathy S. Thermoeffector Responses at a Fixed Rate of Heat Production in Heart Failure Patients. Med Sci Sports Exerc 2018; 50:417-426. [PMID: 29040221 DOI: 10.1249/mss.0000000000001455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Heart failure (HF) patients seem to exhibit altered thermoregulatory responses during exercise in the heat. However, the extent to which these responses are altered due to physiological impairments independently of biophysical factors associated with differences in metabolic heat production (Hprod), evaporative heat balance requirements (Ereq), and/or body size is presently unclear. Therefore, we examined thermoregulatory responses in 10 HF patients and 10 age-matched controls (CON) similar in body size during exercise at a fixed rate of Hprod and therefore Ereq in a 30°C environment. METHODS Rectal temperature, local sweat rate, and cutaneous vascular conductance were measured throughout 60 min of cycle ergometry. Whole-body sweat rate was estimated from pre-post nude body weight corrected for fluid intake. RESULTS Despite exercising at the same rate of Hprod (HF, 338 ± 43 W; CON, 323 ± 31 W; P = 0.25), the rise in rectal temperature was greater (P < 0.01) in HF (0.81°C ± 0.16°C) than in CON (0.49°C ± 0.27°C). In keeping with a similar Ereq (HF, 285 ± 40 W; CON, 274 ± 28 W; P = 0.35), no differences in whole-body sweat rate (HF, 0.45 ± 0.11 L·h; CON, 0.41 ± 0.07 L·h; P = 0.38) or local sweat rate (HF, 0.96 ± 0.17 mg·cm·min; CON, 0.79 ± 0.15 mg·cm·min; P = 0.50) were observed between groups. However, the rise in cutaneous vascular conductance was lower in HF than in CON (HF, 0.83 ± 0.42 au·mm Hg; CON, 2.10 ± 0.79 au·mm Hg; P < 0.01). In addition, the cumulative body heat storage estimated from partitional calorimetry was similar between groups (HF, 154 ± 106 kJ; CON, 196 ± 174 kJ; P = 0.44). CONCLUSIONS Collectively, these findings demonstrate that HF patients exhibit a blunted skin blood flow response, but no differences in sweating. Given that HF patients had similar body heat storage to that of CON at the same Hprod, their greater rise in core temperature can be attributed to a less uniform internal distribution of heat between the body core and periphery.
Collapse
Affiliation(s)
- Bryce N Balmain
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Ollie Jay
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Norman R Morris
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Kenji Shiino
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Glenn M Stewart
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Rohan Jayasinghe
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Jonathan Chan
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Surendran Sabapathy
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| |
Collapse
|
33
|
Coffman KE, Stewart GM, Carlson AR, Wheatley CM, Johnson BD. Effect of age on the presence of comet tails at high altitude. Respir Physiol Neurobiol 2018; 259:166-169. [PMID: 30056244 DOI: 10.1016/j.resp.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/16/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022]
Abstract
Extravascular lung water (EVLW) increases in healthy adults upon exposure to high altitude, likely due to increased pulmonary vascular resistance (PVR). Older individuals experience increased PVR during exercise, which may be exacerbated by trekking at high altitude. This study aimed to determine whether EVLW development is greater in older versus younger adults during graded altitude exposure. Fourteen younger (32 ± 6y) and 12 older (58 ± 5y) healthy adults completed an 11-day trek of Mount Kilimanjaro. EVLW was assessed at rest via comet tails prior to the trek in Moshi (950 m), at Shira Camp (3505 m), at Barafu Camp (4837 m), and post-descent. An increase in altitude from Baseline to Barafu tended to increase the proportion of participants with mild EVLW (p = 0.06). A higher proportion of older versus younger individuals tended to show mild EVLW at Barafu (56 vs. 14%, p = 0.06). In conclusion, EVLW formation may be more common in older adults trekking at high altitude. However, the presence of EVLW in older adults was subclinical.
Collapse
Affiliation(s)
- Kirsten E Coffman
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, USA.
| | - Glenn M Stewart
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Alex R Carlson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Courtney M Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, E Shea Blvd, Phoenix, AZ, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic, E Shea Blvd, Phoenix, AZ, USA
| |
Collapse
|
34
|
Balmain BN, Jay O, Morris NR, Stewart GM, Shiino K, McFarland AJ, Jayasinghe R, Chan J, Sabapathy S. Folic acid supplementation improves vascular endothelial function, yet not skin blood flow during exercise in the heat, in patients with heart failure. Am J Physiol Regul Integr Comp Physiol 2018; 315:R810-R819. [PMID: 29975566 DOI: 10.1152/ajpregu.00132.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure (HF) patients are susceptible to heat strain during exercise, secondary to blunted skin blood flow (SkBF) responses, which may be explained by impaired nitric oxide (NO)-dependent vasodilation. Folic acid improves vascular endothelial function and SkBF through NO-dependent mechanisms in healthy older individuals and patients with cardiovascular disease. We examined the effect of folic acid supplementation (5 mg/day for 6 wk) on vascular function [brachial artery flow-mediated dilation (FMD)] and SkBF responses [cutaneous vascular conductance (CVC)] during 60 min of exercise at a fixed metabolic heat production (300 ẆHprod) in a 30°C environment in 10 patients with HF (New York Heart Association Class I-II) and 10 healthy controls (CON). Serum folic acid concentration increased in HF [preintervention (pre): 1.4 ± 0.2; postintervention (post): 8.9 ± 6.7 ng/ml, P = 0.01] and CON (pre: 1.3 ± 0.6; post: 5.2 ± 4.9 ng/ml, P = 0.03). FMD improved by 2.1 ± 1.3% in HF ( P < 0.01), but no change was observed in CON postintervention ( P = 0.20). During exercise, the external workload performed on the cycle ergometer to attain the fixed level of heat production for exercise was similar between groups (HF: 60 ± 13; CON: 65 ± 20 external workload, P = 0.52). Increases in CVC during exercise were similar in HF (pre: 0.89 ± 0.43; post: 0.83 ± 0.45 au/mmHg, P = 0.80) and CON (pre: 2.01 ± 0.79; post: 2.03 ± 0.72 au/mmHg, P = 0.73), although the values were consistently lower in HF for both pre- and postintervention measurement intervals ( P < 0.05). These findings demonstrate that folic acid improves vascular endothelial function in patients with HF but does not enhance SkBF during exercise at a fixed metabolic heat production in a warm environment.
Collapse
Affiliation(s)
- Bryce N Balmain
- School of Allied Health Sciences, Griffith University , Gold Coast , Australia
| | - Ollie Jay
- Charles Perkins Centre, University of Sydney , Australia.,Thermal Ergonomics Laboratory, Exercise and Sport Science, Faculty of Health Sciences, University of Sydney , Sydney , Australia
| | - Norman R Morris
- School of Allied Health Sciences, Griffith University , Gold Coast , Australia.,Metro North Hospital and Health Service, Allied Health Research Collaborative, The Prince Charles Hospital , Brisbane , Australia
| | - Glenn M Stewart
- Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Kenji Shiino
- School of Allied Health Sciences, Griffith University , Gold Coast , Australia
| | - Amelia J McFarland
- School of Pharmacy and Pharmacology, Griffith University , Gold Coast , Australia
| | - Rohan Jayasinghe
- Cardiology, Gold Coast University Hospital , Gold Coast , Australia
| | - Jonathan Chan
- Cardiology, Gold Coast University Hospital , Gold Coast , Australia
| | - Surendran Sabapathy
- School of Allied Health Sciences, Griffith University , Gold Coast , Australia
| |
Collapse
|
35
|
Sabapathy S, Balmain BN, Jay O, Shiino K, Stewart GM, Jayasinghe R, Chan J, Morris NR. Heart Failure Modulates Thermoregulatory Control Independently Of Differences In Physical Characteristics And Metabolic Heat Production. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000537137.53727.2d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
36
|
Balmain BN, Jay O, Morris NR, McFarland AJ, Shiino K, Stewart GM, Jayasinghe R, Chan J, Sabapathy S. Folic Acid Improves Vascular Function, But Not Skin Blood Flow, In Heart Failure Patients. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536220.12269.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
37
|
Stewart GM, Chan J, Yamada A, Kavanagh JJ, Haseler LJ, Shiino K, Sabapathy S. Impact of high-intensity endurance exercise on regional left and right ventricular myocardial mechanics. Eur Heart J Cardiovasc Imaging 2018; 18:688-696. [PMID: 27378770 DOI: 10.1093/ehjci/jew128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/22/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Strenuous endurance exercise acutely increases myocardial wall stress and evokes transient functional cardiac perturbations. However, it is unclear whether exercise-induced functional cardiac disturbances are ubiquitous throughout the myocardium or are segment specific. The aim of this study was to examine the influence of high-intensity endurance exercise on global and segmental left (LV) and right (RV) ventricular tissue deformation (strain). Methods and results Echocardiography was used to measure strain in 23 active men (age: 28 ± 2 years; VO2 peak: 4.5 ± 0.7 L min-1) at rest and during a standardized low-intensity exercise challenge, before and after a 90-min high-intensity endurance cycling intervention. Following the cycling intervention, LV and RV global strain decreased at rest (LV: -18.4 ± 0.4% vs. -17.7 ± 0.4%, P < 0.05; RV: -27.6 ± 0.7% vs. -26.4 ± 0.6%, P < 0.05) and by a greater extent during the low-intensity exercise challenge (LV: -21.3 ± 0.4% vs. -19.2 ± 0.5%, P < 0.01; RV: -28.4 ± 0.8% vs. -23.5 ± 0.9%, P < 0.01). Reductions in LV strain were unique to regions of RV attachment (e.g. LV septum: -24.4 ± 0.5% vs. -21.4 ± 0.6%, P < 0.01) with lateral (-18.9 ± 0.4% vs. -18.4 ± 0.5%) and posterior segments (-19.5 ± 0.4% vs. -18.8 ± 0.7%) unaffected. Similarly, augmentation of strain from rest to exercise was abolished in the RV free wall (-1.1 ± 1.0% vs. 2.9 ± 1.2%, P < 0.01), reduced in the septum (-4.6 ± 0.4% vs. -2.4 ± 0.5%, P < 0.01), and unchanged in the lateral (-1.2 ± 0.6% vs. -0.9 ± 0.6%) and posterior walls (-1.7 ± 0.6% vs. -1.3 ± 0.7%). Conclusion Changes in ventricular strain following high-intensity exercise are more profound in the right ventricle than in the left ventricle. Reductions in LV strain were unique to the septal myocardium and may reflect ventricular interactions secondary to exercise-induced RV dysfunction.
Collapse
Affiliation(s)
- Glenn M Stewart
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jonathan Chan
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Cardiology Division, The Prince Charles Hospital, Brisbane, Australia
| | - Akira Yamada
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Cardiology, Fujita Health University, Nagoya, Japan
| | - Justin J Kavanagh
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Luke J Haseler
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Kenji Shiino
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Department of Cardiology, Fujita Health University, Nagoya, Japan
| | - Surendran Sabapathy
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| |
Collapse
|
38
|
Cross TJ, Wheatley C, Stewart GM, Coffman K, Carlson A, Stepanek J, Morris NR, Johnson BD. The influence of thoracic gas compression and airflow density dependence on the assessment of pulmonary function at high altitude. Physiol Rep 2018; 6:e13576. [PMID: 29595881 PMCID: PMC5875542 DOI: 10.14814/phy2.13576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/14/2017] [Accepted: 12/17/2017] [Indexed: 11/27/2022] Open
Abstract
The purpose of this report was to illustrate how thoracic gas compression (TGC) artifact, and differences in air density, may together conflate the interpretation of changes in the forced expiratory flows (FEFs) at high altitude (>2400 m). Twenty-four adults (10 women; 44 ± 15 year) with normal baseline pulmonary function (>90% predicted) completed a 12-day sojourn at Mt. Kilimanjaro. Participants were assessed at Moshi (Day 0, 853 m) and at Barafu Camp (Day 9, 4837 m). Typical maximal expiratory flow-volume (MEFV) curves were obtained in accordance with ATS/ERS guidelines, and were either: (1) left unadjusted; (2) adjusted for TGC by constructing a "maximal perimeter" MEFV curve; or (3) adjusted for both TGC and differences in air density between altitudes. Forced vital capacity (FVC) was lower at Barafu compared with Moshi camp (5.19 ± 1.29 L vs. 5.40 ± 1.45 L, P < 0.05). Unadjusted data indicated no difference in the mid-expiratory flows (FEF25-75% ) between altitudes (∆ + 0.03 ± 0.53 L sec-1 ; ∆ + 1.2 ± 11.9%). Conversely, TGC-adjusted data revealed that FEF25-75% was significantly improved by sojourning at high altitude (∆ + 0.58 ± 0.78 L sec-1 ; ∆ + 12.9 ± 16.5%, P < 0.05). Finally, when data were adjusted for TGC and air density, FEFs were "less than expected" due to the lower air density at Barafu compared with Moshi camp (∆-0.54 ± 0.68 L sec-1 ; ∆-10.9 ± 13.0%, P < 0.05), indicating a mild obstructive defect had developed on ascent to high altitude. These findings clearly demonstrate the influence that TGC artifact, and differences in air density, bear on flow-volume data; consequently, it is imperative that future investigators adjust for, or at least acknowledge, these confounding factors when comparing FEFs between altitudes.
Collapse
Affiliation(s)
- Troy J. Cross
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
- Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
| | | | - Glenn M. Stewart
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
- Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
| | - Kirsten Coffman
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
| | - Alex Carlson
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
| | - Jan Stepanek
- Preventive, Occupational and Aerospace MedicineMayo ClinicScottsdaleArizona
| | - Norman R. Morris
- Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
- Allied Health Research CollaborativeThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Bruce D. Johnson
- Division of Cardiovascular DiseasesMayo ClinicRochesterMinnesota
| |
Collapse
|
39
|
Balmain BN, Sabapathy S, Jay O, Adsett J, Stewart GM, Jayasinghe R, Morris NR. Heart Failure and Thermoregulatory Control: Can Patients With Heart Failure Handle the Heat? J Card Fail 2017; 23:621-627. [DOI: 10.1016/j.cardfail.2017.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 12/28/2022]
|
40
|
Taylor BJ, Stewart GM, Marck JW, Summerfield DT, Issa AN, Johnson BD. Interstitial lung fluid balance in healthy lowlanders exposed to high-altitude. Respir Physiol Neurobiol 2017; 243:77-85. [PMID: 28554819 DOI: 10.1016/j.resp.2017.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/16/2017] [Accepted: 05/24/2017] [Indexed: 11/27/2022]
Abstract
We aimed to assess lung fluid balance before and after gradual ascent to 5150m. Lung diffusion capacity for carbon monoxide (DLCO), alveolar-capillary membrane conductance (DmCO) and ultrasound lung comets (ULCs) were assessed in 12 healthy lowlanders at sea-level, and on Day 1, Day 5 and Day 9 after arrival at Mount Everest Base Camp (EBC). EBC was reached following an 8-day hike at progressively increasing altitudes starting at 2860m. DLCO was unchanged from sea-level to Day 1 at EBC, but increased on Day 5 (11±10%) and Day 9 (10±9%) vs. sea-level (P≤0.047). DmCO increased from sea-level to Day 1 (9±6%), Day 5 (12±8%), and Day 9 (17±11%) (all P≤0.001) at EBC. There was no change in ULCs from sea-level to Day 1, Day 5 and Day 9 at EBC. These data provide evidence that interstitial lung fluid remains stable or may even decrease relative to at sea-level following 8days of gradual exposure to high-altitude in healthy humans.
Collapse
Affiliation(s)
- Bryan J Taylor
- Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, UK; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA.
| | - Glenn M Stewart
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA
| | - Jan W Marck
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA
| | - Douglas T Summerfield
- Critical Care Medicine, Department of Internal Medicine, Mayo Clinic and Foundation, USA
| | - Amine N Issa
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, USA
| |
Collapse
|
41
|
Pathangey G, Wheatley CM, Carson AR, Stewart GM, Coffman KE, Issa AN, Morris ND, Stepanek J, Johnson BD. Influence of Physical Activity Patterns and Age on Acute Mountain Sickness Incidence during Mt. Kilimanjaro Trek. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000520006.48099.3d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
42
|
Cross TJ, Wheatley C, Stewart GM, Coffman K, Carlson A, Stepanek J, Morris NM, Johnson BD. The Effect Of Thoracic Gas Compression On Forced Expiratory Flows Is Increased At High-altitude. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000516856.88717.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
43
|
Balmain BN, Jay O, Sabapathy S, Royston D, Stewart GM, Jayasinghe R, Morris NR. Altered thermoregulatory responses in heart failure patients exercising in the heat. Physiol Rep 2016; 4:e13022. [PMID: 27905297 PMCID: PMC5112500 DOI: 10.14814/phy2.13022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/03/2016] [Accepted: 10/09/2016] [Indexed: 01/11/2023] Open
Abstract
Heart failure (HF) patients appear to exhibit impaired thermoregulatory capacity during passive heating, as evidenced by diminished vascular conductance. Although some preliminary studies have described the thermoregulatory response to passive heating in HF, responses during exercise in the heat remain to be described. Therefore, the aim of this study was to compare thermoregulatory responses in HF and controls (CON) during exercise in the heat. Ten HF (NYHA classes I-II) and eight CON were included. Core temperature (Tc), skin temperature (Tsk), and cutaneous vascular conductance (CVC) were assessed at rest and during 1 h of exercise at 60% of maximal oxygen uptake. Metabolic heat production (Hprod) and the evaporative requirements for heat balance (Ereq) were also calculated. Whole-body sweat rate was determined from pre-post nude body mass corrected for fluid intake. While Hprod (HF: 3.9 ± 0.9; CON: 6.4 ± 1.5 W/kg) and Ereq (HF: 3.3 ± 0.9; CON: 5.6 ± 1.4 W/kg) were lower (P < 0.01) for HF compared to CON, both groups demonstrated a similar rise in Tc (HF: 0.9 ± 0.4; CON: 1.0 ± 0.3°C). Despite this similar rise in Tc, Tsk (HF: 1.6 ± 0.7; CON: 2.7 ± 1.2°C), and the elevation in CVC (HF: 1.4 ± 1.0; CON: 3.0 ± 1.2 au/mmHg) was lower (P < 0.05) in HF compared to CON Additionally, whole-body sweat rate (HF: 0.36 ± 0.15; CON: 0.81 ± 0.39 L/h) was lower (P = 0.02) in HF compared to CON Patients with HF appear to be limited in their ability to manage a thermal load and distribute heat content to the body surface (i.e., skin), secondary to impaired circulation to the periphery.
Collapse
Affiliation(s)
- Bryce N Balmain
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Surendran Sabapathy
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Danielle Royston
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Glenn M Stewart
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Rohan Jayasinghe
- Menzies Health Institute, Gold Coast, Queensland, Australia
- Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Norman R Morris
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
44
|
Stewart GM, Kavanagh JJ, Haseler LJ, Sabapathy S. Reply from Glenn M. Stewart, Justin J. Kavanagh, Luke J. Haseler and Surendran Sabapathy. J Physiol 2016; 594:3159-60. [DOI: 10.1113/jp272480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Glenn M. Stewart
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN 55905 USA
- Menzies Health Institute Queensland; Griffith University; Gold Coast Australia
| | - Justin J. Kavanagh
- Menzies Health Institute Queensland; Griffith University; Gold Coast Australia
| | - Luke J. Haseler
- Menzies Health Institute Queensland; Griffith University; Gold Coast Australia
| | - Surendran Sabapathy
- Menzies Health Institute Queensland; Griffith University; Gold Coast Australia
| |
Collapse
|
45
|
Stewart GM, Yamada A, Haseler LJ, Kavanagh JJ, Chan J, Koerbin G, Wood C, Sabapathy S. Influence of exercise intensity and duration on functional and biochemical perturbations in the human heart. J Physiol 2016; 594:3031-44. [PMID: 26801350 PMCID: PMC4887693 DOI: 10.1113/jp271889] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/15/2016] [Indexed: 12/22/2022] Open
Abstract
KEY POINTS Strenuous endurance exercise induces transient functional and biochemical cardiac perturbations that persist for 24-48 h. The magnitude and time-course of exercise-induced reductions in ventricular function and increases in cardiac injury markers are influenced by the intensity and duration of exercise. In a human experimental model, exercise-induced reductions in ventricular strain and increases in cardiac troponin are greater, and persist for longer, when exercise is performed within the heavy- compared to moderate-intensity exercise domain, despite matching for total mechanical work. The results of the present study help us better understand the dose-response relationship between endurance exercise and acute cardiac stress/injury, a finding that has implications for the prescription of day-to-day endurance exercise regimes. ABSTRACT Strenuous endurance exercise induces transient cardiac perturbations with ambiguous health outcomes. The present study investigated the magnitude and time-course of exercise-induced functional and biochemical cardiac perturbations by manipulating the exercise intensity-duration matrix. Echocardiograph-derived left (LV) and right (RV) ventricular global longitudinal strain (GLS), and serum high-sensitivity cardiac troponin (hs-cTnI) concentration, were examined in 10 males (age: 27 ± 4 years; V̇O2, peak : 4.0 ± 0.8 l min(-1) ) before, throughout (50%, 75% and 100%), and during recovery (1, 3, 6 and 24 h) from two exercise trials. The two exercise trials consisted of 90 and 120 min of heavy- and moderate-intensity cycling, respectively, with total mechanical work matched. LVGLS decreased (P < 0.01) during the 90 min trial only, with reductions peaking at 1 h post (pre: -19.9 ± 0.6%; 1 h post: -18.5 ± 0.7%) and persisting for >24 h into recovery. RVGLS decreased (P < 0.05) during both exercise trials with reductions in the 90 min trial peaking at 1 h post (pre: -27.5 ± 0.7%; 1 h post: -25.1 ± 0.8%) and persisting for >24 h into recovery. Serum hs-cTnI increased (P < 0.01) during both exercise trials, with concentrations peaking at 3 h post but only exceeding cardio-healthy reference limits (14 ng l(-1) ) in the 90 min trial (pre: 4.2 ± 2.4 ng l(-1) ; 3 h post: 25.1 ± 7.9 ng l(-1) ). Exercise-induced reductions in ventricular strain and increases in cardiac injury markers persist for 24 h following exercise that is typical of day-to-day endurance exercise training; however, the magnitude and time-course of this response can be altered by manipulating the intensity-duration matrix.
Collapse
Affiliation(s)
- Glenn M Stewart
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Akira Yamada
- Department of Cardiology, Fujita Health University, Nagoya, Japan
| | - Luke J Haseler
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Justin J Kavanagh
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jonathan Chan
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Cardiology Division, The Prince Charles Hospital, Brisbane, Australia
| | - Gus Koerbin
- Faculty of Education, Science, Technology and Maths, University of Canberra, Canberra, Australia
| | - Cameron Wood
- Pathology North, Royal North Shore Hospital, Sydney, Australia
| | - Surendran Sabapathy
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| |
Collapse
|
46
|
Stewart GM, Yamada A, Kavanagh JJ, Haseler LJ, Chan J, Sabapathy S. Reproducibility of Echocardiograph-Derived Multilevel Left Ventricular Apical Twist Mechanics. Echocardiography 2015; 33:257-63. [DOI: 10.1111/echo.13020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Glenn M. Stewart
- Menzies Health Institute Queensland; Griffith University; Gold Coast QLD Australia
| | - Akira Yamada
- Menzies Health Institute Queensland; Griffith University; Gold Coast QLD Australia
| | - Justin J. Kavanagh
- Menzies Health Institute Queensland; Griffith University; Gold Coast QLD Australia
| | - Luke J. Haseler
- Menzies Health Institute Queensland; Griffith University; Gold Coast QLD Australia
| | - Jonathan Chan
- Cardiology Division; The Prince Charles Hospital; Brisbane QLD Australia
- School of Medicine; Griffith University; Gold Coast QLD Australia
| | - Surendran Sabapathy
- Menzies Health Institute Queensland; Griffith University; Gold Coast QLD Australia
| |
Collapse
|
47
|
Stewart GM, Yamada A, Haseler LJ, Kavanagh JJ, Koerbin G, Chan J, Sabapathy S. Altered ventricular mechanics after 60 min of high-intensity endurance exercise: insights from exercise speckle-tracking echocardiography. Am J Physiol Heart Circ Physiol 2015; 308:H875-83. [DOI: 10.1152/ajpheart.00917.2014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/29/2015] [Indexed: 11/22/2022]
Abstract
Transient reductions in myocardial strain coupled with cardiac-specific biomarker release have been reported after prolonged exercise (>180 min). However, it is unknown if 1) shorter-duration exercise (60 min) can perturb cardiac function or 2) if exercise-induced reductions in strain are masked by hemodynamic changes that are associated with passive recovery from exercise. Left ventricular (LV) and right ventricular global longitudinal strain (GLS), LV torsion, and high-sensitivity cardiac troponin T were measured in 15 competitive cyclists (age: 28 ± 3 yr, peak O2 uptake: 4.8 ± 0.6 l/min) before and after a 60-min high-intensity cycling race intervention (CRIT60). At both time points (pre- and post-CRIT60), strain and torsion were assessed at rest and during a standardized low-intensity exercise challenge (power output: 96 ± 8 W) in a semirecumbent position using echocardiography. During rest, hemodynamic conditions were different from pre- to post-CRIT60 (mean arterial pressure: 96 ± 1 vs. 86 ± 2 mmHg, P < 0.001), and there were no changes in strain or torsion. In contrast, during the standardized low-intensity exercise challenge, hemodynamic conditions were unchanged from pre- to post-CRIT60 (mean arterial pressure: 98 ± 1 vs. 97 ± 1 mmHg, not significant), but strain decreased (left ventricular GLS: −20.3 ± 0.5% vs. −18.5 ± 0.4%, P < 0.01; right ventricular GLS: −26.4 ± 1.6% vs. −22.4 ± 1.5%, P < 0.05), whereas LV torsion remained unchanged. Serum high-sensitivity cardiac troponin T increased by 345% after the CRIT60 (6.0 ± 0.6 vs. 20.7 ± 6.9 ng/l, P < 0.05). This study demonstrates that exercise-induced functional and biochemical cardiac perturbations are not confined to ultraendurance sporting events and transpire during exercise that is typical of day-to-day training undertaken by endurance athletes. The clinical significance of cumulative exposure to endurance exercise warrants further study.
Collapse
Affiliation(s)
- Glenn M. Stewart
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Akira Yamada
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Luke J. Haseler
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Justin J. Kavanagh
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Gus Koerbin
- ACT Pathology, The Canberra Hospital, Garran, Australian Capital Territory, Australia
- Faculty of Education, Science, Technology and Maths, University of Canberra, Bruce, Australian Capital Territory, Australia; and
| | - Jonathan Chan
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
- Cardiology Division, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Surendran Sabapathy
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
48
|
|
49
|
Stewart GM. The unintended consequences of measuring quality on the quality of medical care. N Engl J Med 2000; 342:519; author reply 520. [PMID: 10691496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
|
50
|
Stewart GM. Bitter pills to swallow. N Engl J Med 1998; 339:1863. [PMID: 9867575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|