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Pubblicazioni recenti - cardiopulmonary exercise
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From accelerometer output to physical activity intensities in breast cancer patients.
J Sci Med Sport2019 Sep;():. doi: S1440-2440(19)30298-1.
Sweegers Maike G, Buffart Laurien M, Huijsmans Rosalie J, Konings Inge R, van Zweeden Annette A, Brug Johannes, Chinapaw Mai J M, Altenburg Teatske M,
Abstract
OBJECTIVES:
We aimed to investigate accelerometer output corresponding to physical activity intensity cut-points based on percentage of peak oxygen consumption (%VOpeak) and Metabolic Equivalent of Task (MET) value in women treated for breast cancer.
DESIGN:
Laboratory study.
METHODS:
Fifty female patients shortly after completion of treatment for breast cancer were included. VOpeak was determined during a cardiopulmonary exercise test. Subsequently, patients performed ten activities with different intensities while wearing an accelerometer on the right hip and a mobile oxycon to assess oxygen consumption. We studied the relationship between energy expenditure (expressed as %VOpeak and MET-value) and accelerometer output (in counts per minute (cpm)) with linear regression analyses. We determined accelerometer output corresponding to physical activity intensity cut-points (40% and 60%VOpeak; 3 and 6 MET) using regression equations.
RESULTS:
VOpeak was 22.4mL/kg/min (SD 5.2) and resting metabolic rate was 3.1mL/kg/min (SD 0.6). Accelerometer output corresponding to the cut-points for moderate (40% VOpeak) and vigorous intensity (60% VOpeak) were 1123 and 1911, respectively. The analyses based on MET-values resulted in accelerometer output of 1189cpm for the moderate (3 MET) and 2768 cpm for the vigorous intensity cut-point (6 MET).
CONCLUSIONS:
Accelerometer outputs for moderate and vigorous intensity physical activity were lower than commonly used cut-points (i.e. 1952 and 5724 cpm), irrespective of the method used to express energy expenditure (%VOpeak versus MET-value). Thus, categorizing physical activity intensities based on general-population cut-points, may underestimate physical activity intensities for women treated for breast cancer.
Copyright © 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
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Cardiopulmonary Performance After Left Cardiac Sympathetic Denervation for Long QT Syndromes: Yes We Can!
JACC Clin Electrophysiol2019 Sep;5(9):1091-1092. doi: S2405-500X(19)30587-0.
Dusi Veronica, Ajijola Olujimi A,
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The Effect of Left Cardiac Sympathetic Denervation on Exercise in Patients With Long QT Syndrome.
JACC Clin Electrophysiol2019 Sep;5(9):1084-1090. doi: S2405-500X(19)30418-9.
Anderson Heather N, Bos J Martijn, Rohatgi Ram K, Ackerman Michael J,
Abstract
OBJECTIVES:
This study evaluated the effect of left cardiac sympathetic denervation (LCSD) on heart rate, cardiac contractility, and cardiopulmonary fitness in human subjects.
BACKGROUND:
The primary treatment for long QT syndrome (LQTS) is beta-blocker (BB) therapy, but some patients experience breakthrough cardiac events or intolerable side effects. LCSD provides a significant antifibrillatory, protective effect in LQTS. However, the effect of LCSD on cardiopulmonary fitness in humans has not been previously described.
METHODS:
A retrospective analysis of patients with LQTS and LCSD (2006 to 2017) who had both pre- and post-LCSD exercise stress tests (N = 55; 39 females; mean age at LCSD 22 ± 12 years; mean follow-up 5.1 ± 2.5 years; 36 patients with LQT1; 15 patients with LQT2). Forty patients (73%) were receiving BBs pre-LCSD.
RESULTS:
Mean peak heart rate before LCSD was 143 ± 23 beats/min, mean peak oxygen consumption (VO) was 32 ± 10 ml/kg/min, and mean peak respiratory exchange ratio was 1.14 ± 0.12. There was no difference in peak heart rate, peak VO, peak QTc, or respiratory exchange ratio pre- and post-LCSD. To evaluate the isolated effect of LCSD, the study performed a subset analysis of patients with LCSD monotherapy (n = 10) or no change in BB dose (n = 12). Patient-matched pre- and post-LCSD exercise testing showed no difference in heart rate, VO, or left ventricular function following LCSD.
CONCLUSIONS:
LCSD provides increased protection from an LQTS-triggered event without negatively affecting peak heart rate, cardiopulmonary fitness, or cardiac contractility, as assessed by both treadmill exercise stress testing and echocardiography.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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The effect of Baduanjin exercise on health-related physical fitness of college students: study protocol for a randomized controlled trial.
Trials2019 Sep;20(1):569. doi: 10.1186/s13063-019-3672-1.
Zhao Fang, Sun Shanshan, Xiong Jian, Zheng Guohua,
Abstract
BACKGROUND:
Low health-related physical fitness in college students is a risk factor for future development of cardiovascular diseases at later stages in life, but appropriate exercise is one of the main determinant factors of health-related physical fitness. Previous studies have showed that Baduanjin exercise is beneficial in improving sleep quality, mental health, body flexibility, and body physique. However, the evidence is unclear whether Baduanjin exercise can be recommended as an effective exercise to promote health-related physical fitness of college students.
METHODS/DESIGN:
One hundred twenty college students will be recruited and randomly allocated to either the Baduanjin exercise or the control group at a ratio of 1:1. The students in the Baduanjin exercise group will receive a 12-week supervised Baduanjin exercise training intervention with a frequency of 1 h each day and 4 days per week, while those in the control group will not receive any specific exercise intervention and will be informed to maintain their original lifestyle for 12?weeks. The primary outcome of health-related physical fitness involving measurements of body flexibility, muscular strength, cardiopulmonary fitness, and body endurance will be measured at baseline and after the 12-week intervention period. Mixed linear models will be used to analyze the effect of the Baduanjin exercise intervention on the health-related physical fitness of college students.
DISCUSSION:
This is the first trial to evaluate the effects of Baduanjin exercise on health-related physical fitness in college students. If the results are as expected, they will provide evidence of Baduanjin exercise in promoting health-related physical fitness in young adults.
TRIAL REGISTRATION:
Chinese Clinical Trial Registry, ChiCTR-IOR-17013011 . Registered on 17 November 2017.
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Does Restrictive Lung Function Affect the Exercise Capacity in Patients with Repaired Tetralogy of Fallot?
Pediatr Cardiol2019 Sep;():. doi: 10.1007/s00246-019-02205-0.
Akam-Venkata Jyothsna, Sriram Chenni, French Michelle, Smith Roxann, Aggarwal Sanjeev,
Abstract
Patients with repaired Tetralogy of Fallot (rTOF) have decreased exercise capacity (XC) and restrictive lung function (RLF). Our objective was to determine the association between RLF and impaired XC in patients with rTOF. This was a single center retrospective review of patients with rTOF who underwent a cardiopulmonary treadmill exercise testing and spirometry from 2005 to 2015. Patients with a respiratory exchange ratio???1.05 and peak heart rate?>?90% of predicted value were included. Forced vital capacity (FVC) and Forced expiratory volume in 1st second of forceful expiration (FEV) were used to classify the lung function. Exercise parameters such as peak oxygen uptake (VO), % of predicted VO (%VO), Metabolic equivalents (METS), and exercise time (ET) were compared between the two groups (i) compared patients with normal lung function (normal FEV, FVC, and FEV/FVC?>?80%) (ii) RLF (FVC??80%). In our cohort (n?=?151, 52% male, mean age?±?SD of 22.3?±?9.1 years), patients with RLF (n?=?73) compared to those with normal lung function (n?=?86) had a lower peak VO (30.8?±?8.6 vs. 36.6?±?9.8 mL/kg/min; p?
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The effect of cardiac rehabilitation at 4 weeks postoperatively on quality of life in patients treated with totally thoracoscopic ablation.
J Exerc Rehabil2019 Aug;15(4):610-615. doi: 10.12965/jer.1938340.170.
Seo Yong-Gon, Sung Jidong, Shin Mal-Soon, Park Yun-Jin, Min Kyoung-Bin, Kang Gyu-Min, Lee Jong-Min, Kim Myung-Ki,
Abstract
There is a lack of evidence on the effect of exercise-based cardiac rehabilitation (EBCR) in patients treated with total thoracoscopic ablation (TTA) for atrial fibrillation (AF). Our study investigated the efficacy and safety of postoperative exercise intervention in patients recovering from TTA. Twenty-four patients participated in the study, and were divided into the two groups, exercise group (EG) (n=12) and control group (n= 12). Patients in EG performed the exercise intervention including the aerobic and resistance exercise program twice a week for 8 weeks, which was used as a hospital-based cardiac rehabilitation for the out-patient. A cardiopulmonary exercise test was administered to evaluate aerobic exercise capacity, and qualitative aspect of patient's life was assessed using the Short Form 36 questionnaires to compare pre and postoperative wellness of patient's life. Although there was an increase of VO (peak oxygen uptake) after exercise intervention, no significant improvement was found (=0.055). Two of 4 physical health scores (role-physical, =0.013 and general health, =0.05) and three of four mental health scores (vitality, =0.027, social function, =0.016, and mental health, =0.003) were significantly improved after 8 weeks of EBCR. Each summarized scale in the physical (=0.022) and mental (= 0.004) survey section was also significantly improved in postoperative assessment compared to the preoperative one. In this context, we concluded that EBCR initiated at the time point of 4th week after TTA operation can guarantee the secure postoperative physical activity, and the 8 weeks of EBCR can effectively improve the quality of life in AF Patients.
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Effects of lung deflation induced by tiotropium/olodaterol on the cardiocirculatory responses to exertion in COPD.
Respir Med2019 Oct;157():59-68. doi: S0954-6111(19)30286-0.
Berton Danilo C, Marques Renata D, Palmer Brandon, O'Donnell Denis E, Neder J Alberto,
Abstract
BACKGROUND:
Hyperinflation has been associated with negative cardiocirculatory consequences in patients with chronic obstructive pulmonary disease (COPD). These abnormalities are likely to worsen when the demands for O increase, e.g., under the stress of exercise. Thus, pharmacologically-induced lung deflation may improve cardiopulmonary interactions and exertional cardiac output leading to higher limb muscle blood flow and oxygenation in hyperinflated patients with COPD.
METHODS:
20 patients (residual volume?=?201.6?±?63.6% predicted) performed endurance cardiopulmonary exercise tests (75% peak) 1?h after placebo or tiotropium/olodaterol 5/5??g via the Respimat® inhaler (Boehringer Ingelheim, Ingelheim am Rhein, Germany). Cardiac output was assessed by signal-morphology impedance cardiography. Near-infrared spectroscopy determined quadriceps blood flow (indocyanine green dye) and intra-muscular oxygenation.
RESULTS:
Tiotropium/olodaterol was associated with marked lung deflation (p?
CONCLUSIONS:
The beneficial effects of tiotropium/olodaterol on resting and operating lung volumes are not translated into enhanced cardiocirculatory responses to exertion in hyperinflated patients with COPD. Improvement in exercise tolerance after dual bronchodilation is unlikely to be mechanistically linked to higher muscle blood flow and/or O delivery.
Copyright © 2019. Published by Elsevier Ltd.
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Myocardial work is a predictor of exercise tolerance in patients with dilated cardiomyopathy and left ventricular dyssynchrony.
Int J Cardiovasc Imaging2019 Sep;():. doi: 10.1007/s10554-019-01689-4.
Schrub Florian, Schnell Frédéric, Donal Erwan, Galli Elena,
Abstract
The assessment of myocardial work (MW) by pressure-strain loops is a recently introduced tool for the assessment of myocardial performance. Aim of the present study is to evaluate the relationship between myocardial work and exercise tolerance in patients with dilated cardiomyopathy (DCM). 51 patients with DCM (mean age 57?±?13 years, left ventricular ejection fraction: 32?±?9%) underwent cardiopulmonary exercise test (CPET) to assess exercise performance. 22 patients (43%) had left or right bundle branch block with QRS duration?>?120 ms. Trans-thoracic echocardiography (TTE) was performed before CPET. The following indices of myocardial work (MW) were measured regionally and globally: constructive work (CW), wasted work (WW), and work efficiency (WE). Left ventricular dyssynchrony (LV-DYS) was defined by the presence of septal flash or apical rocking at TTE. LV-DYS was observed in 16 (31%) patients and associated with lower LV ejection fraction (LVEF), lower global and septal WE, and higher global and septal WW. In patients with LV-DYS, septal WE was the only predictor of exercise capacity at multivariable analysis (??=?0.68, p?=?0.03), whereas LVEF (??=?0.47, p?=?0.05) and age (? =?-?0.42, p?=?0.04) were predictors of exercise capacity in patients without LV-DYS. In patients with DCM, LV-DYS is associated with an heterogeneous distribution of myocardial work. Septal WE is the best predictor of exercise performance in these patients.
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Impaired right ventricular lusitropy is associated with ventilatory inefficiency in PAH.
Eur Respir J2019 Sep;():. doi: 1900342.
Tello Khodr, Dalmer Antonia, Vanderpool Rebecca, Ghofrani Hossein A, Naeije Robert, Roller Fritz, Seeger Werner, Dumitrescu Daniel, Sommer Natascha, Brunst Anne, Gall Henning, Richter Manuel J,
Abstract
Cardiopulmonary exercise testing (CPET) is an important tool to assess functional capacity and prognosis in pulmonary arterial hypertension (PAH). However, the association of CPET parameters with the adaptation of right ventricular (RV) function to afterload remains incompletely understood.Thirty-seven patients with PAH (idiopathic in 31 cases) underwent single-beat pressure-volume loop measurements of RV end-systolic elastance (Ees), arterial elastance (Ea) and diastolic elastance (Eed). They also underwent magnetic resonance imaging of pulmonary arterial stiffness. The results were correlated to CPET variables. Predictive relevance of RV function parameters for clinically relevant ventilatory inefficiency, defined as minute ventilation/carbon dioxide production (V/VCO) slope >48, was evaluated using logistic regression analysis.Median [interquartile range] of V/VCO slope was 42 [32-52], of V/VCO nadir was 40 [31-44], and mean±sd of peak end-tidal CO tension (PCO) was 23±8?mmHg. Ea, Eed and parameters reflecting pulmonary arterial stiffness (capacitance and distensibility) were correlated to V/VCO slope, V/VCO nadir, PCO and peak oxygen pulse. RV Ees and RV-arterial coupling as assessed by the Ees/Ea ratio showed no correlations with CPET parameters. Ea (univariate odds ratio: 7.28; 95% confidence interval: 1.20-44.04) and Eed (univariate odds ratio: 2.21; 95% confidence interval: 0.93-5.26) were significantly associated with ventilatory inefficiency (p<0.10).Our data suggest that impaired RV lusitropy and increased afterload are associated with ventilatory inefficiency in PAH.
Copyright ©ERS 2019.
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The neurohormonal basis of pulmonary hypertension in heart failure with preserved ejection fraction.
Eur Heart J2019 Sep;():. doi: ehz626.
Obokata Masaru, Kane Garvan C, Reddy Yogesh N V, Melenovsky Vojtech, Olson Thomas P, Jarolim Petr, Borlaug Barry A,
Abstract
AIMS:
Pulmonary hypertension (PH) represents an important phenotype among the broader spectrum of patients with heart failure with preserved ejection fraction (HFpEF), but its mechanistic basis remains unclear. We hypothesized that activation of endothelin and adrenomedullin, two counterregulatory pathways important in the pathophysiology of PH, would be greater in HFpEF patients with worsening PH, and would correlate with the severity of haemodynamic derangements and limitations in aerobic capacity and cardiopulmonary reserve.
METHODS AND RESULTS:
Plasma levels of C-terminal pro-endothelin-1 (CT-proET-1) and mid-regional pro-adrenomedullin (MR-proADM), central haemodynamics, echocardiography, and oxygen consumption (VO2) were measured at rest and during exercise in subjects with invasively-verified HFpEF (n?=?38) and controls free of HF (n?=?20) as part of a prospective study. Plasma levels of CT-proET-1 and MR-proADM were highly correlated with one another (r?=?0.89, P?
CONCLUSION:
Subjects with HFpEF display activation of the endothelin and adrenomedullin neurohormonal pathways, the magnitude of which is associated with pulmonary haemodynamic derangements, limitations in RV functional reserve, reduced cardiac output, and more profoundly impaired exercise capacity in HFpEF. Further study is required to evaluate for causal relationships and determine if therapies targeting these counterregulatory pathways can improve outcomes in patients with the HFpEF-PH phenotype.
CLINICAL TRIAL REGISTRATION:
NCT01418248; https://clinicaltrials.gov/ct2/results? term=NCT01418248&Search=Search.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
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Arterial switch operation for transposition of the great arteries: A single-centre 32-year experience.
J Card Surg2019 Sep;():. doi: 10.1111/jocs.14045.
Vida Vladimiro L, Zanotto Lorenza, Zanotto Lucia, Triglia Laura T, Bellanti Ermanno, Castaldi Biagio, Padalino Massimo A, Gasperetti Andrea, Battista Francesca, Varnier Maurizio, Stellin Giovanni,
Abstract
OBJECTIVE:
Arterial switch operation (ASO) is nowadays the standard of care for neonates with D-transposition of the great arteries (D-TGA). We evaluated our early and late results with ASO for D-TGA.
MATERIALS AND METHODS:
We collected data on 267 patients with D-TGA, either with intact ventricular septum (D-TGA/IVS; n?=?182, 68%) and with other associated congenital heart malformations (complex D-TGA; n?=?85, 32%) that underwent ASO between January 1987 and July 2018.
RESULTS:
Median age at ASO was 8 days (interquartile range [IQR], 6-12 days). Fifteen patients (5.6%) died in hospital (6/182 with D-TGA/IVS, 3.3% and 9/85 with complex D-TGA, 11%; P?=?0.02). Median follow-up time was 10.2 years (IQR, 3.7-18 years). There were 2 (0.8%) late sudden deaths. Overall survival at 10 and 20 years was 94% and 93%, respectively. Thirty-five patients (14%) required either reoperations or reinterventions, mainly for right ventricular outflow tract obstruction (n?=?28, 11%). Freedom from reoperation/reintervention at 10 and 20 years was 87% and 78%, respectively. All patients were in NYHA I at latest clinical examination. Six over 173 patients (3.4%) who underwent a postoperative evaluation of their coronaries presented acquired anomalies. Forty-four patients (17%) who performed a cardiopulmonary exercise testing (CPET) have a predicted VO comparable to normal peers.
CONCLUSIONS:
The results of ASO for D-TGA are excellent, with a fairly low mortality and reoperation/reintervention rate. Functional capacity evaluated with CPET is comparable to normal peers. Continuous follow-up for detecting asymptomatic acquired coronary artery disease is mandatory. A reassessment of competitive sport eligibility criteria for specific D-TGA patients should be considered.
© 2019 Wiley Periodicals, Inc.
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Can we predict potentially dangerous coronary patterns in patients with transposition of the great arteries after an arterial switch operation?
Cardiol Young2019 Sep;():1-6. doi: 10.1017/S104795111900204X.
Michalak Krzysztof W, Sobczak-Budlewska Katarzyna, Moll Jacek J, Szymczyk Konrad, Moll Jadwiga A, Niwald Marek, Dry?ek Pawe?, Moll Maciej,
Abstract
INTRODUCTION:
Coronary artery complications are the main reason for early mortality after an arterial switch operation. Late complications are relatively rare, and there is no consensus regarding the need or indications for routine follow-up coronary artery evaluations or the best first-line assessment modality. The aim of this study was to present the long-term post-operative frequency of coronary abnormalities in asymptomatic patients with transposition of the great arteries discovered by coronary CT angiography and potential "red flags" revealed by other examinations.
PATIENTS AND METHODS:
A group of 50 consecutive asymptomatic patients who underwent routine long-term coronary artery evaluation after an arterial switch operation according to our institutional protocol were qualified for this study. This routine in-hospital visit included a detailed medical interview, electrocardiography, echocardiography, Holter electrocardiography examinations, and laboratory and cardiopulmonary exercise tests. Patients who showed significant abnormalities were qualified for perfusion scintigraphy.
RESULTS:
Unfavourable coronary abnormalities were detected in 30 patients (60%) and included ostial stenosis, muscular bridge, coronary fistula, interarterial course, proximal kinking, high ellipticity index, proximal acute angulation (<30 degree) of the left coronary artery, and proximal acute angulation of the right coronary artery. These features could not be predicted based on the medical interviews, surgical reports, or non-invasive screening test results.
CONCLUSION:
Complex coronary configurations with potentially dangerous coronary features are common in patients with transposition after an arterial switch operation. Such high-risk patients cannot be identified indirectly, and coronary CT angiography provides accurate information that is useful for post-operative management.
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Regression of Left Ventricular Mass in Athletes Undergoing Complete Detraining Is Mediated by Decrease in Intracellular but Not Extracellular Compartments.
Circ Cardiovasc Imaging2019 Sep;12(9):e009417. doi: 10.1161/CIRCIMAGING.119.009417.
Swoboda Peter P, Garg Pankaj, Levelt Eylem, Broadbent David A, Zolfaghari-Nia Ashkun, Foley A James R, Fent Graham J, Chew Pei G, Brown Louise A, Saunderson Christopher E, Dall'Armellina Erica, Greenwood John P, Plein Sven,
Abstract
BACKGROUND:
Athletic cardiac remodeling can occasionally be difficult to differentiate from pathological hypertrophy. Detraining is a commonly used diagnostic test to identify physiological hypertrophy, which can be diagnosed if hypertrophy regresses. We aimed to establish whether athletic cardiac remodeling assessed by cardiovascular magnetic resonance is mediated by changes in intracellular or extracellular compartments and whether this occurs by 1 or 3 months of detraining.
METHODS:
Twenty-eight athletes about to embark on a period of forced detraining due to incidental limb bone fracture underwent clinical assessment, ECG, and contrast-enhanced cardiovascular magnetic resonance within a week of their injury and then 1 month and 3 months later.
RESULTS:
After 1 month of detraining, there was reduction in left ventricular (LV) mass (130±28 to 121±25 g; <0.0001), increase in native T1 (1225±30 to 1239±30 ms; =0.02), and extracellular volume fraction (24.5±2.3% to 26.0±2.6%; =0.0007) with no further changes by 3 months. The decrease in LV mass was mediated by a decrease in intracellular compartment volume (94±22 to 85±19 mL; <0.0001) with no significant change in the extracellular compartment volume. High LV mass index, low native T1, and low extracellular volume fraction at baseline were all predictive of regression in LV mass in the first month.
CONCLUSIONS:
Regression of athletic LV hypertrophy can be detected after just 1 month of complete detraining and is mediated by a decrease in the intracellular myocardial compartment with no change in the extracellular compartment. Further studies are needed in athletes with overt and pathological hypertrophy to establish whether native T1 and extracellular volume fraction may complement electrocardiography, echocardiography, cardiopulmonary exercise testing, and genetic testing in predicting the outcome of detraining.
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Prolonged treadmill running in normobaric hypoxia causes gastrointestinal barrier permeability and elevates circulating levels of pro- and anti-inflammatory cytokines.
Appl Physiol Nutr Metab2019 Sep;():. doi: 10.1139/apnm-2019-0378.
Hill Garrett W, Gillum Trevor L, Lee Ben J, Romano Phebe A, Schall Zach J, Hamilton Ally M, Kuennen Matthew R,
Abstract
PURPOSE:
This study examined the impact of treadmill running in normobaric hypoxia on gastrointestinal barrier permeability and the systemic inflammatory response.
METHODS:
Ten recreationally-active participants completed two 1h bouts of matched-workload treadmill exercise(65% normoxic VO2max) in counterbalanced order. One bout was performed in normoxia(NORM: FIO2=20.9%) and the other in normobaric hypoxia(HYP: FIO2=13.5%). Minute ventilation(VE), respiratory rate(RR), tidal volume(VT), oxygen consumption(VO2), carbon dioxide production(VCO2), respiratory quotient(RQ), and heart rate(HR) were measured with a metabolic cart. Peripheral oxygen saturation(SpO2) was measured with pulse oximetry. Absolute tissue saturation(StO2) was measured with near-infrared spectroscopy. Fatty acid-binding protein(I-FABP) and circulating cytokine concentrations(IL-1Ra, IL-6, IL-10, TNF?) were assayed from plasma samples collected Pre, Post, 1h-Post, and 4h-Post exercise. Data were analyzed with 2-Way(Condition*Time) RM ANOVAs and Newman-Keuls post hocs were run where appropriate(p<0.05).
RESULTS:
As compared to NORM, 1h of treadmill exercise in HYP caused greater(p<0.05) changes in VE(+30%), RR(+16%), VT(+10%), VCO2(+18%), RQ(+16%), HR(+4%), SpO2(-16%) and StO2(-10%). Gut barrier permeability and circulating cytokine concentrations were also greater(p<0.05) following HYP exercise, where I-FABP was shown increased at Post(+68%) and IL-1Ra at 1h-Post(+266%). I-FABP and IL-1Ra did not change following NORM exercise. IL-6 and IL-10 increased with exercise in both study conditions but were increased more(p<0.05) following HYP exercise at Post(+705% and +127%; respectively) and 1h-Post(+400% and +128%; respectively).
KEY FINDINGS:
? Normobaric hypoxia caused significant desaturation and increased most cardiopulmonary responses by 10-30%. ? Significant gut barrier permeability and increased pro- and anti-inflammatory cytokine concentrations could promote an "open window" in the hours following HYP exercise.
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The 2-minute walk test is not a valid method to determine aerobic capacity in persons with multiple sclerosis.
NeuroRehabilitation2019 Sep;():. doi: 10.3233/NRE-192792.
Beckerman Heleen, Heine Martin, van den Akker Lizanne E, de Groot Vincent,
Abstract
BACKGROUND:
Walking tests, like the 2-minute fast walk test, are simple, inexpensive performance-based tests, and therefore seem attractive to estimate the aerobic fitness in people with chronic diseases.
OBJECTIVE:
To determine the criterion validity of the 2-minute fast walk test for estimating aerobic capacity in patients with Multiple Sclerosis (MS), by comparing it with the peak oxygen uptake (VO2peak in mL/kg/min) as measured by Cardiopulmonary Exercise Testing (CPET) on a cycle ergometer.
METHODS:
The 2?min fast walk test was performed on a marked indoor trajectory, using a static start protocol. Aerobic capacity (VO2peak, in mL/kg/min) was derived from CPET on a cycle ergometer. Criterion validity was tested by means of Pearson's correlation coefficient and should be at least 0.70 for a good criterion validity of the 2?min walk test. Linear regression analysis was applied to more precisely estimate VO2peak.
RESULTS:
In total 141 people with severe MS-related fatigue (mean age 47.0 years (range 23-68 years), 73% women, median disease duration 7.8 years (range 0.3 - 28.7 years)) performed both tests. The distance walked in two minutes ranged from 52.0 to 290.0?m (mean 175.1?m, sd 44.9?m), while the VO2peak varied between 11.31 and 40.28?mL/kg/min (mean 22.52?mL/kg/min, sd 6.07?mL/kg/min). The correlation between the 2?min walk test and VO2peak was 0.441 (95% CI: 0.309-0.570). The absolute residual error in estimated VO2peak was 5.47?mL/kg/min.
CONCLUSIONS:
Due to the poor correlation found between the 2?min walk test and VO2peak, the 2-min walk test cannot be recommended as a valid alternative for estimating aerobic capacity in persons with MS.
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Failing Homeostasis of Quadriceps Muscle Energy- and pH Balance During Bicycling in a Young Patient With a Fontan Circulation.
Front Cardiovasc Med2019 ;6():121. doi: 10.3389/fcvm.2019.00121.
Haarman Meindina G, Vos Johannes D L, Berger Rolf M F, Willems Tineke P, Jeneson Jeroen A L,
Abstract
Patients with a congenital heart condition palliated with a Fontan circulation generally present with decreased exercise capacity due to impaired cardiopulmonary function. Recently, a study in patients with a Fontan circulation reported evidence for abnormal vascular endothelial function in leg muscle. We investigated if abnormal skeletal muscle hemodynamics during exercise play a role in the limited exercise tolerance of Fontan patients. If so, abnormalities in intramuscular energy metabolism would be expected both during exercise as well as during post-exercise metabolic recovery. In a young patient with a Fontan circulation and his healthy twin brother we studied the dynamics of energy- and pH-balance in quadriceps muscle during and after a maximal in-magnet bicycling exercise challenge using 31-phosphorus magnetic resonance spectroscopy. An unrelated age-matched boy was also included as independent control. Quadriceps phosphocreatine (PCr) depletion during progressive exercise was more extensive in the Fontan patient than in both controls (95% vs. 80%, respectively). Importantly, it failed to reach an intermittent plateau phase observed in both controls. Quadriceps pH during exercise in the Fontan patient fell 0.3 units at low to moderate workloads, dropping to pH 6.6 at exhaustion. In both controls quadriceps acidification during exercise was absent but for the maximal workload in the twin brother (pH 6.8). Post-exercise, the rate of metabolic recovery in the Fontan patient and both controls was identical (time constant of PCr recovery 32 ± 4, 31 ± 2, and 28 ± 4 s, respectively). Homeostasis of quadriceps energy- and pH-balance during a maximal exercise test failed in the Fontan patient in comparison to his healthy twin brother and an age-matched independent control. Post-exercise metabolic recovery was normal which does not support the contribution of significant endothelial dysfunction affecting adequate delivery of oxidative substrates to the muscle to the lower exercise capacity in this particular Fontan patient. These results suggest that mitochondrial ATP synthetic capacity of the quadriceps muscle was intact but cardiac output to the leg muscles during exercise was insufficient to meet the muscular demand for oxygen. Therefore, improving cardiac output remains the main therapeutic target to improve exercise capacity in patients with a Fontan circulation.
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[Effect of trimetazidine on cardiac function and exercise tolerance in hypertension patients with diabetic].
Zhejiang Da Xue Xue Bao Yi Xue Ban2019 May;48(3):282-288.
Ye Pingxian, Ye Pingzhen, He Jinping,
Abstract
OBJECTIVE:
To determine the effect of trimetazidine on cardiac function and exercise tolerance in primary hypertension patients with type 2 diabetic.
METHODS:
In this randomized, double-blind, placebo-controlled prospective study, 60 primary hypertensive patients with diabetic were equally assigned into two groups, patients received trimetazidine (20 mg, 3 times a day) or placebo for 1 year. Echocardiography, cardiopulmonary exercise testing were performed; and the plasma N terminal pro B type natriuretic peptide (NT-ProBNP), hr-CRP, TNF-?, angiotensin ? and endothelin concentration were determined before and after treatment.
RESULTS:
In trimetazidine group, the left ventricular mass index, the mitral flow velocity E wave to A wave ratio (E/A), the peak early diastolic velocity (V) to late diastolic velocity (V) ratio (V/V) and the peak systolic velocity (Vs) were significantly improved, the plasma NT-ProBNP level was significantly decreased, and the exercise time, metabolic equivalent, maximal oxygen uptake and anaerobic threshold were significantly increased (all <0.05); plasma concentration of hr-CRP, TNF-?, angiotensin ? and endothelin were significantly reduced after trimetazidine treatment, compared with baseline (all <0.05) and with placebo (all <0.05). There were no significant differences in any of above parameters after treatment in placebo group (all >0.05). No severe adverse reaction was observed in both groups.
CONCLUSIONS:
For patients with both hypertension and diabetes, trimetazidine can improve cardiac function and increase exercise tolerance.
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Unexplained exertional intolerance associated with impaired systemic oxygen extraction.
Eur J Appl Physiol2019 Sep;():. doi: 10.1007/s00421-019-04222-6.
Melamed Kathryn H, Santos Mário, Oliveira Rudolf K F, Urbina Mariana Faria, Felsenstein Donna, Opotowsky Alexander R, Waxman Aaron B, Systrom David M,
Abstract
PURPOSE:
The clinical investigation of exertional intolerance generally focuses on cardiopulmonary diseases, while peripheral factors are often overlooked. We hypothesize that a subset of patients exists whose predominant exercise limitation is due to abnormal systemic oxygen extraction (SOE).
METHODS:
We reviewed invasive cardiopulmonary exercise test (iCPET) results of 313 consecutive patients presenting with unexplained exertional intolerance. An exercise limit due to poor SOE was defined as peak exercise (Ca-vO)/[Hb]???0.8 and VO??0.8, VO???80%, and no cardiac or pulmonary limit were considered otherwise normal. The otherwise normal group was divided into hyperventilators (HV) and normals (NL). Hyperventilation was defined as peak PaCO?
RESULTS:
Prevalence of impaired SOE as the sole cause of exertional intolerance was 12.5% (32/257). At peak exercise, poor SOE and HV had less acidemic arterial blood compared to NL (pHa?=?7.39?±?0.05 vs. 7.38?±?0.05 vs. 7.32?±?0.02, p?
CONCLUSIONS:
We identified a cohort of patients whose exercise limitation is due only to systemic oxygen extraction, due to either an intrinsic abnormality of skeletal muscle mitochondrion, limb muscle microcirculatory dysregulation, or hyperventilation and left shift the oxyhemoglobin dissociation curve.
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Pulmonary artery size is associated with functional clinical status in the Fontan circulation.
Heart2019 Sep;():. doi: heartjnl-2019-314972.
Ridderbos Floris-Jan S, Bonenkamp Bregje E, Meyer Sophie L, Eshuis Graziella, Ebels Tjark, van Melle Joost P, Willems Tineke P, Berger Rolf M F,
Abstract
OBJECTIVE:
In the Fontan circulation, non-pulsatile pulmonary blood flow is suggested to negatively affect pulmonary artery growth. The pulmonary vasculature is regarded a key determinant of outcome after Fontan completion. We hypothesised that in Fontan patients pulmonary artery size correlates with follow-up and functional clinical status.
METHODS:
This is a single-centre, cross-sectional cohort study. Thirty-nine paediatric and adult Fontan patients with a concomitant cardiac magnetic resonance (CMR) scan and a cardiopulmonary exercise test between 2012 and 2013 were included. CMR-derived left and right pulmonary artery cross-sectional areas were expressed as Nakata index. Functional status was defined as peak oxygen consumption (pVO) indexed for weight, as percentage of predicted (pred) and as New York Heart Association Functional Class (NYHA-FC).
RESULTS:
Age at CMR was 18±7.2 years. Time since Fontan completion was 11.9±7.4 years. Nakata index was lower versus the reference values (238.6±78.5 vs 330±30?mm/m, p<0.001). Nakata index correlated negatively with age at CMR (r=-0.393, p=0.013) and time since Fontan completion (r=-0.341, p=0.034). pVO was 27.9±8.9?mL/min/kg and pVOpred was 58.1%±14.1%. Nakata index correlated positively with pVO (r=0.468, p=0.003) and pVOpred (r=0.353, p=0.028). Nakata index correlated negatively with NYHA-FC (r=-0.450, p=0.004). Nakata index was an independent predictor (?=0.359, p=0.007) for pVO (adjusted R=0.442, with maximum heart rate and oxygen pulse at peak exercise).
CONCLUSIONS:
Pulmonary artery size expressed as Nakata index is a novel independent predictor for functional clinical status. Nakata index negatively correlated with follow-up duration, suggesting that chronic abnormal non-pulsatile pulmonary blood flow plays a role in lagging pulmonary arterial growth in the Fontan circulation.
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
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Acquired loss of cardiac vagal activity is associated with myocardial injury in patients undergoing noncardiac surgery: prospective observational mechanistic cohort study.
Br J Anaesth2019 Sep;():. doi: S0007-0912(19)30600-2.
May Shaun M, Reyes Anna, Martir Gladys, Reynolds Joseph, Paredes Laura Gallego, Karmali Shamir, Stephens Robert C M, Brealey David, Ackland Gareth L,
Abstract
BACKGROUND:
Myocardial injury is more frequent after noncardiac surgery in patients with preoperative cardiac vagal dysfunction, as quantified by delayed heart rate (HR) recovery after cessation of cardiopulmonary exercise testing. We hypothesised that serial and dynamic measures of cardiac vagal activity are also associated with myocardial injury after noncardiac surgery.
METHODS:
Serial autonomic measurements were made before and after surgery in patients undergoing elective noncardiac surgery. Cardiac vagal activity was quantified by HR variability and HR recovery after orthostatic challenge (supine to sitting). Revised cardiac risk index (RCRI) was calculated for each patient. The primary outcome was myocardial injury (high-sensitivity troponin ?15 ng L) within 48 h of surgery, masked to investigators. The exposure of interest was cardiac vagal activity (high-frequency power spectral analysis [HF]) and HR recovery 90 s from peak HR after the orthostatic challenge.
RESULTS:
Myocardial injury occurred in 48/189 (25%) patients, in whom 41/48 (85%) RCRI was <2. In patients with myocardial injury, vagal activity (HF) declined from 5.15 (95% confidence interval [CI]: 4.58-5.72) before surgery to 4.33 (95% CI: 3.76-4.90; P<0.001) 24 h after surgery. In patients who remained free of myocardial injury, HF did not change (4.95 [95% CI: 4.64-5.26] before surgery vs 4.76 [95% CI: 4.44-5.08] after surgery). Before and after surgery, the orthostatic HR recovery was slower in patients with myocardial injury (5 beats min [95% CI: 3-7]), compared with HR recovery in patients who remained free of myocardial injury (10 beats min [95% CI: 7-12]; P=0.02).
CONCLUSIONS:
Serial HR measures indicating loss of cardiac vagal activity are associated with perioperative myocardial injury in lower-risk patients undergoing noncardiac surgery.
Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
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