DONA ORA
Pubblicazioni recenti - cardiopulmonary exercise
-
Performance and Interpretation of Invasive Hemodynamic Exercise Testing.
Chest2020 May;():. doi: S0012-3692(20)31617-2.
Jain C Charles, Borlaug Barry A,
Abstract
Exertional dyspnea is a common complaint for patients seen in pulmonary, cardiac and general medicine clinics, and elucidating the cause is often challenging, particularly when physical examination, echocardiography, radiography and pulmonary function test results are inconclusive. Invasive cardiopulmonary exercise testing (CPET) has emerged as the gold standard test to define causes of dyspnea and exertional limitation in this population. In this review, we describe the methods for performing and interpreting invasive CPET, with particular attention to the hemodynamic and blood sampling data as they apply to patients being evaluated for heart failure and pulmonary hypertension.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Wearable Patch Based Estimation of Oxygen Uptake and Assessment of Clinical Status during Cardiopulmonary Exercise Testing in Patients with Heart Failure.
J Card Fail2020 May;():. doi: S1071-9164(19)31644-6.
Shandhi Md Mobashir Hasan, Hersek Sinan, Fan Joanna, Sander Erica, Marco Teresa De, Heller J Alex, Etemadi Mozziyar, Klein Liviu, Inan Omer T,
Abstract
OBJECTIVE:
To estimate oxygen uptake (VO) from cardiopulmonary exercise testing (CPX) using simultaneously recorded seismocardiogram (SCG) and electrocardiogram (ECG) signals captured with a small wearable patch.
BACKGROUND:
CPX is an important risk stratification tool for patients with heart failure (HF) due to the prognostic value of the features derived from the gas exchange variables such as VO. However, CPX requires specialized equipment, as well as trained professionals to conduct the study.
METHODS:
We have conducted a total of 68 CPX tests on 59 subjects with HF with reduced ejection fraction (31% women, mean age 55±13 years, ejection fraction 0.27±0.11, 79% stage C). The subjects were fitted with a wearable sensing patch and underwent treadmill CPX. We divided the dataset into a training-testing (N=44) and a separate validation set (N=24). We developed globalized (population) regression models to estimate VO from the SCG and ECG signals measured continuously with the patch. We further classified the patients as stage D or C using the SCG and ECG features to assess the ability to detect clinical state from the wearable patch measurements alone. We developed the regression and classification model with cross-validation on the training-testing set and validated the models on the validation set.
RESULTS:
The regression model to estimate VO from the wearable features yielded a moderate correlation (R of 0.64) with a root-mean-square-error (RMSE) of 2.51±1.12 ml.kg.min on the training-testing set, whereas R and RMSE on the validation set were 0.76 and 2.28±0.93 ml.kg.min respectively. Furthermore, the classification of clinical state yielded accuracy, sensitivity, specificity, and an area under the receiver operating characteristic curve values of 0.84, 0.91, 0.64, and 0.74 respectively for the training-testing set, and 0.83, 0.86, 0.67, and 0.92 respectively for the validation set.
CONCLUSION:
Wearable SCG and ECG can assess CPX oxygen uptake and thereby classify clinical status for patients with HF. These methods may provide value in risk stratification of patients with HF by tracking cardiopulmonary parameters and clinical status outside of specialized settings, potentially allowing for more frequent assessments to be performed during longitudinal monitoring and treatment.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Duchenne and Becker muscular dystrophy carriers: Evidence of cardiomyopathy by exercise and cardiac MRI testing.
Int J Cardiol2020 May;():. doi: S0167-5273(20)30477-0.
Mah May Ling, Cripe Linda, Slawinski Michelle K, Al-Zaidy Samiah A, Camino Eric, Lehman Kelly J, Jackson Jamie L, Iammarino Megan, Miller Natalie, Mendell Jerry R, Hor Kan N,
Abstract
BACKGROUND:
Varied detection methods have resulted in conflicting reports on the prevalence of cardiac disease in Duchenne and Becker muscular dystrophy carriers (MDC).
METHODS:
We performed a prospective cohort study of 77 genetically-confirmed MDC mothers, 22 non-carrier mothers, and 25 controls. All participants underwent Cardiopulmonary Exercise Testing (CPET) and Cardiac Magnetic Resonance imaging (CMR).
RESULTS:
25% of carriers had ventricular ectopy in recovery of exercise (RecVE) as compared to 1 non-carrier and no controls (p?=?.003). No difference in age or maximal oxygen consumption was noted. 11 carriers had abnormal (<55%) left ventricular ejection fraction by CMR. Evidence of late gadolinium enhancement (LGE) was noted in 48% of MDC, 1 non-carrier patient and no control subjects (p? 289?U/L; 52.8% v 31.6%, p?=?.065).
CONCLUSION:
We describe the prevalence of disease using CPET and CMR in genetically-proven MDC. 49% of carriers had fibrosis, opposed to 5% of non-carriers, highlighting the importance of genetic testing in this population. Despite cardiomyopathy, functional assessment by treadmill was normal, illustrating the discrepancy in cardiac and skeletal muscle impacts. Age, RecVE and serum CK appear to have an important role in predicting cardiomyopathy. Serum CK levels suggest that a systemic higher global disease severity and not tissue heterogeneity may be the etiology for greater cardiac disease and relatively spared skeletal muscle disease in this population. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT02972580?term=mendell&cond=Duchenne+Muscular+Dystrophy&rank=5; ClinicalTrials.gov Identifier: NCT02972580.
Copyright © 2020. Published by Elsevier B.V.
Guarda su PubMed
-
Exercise efficiency impairment in metabolic myopathies.
Sci Rep2020 May;10(1):8765. doi: 10.1038/s41598-020-65770-y.
Noury Jean-Baptiste, Zagnoli Fabien, Petit François, Marcorelles Pascale, Rannou Fabrice,
Abstract
Metabolic myopathies are muscle disorders caused by a biochemical defect of the skeletal muscle energy system resulting in exercise intolerance. The primary aim of this research was to evaluate the oxygen cost (?V'O/?Work-Rate) during incremental exercise in patients with metabolic myopathies as compared with patients with non-metabolic myalgia and healthy subjects. The study groups consisted of eight patients with muscle glycogenoses (one Tarui and seven McArdle diseases), seven patients with a complete and twenty-two patients with a partial myoadenylate deaminase (MAD) deficiency in muscle biopsy, five patients with a respiratory chain deficiency, seventy-three patients with exercise intolerance and normal muscle biopsy (non-metabolic myalgia), and twenty-eight healthy controls. The subjects underwent a cardiopulmonary exercise test (CPX Medgraphics) performed on a bicycle ergometer. Pulmonary V'O was measured breath-by-breath throughout the incremental test. The ?V'O/?Work-Rate slope for exercise was determined by linear regression analysis. Lower oxygen consumption (peak percent of predicted, mean ± SD; p?
Guarda su PubMed
-
A Frame of Reference for Assessing the Intensity of Exertional Dyspnoea During Incremental Cycle Ergometry.
Eur Respir J2020 May;():. doi: 2000191.
Neder J Alberto, Berton Danilo C, Nery Luiz E, Tan Wan C, Bourbeau Jean, O'Donnell Denis E, ,
Abstract
Assessment of dyspnoea severity during incremental cardiopulmonary exercise testing (CPET) has long been hampered by the lack of reference ranges as a function of work rate (WR) and ventilation (V?E). This is particularly relevant to cycling, a testing modality which overtaxes the leg muscles leading to a heightened sensation of leg discomfort.Reference ranges based on dyspnoea percentiles (0-10 Borg scale) at standardised WRs and V?E were established in 275 apparently healthy subjects aged 20-85 (131 men). They were compared with values recorded in a randomly selected "validation" sample (N=451, 224 men). Their usefulness in properly uncovering the severity of exertional dyspnoea were tested in 167 subjects under investigation for chronic dyspnoea ("testing sample") who terminated CPET due to leg discomfort (86 men).Iso-WR and, to a lesser extent, iso-V?E reference ranges (5th-25th, 25th-50th, 50-75th and 75th-95th percentiles) increased as a function of age, being systematically higher in women (p<0.01). There was no significant differences in percentiles distribution between "reference" and "validation" samples (p>0.05). Submaximal dyspnoea-WR scores lied within the 75th-95th or >95th percentiles in 108/118 (91.5%) subjects of the "testing" sample who showed physiological abnormalities known to elicit exertional dyspnoea , ventilatory inefficiency and/or critical inspiratory constraints. In contrast, dyspnoea scores typically lied in the 5th-50th range in subjects without those abnormalities (p<0.001).This frame of reference might prove useful to uncover the severity of exertional dyspnoea in subjects who otherwise would be labeled as "non-dyspneic" while providing mechanistic insights into the genesis of this distressing symptom.
Copyright ©ERS 2020.
Guarda su PubMed
-
Molecular Choreography of Acute Exercise.
Cell2020 May;181(5):1112-1130.e16. doi: S0092-8674(20)30508-0.
Contrepois Kévin, Wu Si, Moneghetti Kegan J, Hornburg Daniel, Ahadi Sara, Tsai Ming-Shian, Metwally Ahmed A, Wei Eric, Lee-McMullen Brittany, Quijada Jeniffer V, Chen Songjie, Christle Jeffrey W, Ellenberger Mathew, Balliu Brunilda, Taylor Shalina, Durrant Matthew G, Knowles David A, Choudhry Hani, Ashland Melanie, Bahmani Amir, Enslen Brooke, Amsallem Myriam, Kobayashi Yukari, Avina Monika, Perelman Dalia, Schüssler-Fiorenza Rose Sophia Miryam, Zhou Wenyu, Ashley Euan A, Montgomery Stephen B, Chaib Hassan, Haddad Francois, Snyder Michael P,
Abstract
Acute physical activity leads to several changes in metabolic, cardiovascular, and immune pathways. Although studies have examined selected changes in these pathways, the system-wide molecular response to an acute bout of exercise has not been fully characterized. We performed longitudinal multi-omic profiling of plasma and peripheral blood mononuclear cells including metabolome, lipidome, immunome, proteome, and transcriptome from 36 well-characterized volunteers, before and after a controlled bout of symptom-limited exercise. Time-series analysis revealed thousands of molecular changes and an orchestrated choreography of biological processes involving energy metabolism, oxidative stress, inflammation, tissue repair, and growth factor response, as well as regulatory pathways. Most of these processes were dampened and some were reversed in insulin-resistant participants. Finally, we discovered biological pathways involved in cardiopulmonary exercise response and developed prediction models revealing potential resting blood-based biomarkers of peak oxygen consumption.
Copyright © 2020 Elsevier Inc. All rights reserved.
Guarda su PubMed
-
High-intensity interval training improves cardiorespiratory fitness in cancer patients and survivors: A meta-analysis.
Eur J Cancer Care (Engl)2020 May;():e13267. doi: 10.1111/ecc.13267.
Wallen Matthew P, Hennessy Declan, Brown Stephen, Evans Luke, Rawstorn Jonathan C, Wong Shee Anna, Hall Adrian,
Abstract
OBJECTIVE:
The primary objective of this systematic review and meta-analysis was to compare the effects of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) and usual care (UC) on cardiorespiratory fitness (peak V?O ) in cancer patients and survivors. Secondary objectives were to compare the effects of HIIT versus MICT and UC on other cardiopulmonary exercise testing (CPET) indices. Safety and adherence to HIIT were also evaluated.
METHODS:
A systematic review and meta-analysis of controlled trials were undertaken using eligible studies from electronic database searching (inception-December 2019). Mean differences (MD) with 95% confidence intervals (CI) were compared and heterogeneity assessed using Cochran's Q and I statistic.
RESULTS:
Twelve eligible studies included 516 participants with post-intervention CPET data. No serious adverse events occurred. Adherence to HIIT ranged between 71.2% and 95.6%. HIIT had significantly higher peak V?O compared with UC (MD = 2.11 ml kg min , 95% CI 0.75-3.47, p = .002). No significant difference was found between HIIT and MICT (MD = 2.03 ml kg min , 95%CI -0.75-4.83, p = .15). HIIT was more effective than UC to improve peak oxygen pulse (MD = 1.59 ml/beat, 95%CI 0.06-3.12, p = .04).
CONCLUSIONS:
Quantitative assessment of HIIT studies indicates good compliance, with a significant effect on peak V?O and peak oxygen pulse compared with UC in cancer patients and survivors. HIIT demonstrates a comparable effect with MICT to improve peak V?O .
© 2020 John Wiley & Sons Ltd.
Guarda su PubMed
-
Immediate and 24-h post-marathon cardiac troponin T is associated with relative exercise intensity.
Eur J Appl Physiol2020 May;():. doi: 10.1007/s00421-020-04403-8.
Martínez-Navarro Ignacio, Sánchez-Gómez J, Sanmiguel D, Collado E, Hernando B, Panizo N, Hernando C,
Abstract
PURPOSE:
We aimed at exploring whether cardiopulmonary fitness, echocardiographic measures and relative exercise intensity were associated with high-sensitivity cardiac troponin T (hs-TNT) rise and normalization following a marathon.
METHODS:
Nighty-eight participants (83 men, 15 women; 38.72?±?3.63 years) were subjected to echocardiographic assessment and a cardiopulmonary exercise test (CPET) before the race. hs-TNT was measured before, immediately after and at 24, 48, 96, 144 and 192 h post-race. Speed and mean heart rate (HR) during the race were relativized to CPET values: peak speed (%V), peak HR (HR), speed and HR at the second ventilatory threshold (HR and %V).
RESULTS:
Hs-TNT increased from pre- to post-race (5.74?±?5.29 vs. 50.4?±?57.04 ng/L; p?
CONCLUSION:
Post-race hs-TNT was above the URL in barely all runners. Magnitude of hs-TNT rise was correlated with exercise mean HR; whereas, its normalization kept relationship with marathon relative speed.
Guarda su PubMed
-
Elevation of Right-Sided Pressures and Right Ventricular Echocardiographic Parameters: Predictors of Exercise Limitation in Patients with Implanted Continuous Flow Left Ventricular Assist Devices.
J Heart Lung Transplant2020 Apr;39(4S):S439. doi: S1053-2498(20)30262-X.
Bouzas-Cruz N, Gonzalez-Fernandez O, Koshy A, Okwose N, Woods A, Robinson-Smith N, Tovey S, McDiarmid A, Parry G, Schueler S, Jakovljevic D, MacGowan G,
Abstract
PURPOSE:
To determine parameters of exercise intolerance in a group of patients with HeartWare Ventricular Assist Device(HVAD) compared to a group of heart failure(HF)patients METHODS: This was a single-centre parallel prospective group-study.Echocardiograms,right heart catheterisation(RHC) and cardiopulmonary exercise tests were performed in 42patients admitted for a heart transplant assessment between August2017 and October2018:20 belonged to the HVAD group and 22 to the HF group RESULTS: HVADpatients had a better exercise capacity than HFpatients, although no significant differences were noted(14.0±5.0ml/kg/min vs 11.3±3.9ml/kg/min, p=0.06).To determine exercise tolerance,both HVAD and HFgroups were subdivided into 2 groups based on the median peakVO2.The table shows the comparison between preserved and non-preserved exercise tolerance in HF and HVADpatients. In the HVAD group,all resting RHC pressures were significantly lower in the preserved exercise capacity group.However,in HFpatients there were no statistically significant differences between both subgroups in right-sided pressures,but Thermodilution exercise-induced change in cardiac output(?CO) and cardiac index(?CI) was significantly higher in the patients with preserved exercise tolerance.In the HVADgroup the right ventricle was significantly larger in the reduced exercise tolerance subgroup.Patients with lower peakVO2 had more significant tricuspid regurgitation.Nevertheless,in HFpatients none of the echocardiographic parameters were related to the exercise capacity CONCLUSION: Right-sided parameters in the echocardiogram and RHC pressures discriminate between preserved and non-preserved exercise capacity in HVADpatients,but not in HFpatients.In these last patients only ?CO and ?CI were statistically correlated with peak exercise oxygen consumption.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
High Altitude Mountaineering after Lung Transplantation - Jebel Toubkal Peak 4167m.
J Heart Lung Transplant2020 Apr;39(4S):S391-S392. doi: S1053-2498(20)30533-7.
Slama A, Benazzo A, Mühlbacher J, Schrutka L, Besa V, Koch A, Hoetzenecker K, Klepetko W, Aigner C, Jaksch P,
Abstract
PURPOSE:
After successful lung transplantation, patients can potentially reach same strength and endurance as healthy individuals. Although high-altitude trekking has been reported after LuTX, data on the patient's physiological adaptation during prolonged exercise in a reduced oxygen environment remains scarce.
METHODS:
In September 2019, 14 lung transplanted patients and their accompanying doctors, climbed Mount Jebel Toubkal (4167 m; 13 671 ft), the highest peak in North Africa, High Atlas, Morocco. Participants had regular cardiopulmonary exams (lung function, polysomnography, echocardiography) as well as blood sampling (capillary blood gasses, lactate, creatinine) throughout the expedition up to 3145 m (10 318 ft).
RESULTS:
Patients (?: n=3 | ?: n=11) had a median age of 42.1 years (24.8-65.2). Their underlying diagnoses were CF (n=10), Emphysema (n=2), IPF (n=1) and PH (n=1). Median time from LuTX to this expedition was 4.1 Years (1.7-17.6). Controls (?: n=4) were 31.3 (29.3-46.7) years old. Over 7 days, participants hiked a distance of 81km (50.3 mi) with a cumulative elevation gain of 5496 m (18,031 ft.) vertical distance. Eleven Patients (78.6%) reached the summit whereas three patients had to abort because of altitude sickness (n=1 on day 1 at 2431m) or physical exhaustion (n=2 on day 3 at 3124m and day 6 at 3800m). Blood gas analysis and vital signs did not differ significantly between the patients and four healthy controls (pO2: 59.1 ±8.9 vs. 61.8 ±14.4 mmHg | pCO2: 29.8 ±1.5 vs. 29.8 ±0.5 mmHg | lactate 0.82 vs 0.83 mmol/l). Creatinine was significantly higher in transplanted patients (1.87 vs. 0.97 mg/dl; p=0.025).
CONCLUSION:
Although technically challenging, medical monitoring of lung transplanted patients is feasible during high altitude hiking. In carefully selected athletic LuTX patients, gas exchange and metabolism didn't differ compared to healthy adults.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Right Ventricular Function Coupling to the Pulmonary Circulation Predicts Exercise Tolerance in Patients with Heart Failure and Reduced Ejection Fraction. Insight from the Evaluation of Resynchronization Therapy for Heart Failure (EARTH) Trial.
J Heart Lung Transplant2020 Apr;39(4S):S35-S36. doi: S1053-2498(20)31207-9.
Legris V, Thibault B, Dupuis J, White M, Fortier A, Henri C, O'Meara E, Ducharme A,
Abstract
PURPOSE:
Exercise tolerance has important prognostic value in patients with heart failure and reduced ejection fraction (HFrEF). The relationship between right ventricular function and its coupling to pulmonary circulation (RV-PA) and cardiopulmonary exercise tests (CPET) is not fully understood. We aimed to evaluate the value of RV echocardiographic parameters, including RV-PA, to predict exercise tolerance in HFrEF patients.
METHODS:
We performed a sub-analysis of EARTH, which enrolled HFrEF patients undergoing defibrillator implantation. At baseline, an echocardiogram and various CPET [peak VO; minute ventilation/carbon dioxide production slope (VE/VCO); 6-minute walk distance (6MWD) and submaximal exercise duration (SED)] were performed. The primary outcome was the correlation of RV-PA (using TAPSE/sPAP, tricuspid annular plane systolic excursion on pulmonary artery systolic pressure ratio (T/P)) with peak VO. Secondary outcomes include correlation between various RV parameters such as size [diameter at inlet and end-diastolic area in apical 4-chamber], RV function [TAPSE; right ventricular fractional area change (RV-FAC); RV myocardial performance index (RV-MPI)], sPAP and tricuspid regurgitation grade (TRG); and CPET variables. Univariate and multivariate linear regression models were used on patients for which both TAPSE and sPAP were available.
RESULTS:
205 patients were enrolled in EARTH, with 100 having data on both TAPSE and sPAP (Men: 70.0%; NYHA class II: 55.0%; mean LVEF 26.5±7.8%). T/P was the only parameter found to be predictive of peak VO (?=6.8, p<0.01), together with BMI for 6MWD (?=72.4, p=0.04). ROC analysis for T/P value predictive of peak VO ?14mL/kg/min showed sensitivity and specificity of 0.63 and 0.62 respectively, and area under the curve (AUC) of 0.66 (p<0.01) for an optimal threshold ?0.45. T/P and RV-MPI were both predictors (?=-18.0, p<0.01; ?=18.5, p<0.01 respectively) of VE/VCO slope, while only TRG and BMI predicted SED (?=-3.2, p=0.03).
CONCLUSION:
In HFrEF patients, RV-PA coupling (using TAPSE/sPAP) is a powerful predictor of maximal and submaximal exercise capacity and has a greater predictive value than the usual parameters including age, sex and LVEF.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Increased Aortic Stiffness Index is Associated with Reduced Exercise Capacity Following Heart Transplantation.
J Heart Lung Transplant2020 Apr;39(4S):S289. doi: S1053-2498(20)30658-6.
Chun K, Lee C, Oh J, Park S, Lee S, Kang S,
Abstract
PURPOSE:
Augmentation of the central aortic pressure is associated with increased arterial stiffness, which is known to be a predictor for cardiovascular events. We investigated the association between aortic stiffness index and exercise capacity after heart transplantation.
METHODS:
We retrospectively analyzed the patients who underwent cardiopulmonary exercise test (CPET) and examined central hemodynamics using applanation tonometry (SphygmoCor, AtCor Medical) after 1 year from heart transplantation, from Jan 2011 to June 2019. Total 143 patients received HTx in this period. A total of 54 patients (49 years, 72% male) were analysed with available data, CPET and central hemodynamics measurements.
RESULTS:
Study subjects were divided into 2 groups according to peak exercise oxygen uptake (peak VO; median cutoff 21.1 ml/kg/min). There was no significant difference between the 2 groups. Recipients with high peak VO (?median) were likely to have increased hemoglobin (13 ± 1 vs. 12 ± 2 g/dL, p=0.032), lower aortic augmentation pressure (2.4 ± 17.5 vs. 12.6 ± 12.1%, p=0.018) and lower augmentation index at heart rate 75 beats per minute (Aix@75, 9.4 ± 15.9 vs 19.3 ± 11.9%, p=0.013). Aix@75 was correlated with peak VO (R=-0.53, p<0.001). In multivariate linear regression analysis, Aix@75 (ß=-0.15, p=0.010) were significantly associated with peak VO after HTx.
CONCLUSION:
In the present study, increased aortic stiffness is associated with reduced exercise capacity after HTx. Further study to determine whether lowering arterial stiffness may improve exercise tolerance in HTx recipients can warrant these findings.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Heart Rate Response after Heart Transplantation.
J Heart Lung Transplant2020 Apr;39(4S):S285-S286. doi: S1053-2498(20)30647-1.
Nygaard S I, Rolid K, Nytrøen K, Fiane A, Wyller V B, Gullestad L, Broch K,
Abstract
PURPOSE:
Denervation after heart transplantation (HTx) results in attenuated heart rate (HR) control and limited exercise tolerance. The aim of this study was to assess HR response changes to exercise with time in HTx recipients, compared with healthy controls.
METHODS:
The HR response to maximal cardiopulmonary exercise was tested in 50 de novo HTx recipients at 11 weeks (range 7-16) after surgery, at 1-year follow-up and in 50 age and gender matched controls. The HR was measured at rest, at 25-, 50-, 75-, and 100% of VO, and 30 sec, 1, 2, and 4 min after peak exercise on a treadmill or bicycle ergometer. We also assessed the HR reserve and the chronotropic response index.
RESULTS:
11 weeks after HTx, the HR response to exercise was blunted, but improved significantly during follow-up. The change in HR from rest to peak exercise increased by 32% (46 bpm vs 68 bpm; p<0.001) from inclusion to the 12 months' follow-up (Figure). In comparison, the change in HR during exercise in controls was 115 bpm. In HTx recipients, approximately 50 % of the total increase in HR occurred between rest and 25% of VO (figure). In the controls, roughly 40% of the total increase in HR occurred during the initial 25% of VO. The HTx recipients had a significantly higher change in HR between 75- and 100% of VO at inclusion than at 1-year follow-up (p=0.004) and this delayed change in HR was higher than in controls (p?=?0.001). The chronotropic response index increased during follow-up (0.48 ± 0.2 vs 0.79 ± 0.2; p<0.001) and normalized in 50% of the HTx recipients at 1 year. Finally, the HR declined more rapidly after exercise at follow-up than at inclusion, however, the decline remained slower than in controls (Figure).
CONCLUSION:
The increase and decrease in heart rate during exercise are considerably reduced in de novo HTx recipients, but improve during the first year after surgery. Whether this response continues to improve during longer follow-up remains to be determined.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Peak Oxygen Consumption and Survival after Heart Transplant is Similar in Patients with and without Comorbid Obstructive Sleep Apnea.
J Heart Lung Transplant2020 Apr;39(4S):S257. doi: S1053-2498(20)30574-X.
Genuardi M V, Zhang Y, Mazurek J A, Hanff T C, Molina M, Atluri P, Zamani P, McLean R, Goldberg L R, Birati E Y,
Abstract
PURPOSE:
Obstructive sleep apnea (OSA) is associated with increased all-cause and cardiovascular mortality in the general population and may be associated with decreased exercise capacity on cardiopulmonary exercise testing (CPET). While comorbid OSA is often considered when evaluating patients for heart transplantation, post-transplant outcomes are poorly studied.
METHODS:
We conducted a retrospective analysis of 307 heart transplant recipients at a large academic institution with CPET ?2 years after transplant. Patients with and without comorbid OSA were compared with respect to baseline characteristics and post-transplant exercise performance. Survival was compared with Cox proportional hazards modeling with time-varying exposure to account for patients who developed OSA during follow-up. Analyses were repeated after restricting the case definition to only ?moderate OSA (apnea hypopnea index ?15 or physician's qualitative report of sleep study result).
RESULTS:
Of 307 heart transplant recipients, 32 had OSA at baseline with 23 cases ?moderate. Patients with OSA had higher body mass index (30.5 vs 27.0 kg/m, p<0.001) but were of similar age (56 vs 52 years, p=0.15). On CPET, patients with OSA had a similar peak oxygen consumption (VO) normalized to age-predicted values, compared to patients without OSA (61.6 vs 63.4%, p=0.87). Although exercise time was similar between the two groups (7.6 vs 8.5 minutes, p=0.07), patients with ?moderate OSA had shorter exercise times compared to patients with no or mild OSA (7.2 vs 8.5 min, p=0.04). There were no differences between groups in minute ventilation/VCO ratio or end-tidal CO at anerobic threshold using either case definition. There were 89 deaths over a mean 8.2 years of follow-up, with 20 patients developing OSA over the follow-up period (incidence: 8.1 cases/1,000 patient-yrs). Mortality was similar whether the comparison was between patients with OSA vs. no OSA (HR?=?0.9 [95% CI, 0.5-1.8]) or ?moderate OSA vs. no/mild OSA (HR?=?1.0 [0.5-2.2]).
CONCLUSION:
Heart transplant recipients with and without OSA have similar peak VO and post-transplant survival. Exercise time may be shorter in patients with ?moderate OSA compared to patients with no or only mild disease. Whether compliance with nocturnal positive airway pressure mitigates these comparable outcomes remains to be explored.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Run for It: Use of Cardiopulmonary Exercise Testing for Hemodynamic Assessment in Advanced Heart Failure.
J Heart Lung Transplant2020 Apr;39(4S):S234. doi: S1053-2498(20)30913-X.
Moayedi Y, Tremblay-Gravel M, Somerset E, Fan C S, Yang W A, Henricksen E J, Christle J W, Haddad F, Khush K K, Ross H J, Teuteberg J J,
Abstract
PURPOSE:
Cardiopulmonary exercise testing (CPET) is an underutilized resource in the assessment of advanced heart failure (HF) after listing for heart transplant (HT). Currently, the ISHLT recommends repeating right heart catheterization (RHC) periodically after HT listing. The objective of this study was to assess whether CPET metrics could reliably predict hemodynamic pressures.
METHODS:
Patients with pre-transplant RHC and CPET measured within 3 months of each other were included. Pearson correlation between CPET and hemodynamic variables were calculated. We applied a Random Forest method to develop a prediction model with demographics and CPET metrics for each hemodynamic variable. In addition, we ranked the input variables in terms of their relative importance, defined as the relative reduction in accuracy or, equivalent relative increase in RMSE.
RESULTS:
102 patients were included. Of those, 65 had a CI ?2 and 37 had a CI< 2 LPM. Mean peak oxygen consumption (pVO2) was 12.2±2.8 ml/kg/min, with a %predicted 45.8%±11.4%, a respiratory exchange ratio (RER) 1.12±0.11 and a VE/VCO2 slope 41.4±10.4. When comparing HF etiologies, RER was lowest in those with ischemic cardiomyopathy (ICMP 1.08±0.1, DCMP 1.1±0.11, Other 1.16±0.11, p=0.029). There were no differences in pVO2, %predicted or VE/VCO2 slope. The cross-correlation analysis stratified by CI is shown in Fig 1A. We found modest correlations in the low CI group between VE/VCO2 slope and diastolic PA pressure (r=0.44), VE/VCO2 slope and mean PA pressure (r=0.42), and pVO2 and CI (r=0.37). When combining CPET data and demographic data, we were able to rank the importance of each predictor within in each model (Fig 1B).
CONCLUSION:
Using CPET data as a surrogate for invasive hemodynamics in those listed for HT is feasible. The use of serial exercise testing may allow a safer means to monitor patients and determine the timing of more aggressive support prior to HT.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Effect of High-Intensity Interval Training in De Novo Heart Transplant Recipients - 3-year Results from the HITTS Randomized Controlled Trial.
J Heart Lung Transplant2020 Apr;39(4S):S224-S225. doi: S1053-2498(20)30887-1.
Rolid K, Andreassen A K, Yardley M, Bjørkelund E, Authen A R, Grov I, Gude E, Broch K, Gullestad L, Nytrøen K,
Abstract
OF OBJECTIVES:
The HITTS study (High -intensity Interval Training in de novo Heart Transplant Recipients in Scandinavia) is a randomized controlled trial designed to assess the effect of high-intensity interval training (HIT) versus moderate intensity continuous training (MICT) on exercise capacity in de novo heart transplant recipients. The primary endpoint was the change in oxygen consumption (VO) at the end of the intervention period, which began 3 months after heart transplantation (HTx). After the 9-month long intervention period, we reported a between-group difference in VO of 1.8 ml/kg/min in favor of HIT (p?=?0.04).We found that HIT was safe, well tolerated and efficient. The HITTS study is the first randomized controlled trial to assess the effectiveness of HIT in de novo heart transplant recipients. However, long-term effects of commencing HIT soon after HTx remain unknown. In this extension of the HITTS trial, our aim was to examine whether the benefits of 9 months of supervised HIT training persist two years after the end of the intervention.
METHODS:
In the HITTS study, we randomized 81 adult de novo heart transplant recipients to 9 months of HIT (4?×?4 min intervals at 85-95% of peak heart rate (HR) or 9 months of MICT (60-80% of peak HR). The mean ± SD age was 49 ±13 and 73 % were men. Before the start of the intervention and at follow-up shortly after the intervention, we measured VO, isokinetic muscle strength, body composition, left ventricular function by echo, biomarkers, and health-related quality of life (HRQoL). For the extension study, the measurements will be repeated 3 years after enrollment. VO is measured with breath-by-breath gas exchange on a treadmill or bicycle ergometer. The last patient is scheduled to complete his/her 3-year follow-up at Nov 14, 2019. Data will be available for presentation at ISHLT 2020.
ENDPOINTS:
The primary outcome is the long-term effect of HIT vs MICT on aerobic exercise capacity as assessed by VO. Secondary outcomes are: Isokinetic muscular strength in the lower limbs by a dynamometer, body composition (bio-impedance analysis), left ventricular function by echo, heart rate response during the cardiopulmonary exercise test, relevant circulation biomarkers (renal function, NT-proBNP and cardiac troponins), HRQoL, tolerability, safety and adverse events.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Pre LVAD CPET as Predictor of INTERMACS Profile and Early Outcomes Post LVAD.
J Heart Lung Transplant2020 Apr;39(4S):S182-S183. doi: S1053-2498(20)30781-6.
Brailovsky Y, Mondellini G M, Javaid A, Braghieri L, Kleet A C, Shargarodskaya R, Raikhelkar J K, Pineda M F, Fried J A, Kim D S, Takeda K, Naka Y, Sayer G, Uriel N, Goldsmith R L, Colombo P C, Yuzefpolskaya M,
Abstract
PURPOSE:
Cardiopulmonary Exercise Testing (CPET) is the clinical standard to select HF pts for cardiac replacement therapy. INTERMACS profile is used to risk stratify pts who undergo LVAD. We aimed to evaluate the association of CPET performance parameters with INTERMACS profile at implant as well as with clinical outcomes early post LVAD.
METHODS:
A retrospective analysis of LVAD pts implanted from 3/10 to 5/19 with CPET data available within 2y of surgery: peak oxygen consumption (pVO2) and minute ventilation?-?carbon dioxide production relationship (VE/VCO2). The primary endpoints were INTERMACS profile ?2 at implant and a composite of post LVAD in-hospital mortality, right ventricular failure (RVF) and renal replacement therapy (RRT). Length of stay (LOS) in relation to CPET performance parameters was also evaluated. Receiver Operating Characteristics (ROC) curve assessed the ability of pVO and VE/VCO to predict the composite endpoint.
RESULTS:
We studied 81 pts, median age 58 [IQR 16.5] y, 86% M, 41% ischemic, 48% HMII, 40% HM3 and 12% on other pumps. Median time from CPET to LVAD implant was 233 [388]d. Median pVO2 was 11.9[IQR 4.4] ml/kg/min and VE/VCO2 38 [IQR 10.3]. 46(56.8%) pts were INTERMACS ?2 at implant. 6 pts died, 7 had RRT and 23 developed RVF during index admission. PVO2 and VE/VCO2 were not significantly different between INTERMACS ?2 vs >2 groups (p=0.8 and p=0.15, respectively). ROC curves showed that pVO2 <12.8ml/kg/min had a sensitivity of 53% and specificity of 85% for the post LVAD composite endpoint (AUC 0.66, p=0.02), while VE/VCO2 was not a significant predictor (Figure). LOS was longer in pts with pVO2
CONCLUSION:
In a real-world setting, CPET parameters obtained within 2 y of LVAD do not reliably predict INTERMACS profile at implant. However, pVO2 and VE/VCO2 can be helpful to identify pts at risk for in-hospital mortality, major complications and prolonged LOS post LVAD.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
The Relationship between Pulmonary Artery Pulse Pressure and Pulmonary Artery Wedge Pressure during Exercise in Health and in Patients with Suspected Pulmonary Hypertension.
J Heart Lung Transplant2020 Apr;39(4S):S18. doi: S1053-2498(20)31160-8.
Bentley R F, Barker M, Esfandiari S, Wright S P, Valle F H, Granton J T, Mak S,
Abstract
PURPOSE:
Exercise during right heart catheterization (RHC) can demonstrate cardiopulmonary hemodynamic abnormalities not evident at rest. The relationships of pulmonary artery pressure (PAP) or pulmonary artery wedge pressure (PAWP) to cardiac output (CO) do not fully consider that PAP and PAWP should also be closely related. Therefore, we sought to expand our understanding of cardiopulmonary hemodynamic abnormalities by calculating the ratio of PA pulse pressure to PAWP during exercise in health and in patients with dyspnea and uncertain mechanisms of pulmonary hypertension (PH).
METHODS:
Data from 36 healthy individuals (median, Q1-Q3; 55, 50-60 yr, 50% male) and 85 consecutive patients (60, 49-71 yr, 48% male) referred for RHC and exercise (semi-upright submaximal cycling) were analysed.
RESULTS:
In our healthy control population, the upper 95% confidence intervals were determined for the change from rest to exercise in mean PAP over CO (?mPAP/?CO; 3.2 WU), PAWP over CO (?PAWP/?CO; 2 mmHg/L/min), and exercise PA pulse pressure over PAWP (PP/PAWP; 2.5). In the dyspneic population, ?mPAP/?CO < or >3.2 WU identified patients on the vertical and horizontal limbs of the pulmonary resistance-pulmonary compliance relationship respectively. While patients with a ?mPAP/?CO <3.2 WU largely had a ?PAWP/?CO below 2 mmHg/L/min, patients with a ?mPAP/?CO >3.2 WU exhibited a broad ?PAWP/?CO both below and above 2 mmHg/L/min. Exercise PP/PAWP >2.5 revealed subpopulations within each ?mPAP/?CO group with inappropriate PP/PAWP responses (Figure 1).
CONCLUSION:
Among dyspneic patients, we identified abnormal exercise phenotypes based upon ?mPAP/?CO, ?PAWP/?CO, and PP/PAWP responses. Our study refines quantitative classification of abnormal exercise hemodynamic phenotypes based on an improved understanding of the interrelationship between left heart filling pressure and pulmonary vascular behaviour.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Determinants of Oxygen Uptake (VO) among Patients with CF-LVADs.
J Heart Lung Transplant2020 Apr;39(4S):S160. doi: S1053-2498(20)31126-8.
Buchanan C, Tran T, Riordan M, Coe G, Byrd J, Ambardekar A, Pal J, Cornwell W K,
Abstract
PURPOSE:
Characterize individual components of VO (cardiac output [Qc] and (A-V)O difference) at rest and during submaximal and peak exercise among CF-LVAD patients.
METHODS:
Thirteen CF-LVAD participants (56±12 yrs, 12 male) and 9 healthy controls 42±12 yrs, 7 male) completed invasive cardiopulmonary exercise testing on a stationary upright cycle ergometer. Hemodynamic data and gas-exchange parameters were collected at rest, two submaximal levels of exercise below the ventilatory threshold, and peak workload. Swan-Ganz catheterization was performed to determine baseline hemodynamics. A conductance catheter was then used to calculate Qc at each stage of exercise. VOwas recorded on a breath-by-breath basis by indirect calorimetry. Blood pressure was continuously monitored by arterial line. Musculoskeletal performance was assessed by calculating the (A-V)O difference at each stage of exercise.
RESULTS:
Cohort characteristics and baseline demographics are demonstrated in table 1. Peak VO among CF-LVAD participants was severely reduced compared to healthy controls. When CF-LVAD participants were matched to healthy controls by workload according to VO quartiles, the CF-LVAD participants had a hypotensive response to exercise, as well as a blunted rise in Qc, with modest increases only from rest to submaximal exercise (figure 1). As a result, (A-V)O difference was higher for CF-LVAD participants than healthy controls at each VO quartile.
CONCLUSION:
Due to impairments in contractile reserve, CF-LVAD participants exhibit a greater (A-V)O difference than healthy individuals when exercising at similar workloads.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
-
Novel Plug Device for HeartMate 3 Explantation: First Clinical Results.
J Heart Lung Transplant2020 Apr;39(4S):S123. doi: S1053-2498(20)31028-7.
Mariani S, Hanke J, Meyer A, Schöde A, Li T, Merzah A, Chatterjee A, Dogan G, Dogan G, Haverich A, Schmitto J D,
Abstract
PURPOSE:
Recovery after left ventricular assist device (LVAD) implantation occurs in 1-5% of patients, allowing for LVAD explantation. Considering the growth in LVAD numbers, we can expect an increase of potential candidates to LVAD explantation in the near future. Therefore, there is an important need for novel less invasive explantation strategies. Herein, we report the first series of patients who underwent HeartMate 3 (HM3) explantation with the use of a custom-made apical ring plug.
METHODS:
We retrospectively reviewed data of patients who underwent HeartMate3 (HM3) explantation with a new apical ring plug between September 2018 and September 2019. All patients underwent standardized weaning protocol including echocardiography (at rest and under exercise) and right heart catheterization. Apical ring plug positioning was performed through left lateral thoracotomy under cardiopulmonary bypass support. This study analysed perioperative survival, Intensive Care Unit (ICU) stay, postoperative bleeding, perioperative transfusions, infections, thrombosis and strokes.
RESULTS:
Four patients were included. Median age was 44.5 years (M:F= 3:1) and time on LVAD support was 21 months (Table 1). All surgical procedures were uneventful and without technical difficulties. Transfusions and blood loss were minimal. No hemorrhagic, embolic or infective events were recorded. Anticoagulation with heparin was started 6 hours after surgery as bridge to oral anticoagulation (INR: 2-2.5). All patients were discharged from ICU. Three of them were discharged within 48 hours from surgery, one patient required re-intubation for pneumonia and was successfully discharged from ICU after 10 days.
CONCLUSION:
This novel plug device for HM3 explantation was successfully and safely implanted in this first patient series. Even if no plug-related complications were recorded, the plug use should still be considered off-label and wider studies are required before allowing its application on larger populations.
Copyright © 2020. Published by Elsevier Inc.
Guarda su PubMed
