Quantitative assessment of thallium myocardial washout rate: Importance of peak heart rate and lung thallium uptake in defining normal values

Background Chronotropic insufficiency (CI) is defined as the inability of the heart to increase its rate commensurate with increased demand. Exercise CI is an established predictor of major adverse cardiovascular events in patients with cardiovascular diseases. Aim The aim of this study was to evaluate how exercise CI phenotypes different levels of cardiovascular risk and how it may better perform in defining cardiovascular risk when analysed in the context of cardiopulmonary exercise test (CPET)-derived measures and standard echocardiography in a healthy population with variable cardiovascular risk profile. Methods Apparently healthy individuals ( N = 702, 53.8% females) with at least one major cardiovascular risk factor (MCVRF; hypertension, diabetes, tabagism, dyslipidaemia, body mass index > 25), enrolled in the Euro-EX prevention trial, underwent CPET. CI was defined as the inability to reach 80% of the chronotropic index, that is, the ratio of peak heart rate – rest heart rate/peak heart rate – age predicted maximal heart rate (AMPHR: 220 – age), they were divided into four groups according to the heart rate reserve (<80%>) and respiratory gas exchange ratio (RER; < 1.05>) as a marker of achieved maximal performance. Subjects with a RER < 1.05 ( n = 103) were excluded and the final population ( n = 599) was divided into CI group ( n = 472) and no-CI group ( n = 177). Results Compared with no-CI, CI subjects were more frequently females with a history of hypertension in a high rate. CI subjects also exhibited a significantly lower peak oxygen uptake (VO2) and circulatory power and an echocardiographic pattern indicative of higher left atrial volume index and left ventricular mass index. An inverse stepwise relationship between heart rate reserve and number of MCVRFs was observed (one MCVRF: 0.71 ± 0.23; two MCVRFs: 0.68 ± 0.24, three MCVRFs: 0.64 ± 0.20; four MCVRFs: 0.64 ± 0.23; five MCVRFs: 0.57 ± 18; p < 0.01). In multivariate analysis the only variable found predicting CI was peak VO2 ( p < 0.05; odds ratio 0.91; confidence interval 0.85–0.97). Conclusions In a population of apparently healthy subjects, exercise CI is common and phenotypes the progressive level of cardiovascular risk by a tight relationship with MCVRFs. CI patients exhibit some peculiar abnormal exercise gas exchange patterns (lower peak VO2 and exercise oscillatory ventilation) and echo-derived measures (higher left atrium size and left ventricle mass) that may well anticipate evolution toward heart failure.

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Inaccurate normal values of heart rate variability spectral analysis in newborn infants

The American Journal of Cardiology ◽

10.1016/s0002-9149(02)02399-8 ◽

2002 ◽

Vol 90 (3) ◽

pp. 346 ◽

Cited By ~ 20

Author(s):

Jacques-Olivier Fortrat

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Spectral Analysis ◽

Normal Values ◽

Newborn Infants

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Abstract P313: De-Conditioning Adversely Affects Subclinical Atherosclerosis in a Unique Cohort of Spinal Cord Injury

Circulation ◽

10.1161/circ.125.suppl_10.ap313 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Yaga Szlachcic ◽

Rodney H Adkins ◽

Jamie C Reiter ◽

Yanjie Li ◽

Howard N Hodis

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Subclinical Atherosclerosis ◽

Cvd Risk Factors ◽

Peak Heart Rate ◽

Cvd Risk ◽

Cord Injury ◽

Aerobic Conditioning

Introduction: Physical activity is presumed to improve cardiovascular disease (CVD), of which carotid artery intima-media thickness (CIMT) is a common indicator. Individuals with spinal cord injury (SCI) have limited mobility and therefore an expected increased risk for CVD. The purpose of this study was to determine which CVD risk factors predict CIMT among women with SCI, with the ultimate goal of targeting therapy to improve CVD in this population. Methods: One hundred twenty-two women with SCI who attended an outpatient SCI clinic and met inclusion and exclusion criteria participated in this study. SCI was categorized into 1 of 4 categories: complete tetraplegia, incomplete tetraplegia, complete paraplegia, and incomplete paraplegia. Maximum heart rate and VO2 max were obtained using bicycle ergometry with ventilatory gas exchange and continuous electrocardiogram. Hierarchical regression was used to predict CIMT, with the first block including demographic variables (age, race, smoking status) and the second block including physiologic variables (total cholesterol, heart rate, VO2 max, BMI, fasting serum glucose, hemoglobin A1c, and blood pressure). Results: Similar findings were observed for left and right CIMT, therefore only results from right CIMT are reported. The overall model was significant, F(16,46)=8.53, p=.000. Adjusted R square was .54 for the first block of variables and increased significantly (p=.006) to .66 when the second block of variables was added. Significant predictors at alpha=.05 included age (beta=.51, t=4.79, p=.000) and max/peak heart rate (beta=−.336, t=−2.39, p=.02). At alpha=.10, A1c was significant (beta=.187, t=1.99, p=.053). Conclusions: Although low aerobic conditioning is a purported CVD risk factor, quantitative measurements of such lack a demonstrable relationship with subclinical atherosclerosis (CIMT), perhaps because of its reduced importance relative to other CVD risk factors in a mobile population. We found expected relationships with CIMT in our SCI population (i.e., age), however we also found a quantitative measure of aerobic conditioning (max/peak heart rate) to be associated with CIMT. Our data indicate that SCI individuals may bear a greater CVD burden from cardiac de-conditioning than the general population and that investigation of a cohort with mobility limitation may provide a unique opportunity to study the impact of physical conditioning on CVD risk.

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Abstract P127: Gender and Fitness Status Influence Age-related Decline in Peak Heart Rate Achievement: Insight From the FIT Cohort

Circulation ◽

10.1161/circ.133.suppl_1.p127 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Haitham Ahmed ◽

Di Zhao ◽

Eliseo Guallar ◽

Michael J Blaha ◽

Clinton A Brawner ◽

...

Keyword(s):

Heart Rate ◽

Age Groups ◽

Peak Heart Rate ◽

Cross Sectional ◽

Fitness Level ◽

Age Related ◽

Henry Ford ◽

Exercise Treadmill ◽

History Of ◽

Separate Regression

Background: The declines in peak heart rate (HR) and fitness level with age are related; however, whether this association differs based on gender is not well appreciated. In a large cross-sectional cohort of women and men referred for a clinically indicated exercise treadmill test (ETT), we set out to determine whether the decrease in peak HR by age varied by gender (and fitness) in the Henry Ford Exercise Testing (FIT) project. Methods: We analyzed data on 38,196 apparently-healthy patients aged 18-96 [mean age 51 ± 12 yrs, 25% black, 48% women] who completed an ETT. Those with history of coronary heart disease, congestive heart failure, diabetes on medications, atrial fibrillation or flutter, or taking AV nodal blocking medications were excluded. Being “fit” was defined as achieving ≥ the median MET level for each sex/age-decile group. Peak HR vs age was plotted, and regression lines were used to determine the intercept and slope for each group. Results: Men had higher peak HR than women but with a greater decline over time; the respective intercepts and slopes for peak HR estimates were 202.9 and 0.90 for men and 197.3 and 0.80 for women, (p-interaction = 0.023). Fit people also started out with higher peak HR but approached unfit people at higher age groups; respective intercept and slope by fitness status were 203.0 and 0.87 for fit and 194.7 and 0.83 for unfit (p-interaction <0.001). Separate regression lines were generated for categories of fit men/unfit men, fit women/unfit women ( Figure ). Fit and unfit men had similar declines in peak HR with increasing age (slope=0.92); whereas fit women (slope=0.81) had a slightly greater decline in peak HR with increasing age than unfit women (slope=0.73). However, peak absolute HR for fit people still remains higher than for unfit people even into elderly ages. Conclusion: In this cross-sectional cohort of patients referred for a clinical ETT, we found that the age-related decline in peak HR is influenced by both gender and fitness status.

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Competition-Based Heart Rate, Training Load, and Time Played Above 85% Peak Heart Rate in NCAA Division I Women's Basketball

The Journal of Strength and Conditioning Research ◽

10.1519/jsc.0000000000002876 ◽

2018 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 3

Author(s):

Gabriel J. Sanders ◽

Brian Boos ◽

Jessica Rhodes ◽

Roger O. Kollock ◽

Corey A. Peacock

Keyword(s):

Heart Rate ◽

Ncaa Division I ◽

Training Load ◽

Division I ◽

Peak Heart Rate ◽

Women's Basketball

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Reliability and Construct Validity of Yo-Yo Tests in Untrained and Soccer-Trained Schoolgirls Aged 9–16

Pediatric Exercise Science ◽

10.1123/pes.2015-0212 ◽

2016 ◽

Vol 28 (2) ◽

pp. 321-330 ◽

Cited By ~ 15

Author(s):

Susana C. A. Póvoas ◽

Carlo Castagna ◽

José Manuel da Costa Soares ◽

Pedro Silva ◽

Manuel Coelho-e-Silva ◽

...

Keyword(s):

Heart Rate ◽

Construct Validity ◽

Coefficient Of Variation ◽

Intermittent Exercise ◽

Intraclass Correlation ◽

Soccer Players ◽

Confidence Limits ◽

Peak Heart Rate ◽

Level 1 ◽

Level 2

Purpose:The reliability and construct validity of three age-adapted-intensity Yo-Yo tests were evaluated in untrained (n = 67) vs. soccer-trained (n = 65) 9- to 16-year-old schoolgirls.Methods:Tests were performed 7 days apart for reliability (9- to 11-year-old: Yo-Yo intermittent recovery level 1 children’s test; 12- to 13-yearold: Yo-Yo intermittent endurance level 1; and 14- to 16-year-old: Yo-Yo intermittent endurance level 2).Results:Yo-Yo distance covered was 40% (776 ± 324 vs. 556 ± 156 m), 85% (1252 ± 484 vs. 675 ± 252 m) and 138% (674 ± 336 vs. 283 ± 66 m) greater (p ≤ .010) for the soccer-trained than for the untrained girls aged 9–11, 12–13 and 14–16 years, respectively. Typical errors of measurement for Yo-Yo distance covered, expressed as a percentage of the coefficient of variation (confidence limits), were 10.1% (8.1–13.7%), 11.0% (8.6–15.4%) and 11.6% (9.2–16.1%) for soccer players, and 11.5% (9.1–15.8%), 14.1% (11.0–19.8%) and 10.6% (8.5–14.2%) for untrained girls, aged 9–11, 12–13 and 14–16, respectively. Intraclass correlation coefficient values for test-retest were excellent (0.795–0.973) in both groups. No significant differences were observed in relative exercise peak heart rate (%HRpeak) between groups during test and retest.Conclusion:The Yo-Yo tests are reliable for determining intermittent-exercise capacity and %HRpeak for soccer players and untrained 9- to 16-year-old girls. They also possess construct validity with better performances for soccer players compared with untrained age-matched girls, despite similar %HRpeak.

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Quantitative assessment of autonomic nervous system responses induced by graded training workloads in healthy elderly, through indices obtained from heart rate variability analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.3045 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Fenici ◽

M Picerni ◽

D Brisinda

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Nervous System ◽

Autonomic Nervous System ◽

Quantitative Assessment ◽

Training Session ◽

Time Varying ◽

Autonomic Nervous ◽

Healthy Elderly ◽

Hrv Analysis

Abstract Background Quantitative assessment of individual body adaptability to physical training performed with the purposes of health maintenance is particularly necessary in the elderly age, to avoid the risk of overstrain induced by inappropriate exercises workload and physical stress. For that purpose, heart rate monitors and heart rate variability (HRV) analysis are nowadays commercially available. However, their reliability to guide individualized fitness training in elderly people needs to be tested, knowing that users might not have medical education. Objective To preliminary quantify autonomic nervous system (ANS) responses to graded physical effort and recovery in healthy elderly basing on the parasympathetic nervous system (PNSi), the sympathetic nervous system (SNSi) and the stress (STRi) indices, derived by short-term and time-varying HRV analysis. Methods ECG of a 75 healthy male subject was monitored, from April to November 2020, during three times/week training sessions with a professional bike–ergometer. Each session consisted of 10 minutes baseline rest, 5 minutes warm-up, 30 minutes work and 10 minutes recovery. According to age, the training workload was graded from low (65–75 watt/min), to moderate (75–85 watt/min), semi-intensive (85–95 watt/min) and intensive (95–110 watt/min). For this pilot study, ECG data of only 40 training sessions (10 sessions for each workload to evaluate reproducibility) were analyzed with Kubios Premium software (version 3.4.1), in the time (TD) and frequency (FD) domains, with nonlinear (NL) methods and with time-varying (TV) algorithms. Short-time HRV was calculated from 2-minutes intervals. The PNSi, SNSi and STRi induced by each workload were averaged and compared. Results Average values of PNSi, SNSi and STRi were significantly different (p<0.05) among training sessions carried out with different workloads (Table 1A) and among measurements obtained at rest, at every 5 minutes step of each 30 minutes training session, and at 1 and 5 minutes of recovery (Table 1B). Interestingly, the correlation between SNSi and STRi was strictly linear (R= 0,98), whereas that between PNSi and STRi was better fitted by a cubic function (R=0,82 with cubic vs 0.68 with linear function), when evaluated either as a function of the sessions' workloads (Figure 1A), or of four time-intervals of each training session (Figure 1B). PNSi and SNSi were inversely correlated, with cross-point at about 15 minutes of training and 75 watt/min workload. Conclusions The calculation of PNSi, SNSi and STRi from HRV analysis is an efficient method for quick and simplified quantitative assessment of dynamic ASN adaptation to effort-induced stress from HRV analysis. If confirmed, the method may be useful for safer and even remote monitoring of training/rehabilitation in elderly. However, more detailed evaluation of spectral and NL parameters may be necessary to interpret more complex patterns of abnormal cases. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Figure 1

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Verification phase as a useful tool in the determination of the maximal oxygen uptake of distance runners

Applied Physiology Nutrition and Metabolism ◽

10.1139/h06-023 ◽

2006 ◽

Vol 31 (5) ◽

pp. 541-548 ◽

Cited By ~ 53

Author(s):

Adrian W. Midgley ◽

Lars R. McNaughton ◽

Sean Carroll

Keyword(s):

Heart Rate ◽

Oxygen Uptake ◽

Maximal Oxygen Uptake ◽

Peak Oxygen Uptake ◽

Treadmill Running ◽

Distance Runners ◽

Peak Heart Rate ◽

Incremental Test ◽

Volitional Exhaustion

This study investigated the utility of a verification phase for increasing confidence that a “true” maximal oxygen uptake had been elicited in 16 male distance runners (mean age (±SD), 38.7 (± 7.5 y)) during an incremental treadmill running test continued to volitional exhaustion. After the incremental test subjects performed a 10 min recovery walk and a verification phase performed to volitional exhaustion at a running speed 0.5 km·h–1 higher than that attained during the last completed stage of the incremental phase. Verification criteria were a verification phase peak oxygen uptake ≤ 2% higher than the incremental phase value and peak heart rate values within 2 beats·min–1 of each other. Of the 32 tests, 26 satisfied the oxygen uptake verification criterion and 23 satisfied the heart rate verification criterion. Peak heart rate was lower (p = 0.001) during the verification phase than during the incremental phase, suggesting that the verification protocol was inadequate in eliciting maximal values in some runners. This was further supported by the fact that 7 tests exhibited peak oxygen uptake values over 100 mL·min–1 (≥ 3%) lower than the peak values attained in the incremental phase. Further research is required to improve the verification procedure before its utility can be confirmed.

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