Cardiac Reserve and Exercise Capacity: Insights from Combined Cardiopulmonary and Exercise Echocardiography Stress Testing

2021 ◽  
Vol 34 (1) ◽  
pp. 38-50
Author(s):  
Nicola Riccardo Pugliese ◽  
Nicolò De Biase ◽  
Lorenzo Conte ◽  
Luna Gargani ◽  
Matteo Mazzola ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Stress Testing ◽  
Exercise Echocardiography ◽  
Cardiac Reserve

scholarly journals Effect of Beta-Blocker Therapy, Maximal Heart Rate, and Exercise Capacity During Stress Testing on Long-Term Survival (from The Henry Ford Exercise Testing Project)

2016 ◽  
Vol 118 (11) ◽  
pp. 1751-1757 ◽  
Author(s):  
Rupert K. Hung ◽  
Mouaz H. Al-Mallah ◽  
Seamus P. Whelton ◽  
Erin D. Michos ◽  
Roger S. Blumenthal ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Capacity ◽  
Exercise Testing ◽  
Beta Blocker ◽  
Stress Testing ◽  
Maximal Heart Rate ◽  
Term Survival ◽  
Blocker Therapy ◽  
Henry Ford

scholarly journals Impaired Cardiac Reserve and Abnormal Vascular Load Limit Exercise Capacity in Chronic Thromboembolic Disease

2019 ◽  
Vol 12 (8) ◽  
pp. 1444-1456 ◽  
Author(s):  
Mathias Claeys ◽  
Guido Claessen ◽  
Andre La Gerche ◽  
Thibault Petit ◽  
Catharina Belge ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Thromboembolic Disease ◽  
Cardiac Reserve ◽  
Load Limit ◽  
Chronic Thromboembolic Disease

4097Validation of seven different exercise treadmill stress testing protocols in a large 25-year stress testing registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Harb ◽  
V M Menon ◽  
W U Wu ◽  
P C Cremer ◽  
L C Cho ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Stress Testing ◽  
Multivariable Analysis ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Metabolic Equivalents ◽  
The Individual ◽  
Stage Renal Disease ◽  
End Stage ◽  
Testing Protocols

Abstract Background While the Bruce protocol has been extensively validated, other modified exercise protocols with less workload burden are commonly used, though their prognostic value is not well established. Purpose We sought to assess whether exercise capacity (or workload achieved in metabolic equivalents of task [METs]) remains predictive of mortality across various exercise stress testing protocols. Methods In a 25-year stress testing registry spanning from 1991 to 2015, we identified 120,705 patients who underwent 7 different standardized symptom-limited exercise stress testing protocols: Bruce, Modified Bruce, Cornell 0%, Cornell 5%, Cornell 10%, Naughton, and modified Naughton. The choice of the protocol was dependent on the supervising exercise physiologist according to purpose of the test and the individual patient. The primary outcome was all-cause mortality. Results Mean age was 53.3±12.5 years and 59% were male. There were 74953 Bruce, 8368 modified Bruce, 2648 Cornell 0%, 9972 Cornell 5%, 20425 Cornell 10% 1226 Naughton, and 3113 modified Naughton individual protocols. A total of 8426 death occurred over 8.7 years of mean follow-up duration. Figure 1 shows that there was an inverse relationship between peak METs achieved and mortality across all 7 protocols. On multivariable analysis, increasing METs remained protective against death [adjusted HR of 0.46; 95% CI (0.44 - 0.48); p<0.001] even after adjusting for the protocol chosen, age, gender, hypertension, diabetes, coronary disease, end-stage renal disease, smoking, and statin use. METS vs. mortality by protocol Conclusion Across 7 different exercise protocols with various workloads, the predicted exercise capacity remained predictive of mortality irrespective of the protocol chosen, patients' demographics and comorbidities. Different testing choices likely represent different estimated functional capacity.

scholarly journals Decreased pulmonary vascular distensibility in adolescents conceived by in vitro fertilization

2019 ◽  
Vol 34 (9) ◽  
pp. 1799-1808
Author(s):  
K Forton ◽  
Y Motoji ◽  
B Pezzuto ◽  
S Caravita ◽  
A Delbaere ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Aerobic Exercise ◽  
Ventricular Function ◽  
Exercise Capacity ◽  
Right Ventricular Function ◽  
Exercise Echocardiography ◽  
Lung Diffusion ◽  
Diffusion Capacity ◽  
Aerobic Exercise Capacity

Abstract STUDY QUESTION What is the functional relevance of decreased pulmonary vascular distensibility in adolescents conceived by IVF? SUMMARY ANSWER Children born by IVF have a slight decrease in pulmonary vascular distensibility observed during normoxic exercise that is not associated with altered right ventricular function and aerobic exercise capacity. WHAT IS KNOWN ALREADY General vascular dysfunction and increased hypoxic pulmonary hypertension have been reported in ART children as compared to controls. Pulmonary hypertension or decreased pulmonary vascular distensibility may affect right ventricular function and thereby possibly limit maximal cardiac output and aerobic exercise capacity. STUDY DESIGN, SIZE, DURATION This prospective case-control study enrolled 15 apparently healthy adolescents conceived by IVF/ICSI after fresh embryo transfer paired in a 2 to 1 ratio to 30 naturally conceived adolescents between March 2015 and May 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Fifteen IVF/ICSI adolescents and 30 controls from singleton gestations matched by age, gender, weight, height and physical activity underwent exercise echocardiography, lung diffusion capacity measurements and a cycloergometer cardiopulmonary exercise test. A pulmonary vascular distensibility coefficient α was determined from the pulmonary arterial pressure (PAP) versus cardiac output (Q) relationships. Pulmonary capillary volume (Vc) was calculated from single breath nitric oxide and carbon monoxide lung diffusion capacity measurements (DLCO and DLNO) at rest and during exercise (100 W). Eight of the IVF subjects and eight controls underwent a 30 min hypoxic challenge at rest with a fraction of inspired oxygen of 0.12 to assess hypoxic pulmonary vasoconstriction. MAIN RESULTS AND THE ROLE OF CHANCE In normoxia, oxygen uptake (VO2), blood pressure, DLCO, DLNO, echocardiographic indices of right ventricular function, Q and PAP at rest and during exercise were similar in both groups. However, IVF children had a lower pulmonary vascular distensibility coefficient α (1.2 ± 0.3 versus 1.5 ± 0.3%/mmHg, P = 0.02) and a blunted exercise-induced increase in Vc (24 versus 32%, P < 0.05). Hypoxic-induced increase in pulmonary vascular resistance in eight IVF subjects versus eight controls was similar. LIMITATIONS, REASONS FOR CAUTION The IVF cohort was small, and thus type I or II errors could have occurred in spite of careful matching of each case with two controls. ART evolved over the years, so that it is not certain that the presently reported subtle changes will be reproducible in the future. As the study was limited to singletons born after fresh embryo transfers, our observations cannot be extrapolated to singletons born after frozen embryo transfer. WIDER IMPLICATIONS OF THE FINDINGS The present study suggests that adolescents conceived by IVF have preserved right ventricular function and aerobic exercise capacity despite a slight alteration in pulmonary vascular distensibility as assessed by two entirely different methods, i.e. exercise echocardiography and lung diffusing capacity measurements. However, the long-term prognostic relevance of this slight decrease in pulmonary vascular distensibility needs to be evaluated in prospective large scale and long-term outcome studies. STUDY FUNDING/COMPETING INTEREST(S) Dr Caravita was supported by an ERS PAH short term research training fellowship (STRTF2014-5264). Dr Pezzuto was funded by an Italian Society of cardiology grant. Dr Motoji was supported by a grant from the Cardiac Surgery Funds, Belgium. All authors have no conflicts of interests to declare.

scholarly journals Determinants of Exercise Capacity in the Hypertensive Elderly. A Study Based on the Assessment of Cardiac Reserve by Dipyridamole Radionuclide Angiography.

1995 ◽  
Vol 59 (8) ◽  
pp. 547-555 ◽  
Author(s):  
Hiromi Seo ◽  
Taishiro Chikamori ◽  
Toshikazu Yabe ◽  
Naoki Akagi ◽  
Toshio Ozawa ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Radionuclide Angiography ◽  
Cardiac Reserve

Outcomes of Patients With Reduced Exercise Capacity at Time of Exercise Echocardiography

2004 ◽  
Vol 79 (6) ◽  
pp. 750-757 ◽  
Author(s):  
Robert B. McCully ◽  
Veronique L. Roger ◽  
Steve R. Ommen ◽  
Douglas W. Mahoney ◽  
Kelli N. Burger ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Exercise Echocardiography

scholarly journals Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy

2019 ◽  
Vol 27 (17) ◽  
pp. 1821-1831 ◽  
Author(s):  
Luca Ghiselli ◽  
Alberto Marchi ◽  
Carlo Fumagalli ◽  
Niccolò Maurizi ◽  
Andrea Oddo ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Capacity ◽  
Exercise Performance ◽  
Cardiac Death ◽  
Predictive Accuracy ◽  
Multivariable Analysis ◽  
Peak Exercise ◽  
Exercise Echocardiography ◽  
Metabolic Equivalents ◽  
Age Related

Aims Exercise performance is known to predict outcome in hypertrophic cardiomyopathy (HCM), but whether sex-related differences exist is unresolved. We explored whether functional impairment, assessed by exercise echocardiography, has comparable predictive accuracy in females and males with HCM. Methods We retrospectively evaluated 292 HCM patients (46 ± 16 years, 72% males), consecutively referred for exercise echocardiography; 242 were followed for 5.9 ± 4.2 years. Results Peak exercise capacity was 6.5 ± 1.6 metabolic equivalents (METs). Sixty patients (21%) showed impaired exercise capacity (≤5 METs). Exercise performance was reduced in females, compared with males (5.6 ± 1.6 vs 6.9 ± 1.5 METs, p < 0.001; peak METs ≤ 5 in 40% vs 13%, p < 0.001), largely driven by a worse performance in women >50 years of age. At multivariable analysis, female sex was independently associated with impaired exercise capacity (odds ratio: 4.67; 95% confidence interval (CI): 1.83–11.90; p = 0.001). During follow-up, 24 patients (10%) met the primary endpoint (a combination of cardiac death, heart failure requiring hospitalization, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator discharge, resuscitated sudden cardiac death and cardioembolic stroke). Event-free survival was reduced in females ( p = 0.035 vs males). Peak METs were inversely related to outcome in males (hazard ratio (HR) per unit increase: 0.57; 95% CI: 0.39–0.84; p = 0.004) but not in females (HR: 1.22; 95% CI: 0.66–2.24; p = 0.53). Conclusions Female patients with HCM showed significant age-related impairment in functional capacity compared with males, particularly evident in post-menopausal age groups. While women were at greater risk of HCM-related complications and death, impaired exercise capacity predicted adverse outcome only in men. These findings suggest the need for sex-specific management strategies in HCM.

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