Impact of peak respiratory exchange ratio on the prognostic power of symptoms-limited exercise testing using Bruce protocol in patients with Fontan physiology

2020 ◽  
pp. 1-8
Author(s):  
Jianli Niu ◽  
Aliana Godoy ◽  
Talya Kadish ◽  
Bibhuti B. Das
Keyword(s):  
Oxygen Consumption ◽  
Exercise Testing ◽  
Respiratory Exchange Ratio ◽  
Peak Oxygen Consumption ◽  
Cardiopulmonary Exercise ◽  
Bruce Protocol ◽  
Fontan Physiology ◽  
The Impact ◽  
Fontan Patients

Abstract Objectives: We evaluated the impact of peak respiratory exchange ratio on the prognostic values of cardiopulmonary exercise variables during symptoms-limited incremental exercise tests in patients with Fontan physiology. Methods: Retrospective single-centre chart review study of Fontan patients who underwent exercise testing using the Bruce protocol between 2014 and 2018 and follow-up. Results: A total of 34 patients (age > 18 years) had a Borg score of ≥7 on the Borg 10-point scale, but only 50% of patients achieved a peak respiratory exchange ratio of ≥ 1.10 (maximal test). Peak oxygen consumption, percent-predicted peak oxygen consumption, and peak oxygen consumption at the ventilatory threshold was reduced significantly in patients with a peak respiratory exchange ratio of < 1.10. Peak oxygen consumption and percent-predicted peak oxygen consumption was positively correlated with peak respiratory exchange ratio values (r = 0.356, p = 0.039). After a median follow-up of 21 months, cardiac-related events occurred in 16 (47%) patients, with no proportional differences in patients due to their respiratory exchange ratio (odds ratio, 0.62; 95% CI: 0.18–2.58; p = 0.492). Multivariate Cox proportional hazard analysis showed percent-predicted peak oxygen consumption, peak heart rate, and the oxygen uptake efficient slope were highly related to the occurrence of events in patients only with a peak respiratory exchange ratio of ≥ 1.10. Conclusions: The value of peak cardiopulmonary exercise variables is limited for the determination of prognosis and assessment of interventions in Fontan patients with sub-maximal effort. Our findings deserve further research and clinical application.

Abstract 17232: Cardiopulmonary Exercise Testing in Diabetic Chronic Heart Failure Patients With Microalbuminuria

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Thida tabucanon ◽  
Timothy Engelman ◽  
Sanjeeb S Bhattacharya ◽  
J Emanuel Finet ◽  
Wai Hong W Tang
Keyword(s):  
Oxygen Consumption ◽  
Exercise Testing ◽  
Beta Blocker ◽  
Multivariable Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Cardiopulmonary Exercise ◽  
History Of

Introduction: Microalbuminuria can be a presentation of microvascular complication in diabetes mellitus (DM). Hypothesis: Microalbuminuria is associated with impaired exercise performance in chronic HF with DM patients. Methods: We retrospectively analyzed a cardiopulmonary exercise testing (CPET) database in 255 chronic HF patients with DM that had urine microalbumin test between December 2012 and September 2019. Demographic data and CPET parameters were compared between the patients who had and had not microalbuminuria which was defined by microalbumin/creatinine ratio ≥ 30 mg/g. Peak oxygen consumption (peak VO 2 ) ≤ 14 ml/kg/min and ≤ 12 ml/kg/min if had history of beta-blocker uses were classified as low peak VO 2 and used in multivariable analysis. Results: There were a total 92 patients (36.1%) that had microalbuminuria. Mean age was not significant different between the patients with and without microalbuminuria (57.7 vs 59.4 years, p = 0.26). The patients with microalbuminuria had lower body mass index (BMI; 30.8 vs. 32.7 kg/m 2 , p = 0.014) and had more history of beta-blocker (BB) uses (81.5% vs. 69.3%, p = 0.038), no significant different in other medication uses. Left ventricular ejection fraction (LVEF) was significant lower in patients with microalbuminuria (35.8% vs. 41.5%, p = 0.028). The patients with microalbuminuria had significant higher prevalence of low peak VO 2 (45.7% vs. 30.1%, p = 0.015) and lower peak stroke work (VO 2 /HR; 11.5 vs. 12.8 ml/ beat, p = 0.008). No significant different in ventricular efficiency slope (VE/VCO 2 ; 37.1 vs. 35.4, p = 0.094), Multivariable analysis showed that proteinuria was independently associated with low peak VO 2 after adjusted for age, sex, BMI LVEF, history of BB uses, VE/VCO 2 and HR at peak VO 2 , (odds ratio = 3.83, p < 0.001). Conclusions: Microalbuminuria was independently associated with low peak oxygen consumption in chronic HF with DM patients.

scholarly journals The Role of Cardiopulmonary Exercise Test in IPF Prognosis

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Christina Triantafillidou ◽  
Effrosyni Manali ◽  
Panagiotis Lyberopoulos ◽  
Likourgos Kolilekas ◽  
Konstantinos Kagouridis ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Exercise Testing ◽  
Risk Estimation ◽  
Minute Ventilation ◽  
Cardiopulmonary Exercise Testing ◽  
Lung Mechanics ◽  
Peak Oxygen Consumption ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise

Background. In IPF, defects in lung mechanics and gas exchange manifest with exercise limitation due to dyspnea, the most prominent and disabling symptom.Aim. To evaluate the role of exercise testing through the 6MWT (6-minute walk test) and CPET (cardiopulmonary exercise testing) in the survival of patients with IPF.Methods. This is a prospective, observational study evaluating in 25 patients the relationship between exercise variables through both the 6MWT and CPET and survival.Results. By the end of the observational period 17 patients were alive (33% mortality). Observation ranged from 9 to 64 months. VE/VCO2slope (slope of relation between minute ventilation and CO2production), VO2peak/kg (peak oxygen consumption/kg), VE/VCO2ratio at anaerobic threshold, 6MWT distance, desaturation, and DLCO% were significant predictors of survival while VE/VCO2slope and VO2peak/kg had the strongest correlation with outcome. The optimal model for mortality risk estimation was VO2peak/kg + DLCO% combined. Furthermore, VE/VCO2slope and VO2peak/kg were correlated with distance and desaturation during the 6MWT.Conclusion. The integration of oxygen consumption and diffusing capacity proved to be a reliable predictor of survival because both variables reflect major underlying physiologic determinants of exercise limitation.

Cardiopulmonary Exercise Testing — A Survey of Current Use in England

2009 ◽  
Vol 10 (4) ◽  
pp. 275-278 ◽  
Author(s):  
Joanna C Simpson ◽  
Hannah Sutton ◽  
Michael PW Grocott
Keyword(s):  
Risk Assessment ◽  
Oxygen Consumption ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Perioperative Risk ◽  
Peak Oxygen Consumption ◽  
Telephone Contact ◽  
Cardiopulmonary Exercise ◽  
Oxygen Oxygen ◽  
Patients At Risk

Cardiopulmonary exercise testing (CPET) is an objective method of evaluating integrated cardiopulmonary function. Increasingly, it is being used for perioperative risk assessment. This survey was performed between October and December 2008 to identify where and how CPET is being used for perioperative risk assessment in England. Direct telephone contact was made with the Department of Anaesthesia in 154/173 (89%) of NHS Trusts in England in order to ascertain the availability of a CPET service. One hundred and fifteen (66%) Trusts confirmed whether or not they have a CPET service −30 (17%) Trusts have a CPET service and 12 (7%) are in the process of setting one up. These Trusts were sent a nine-question survey, which was completed by 15 Trusts. Criteria for selecting patients for CPET testing included type of surgery, age and co-morbidities. All trusts use anaerobic threshold (AT) values to identify patients at risk of adverse outcome, though many also used additional variables including peak oxygen consumption, ventilatory equivalents for carbon dioxide, ventilatory equivalents for oxygen, oxygen pulse, oxygen consumption/power slope and breathing reserve. Different numerical threshold values were used in different centres. Patients identified as high risk were managed in a variety of ways, including referral for specialist advice, modifying or cancelling surgery, modified perioperative care and augmented postoperative care (in a level 2 or 3 environment). This survey clearly highlights significant inconsistency in the use of CPET for perioperative risk assessment and suggests that some standardisation of practice may be of value.

scholarly journals Revisiting and Implementing the Weber and Ventilatory Functional Classifications in Heart Failure by Cardiopulmonary Imaging Phenotyping

2021 ◽  
Author(s):  
Marco Guazzi ◽  
Barry Borlaug ◽  
Marco Metra ◽  
Maurizio Losito ◽  
Francesco Bandera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Carbon Dioxide ◽  
Oxygen Consumption ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Carbon Dioxide Production ◽  
Peak Oxygen Consumption ◽  
Cardiopulmonary Exercise

Background In heart failure, the exercise gas exchange Weber (A to D) and ventilatory classifications (VC‐1 to VC‐4) historically define disease severity and prognosis. However, their applications in the modern heart failure population of any left ventricular ejection fraction combined with hemodynamics are undefined. We aimed at revisiting and implementing these classifications by cardiopulmonary exercise testing imaging. Methods and Results 269 patients with heart failure with reduced (n=105), mid‐range (n=88) and preserved (n=76) ejection fraction underwent cardiopulmonary exercise testing imaging, primarily assessing the cardiac output (CO), mitral regurgitation, and mean pulmonary arterial pressure (mPAP)/CO slope. Within both classes, a progressively lower exercise CO, higher mPAP/CO slopes, and mitral regurgitation ( P <0.01 all) were observed. After adjustment for age and sex, Cox proportional hazard regression analyses showed that Weber (hazard ratio [HR], 2.9; 95% CI, 1.8–4.7; P <0.001) and ventilatory classes (HR, 1.4; 95% CI, 1.1–2.0; P =0.017) were independently associated with outcome. The best stratification was observed when combining Weber (A/B or C/D) with severe ventilation inefficiency (VC‐4) (HR, 2.7; 95% CI, 1.6–4.8; P <0.001). At multivariable analysis the best hemodynamic determinants of peak oxygen consumption and ventilation to carbon dioxide production slope were CO (β‐coefficient, 0.72±0.16; P <0.001) and mPAP/CO slope (β‐coefficient, 0.72±0.16; P <0.001), respectively. Conclusions In the contemporary heart failure population, the Weber and ventilatory classifications maintain their prognostic ability, especially when combined. Exercise CO and mPAP/CO slope are the best predictors of peak oxygen consumption and ventilation to carbon dioxide production slope classifications representing the main targets of interventions to impact functional class and, likely, event rate.

Reproducibility of cardiac power output and other cardiopulmonary exercise indices in patients with chronic heart failure

2011 ◽  
Vol 122 (4) ◽  
pp. 175-181 ◽  
Author(s):  
Djordje G. Jakovljevic ◽  
Petar M. Seferovic ◽  
David Nunan ◽  
Gay Donovan ◽  
Michael I. Trenell ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Oxygen Consumption ◽  
Chronic Heart Failure ◽  
Power Output ◽  
Respiratory Exchange Ratio ◽  
Maximal Exercise ◽  
Peak Oxygen Consumption ◽  
Cardiopulmonary Exercise ◽  
Cardiac Power

Cardiac power output is a direct measure of overall cardiac function that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the reproducibility of cardiac power output and other more commonly reported cardiopulmonary exercise variables in patients with chronic heart failure. Metabolic, ventilatory and non-invasive (inert gas re-breathing) central haemodynamic measurements were undertaken at rest and near-maximal exercise of the modified Bruce protocol in 19 patients with stable chronic heart failure. The same procedure was repeated 7 days later to assess reproducibility. Cardiac power output was calculated as the product of cardiac output and mean arterial pressure. Resting central haemodynamic variables demonstrate low CV (coefficient of variation) (ranging from 3.4% for cardiac output and 5.6% for heart rate). The CV for resting metabolic and ventilatory measurements ranged from 8.2% for respiratory exchange ratio and 14.2% for absolute values of oxygen consumption. The CV of anaerobic threshold, peak oxygen consumption, carbon dioxide production and respiratory exchange ratio ranged from 3.8% (for anaerobic threshold) to 6.4% (for relative peak oxygen consumption), with minute ventilation having a CV of 11.1%. Near-maximal exercise cardiac power output and cardiac output had CVs of 4.1 and 2.2%, respectively. Cardiac power output demonstrates good reproducibility suggesting that there is no need for performing more than one cardiopulmonary exercise test. As a direct measure of cardiac function (dysfunction) and an excellent prognostic marker, it is strongly advised in the assessment of patients with chronic heart failure undergoing cardiopulmonary exercise testing.

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