Determinants of oxygen uptake and prognostic factors in cardiopulmonary exercise test in patients with Fontan surgery

2021 ◽  
pp. 1-4
Author(s):  
Maria Martin Talavera ◽  
Begoña Manso ◽  
Pilar Cejudo Ramos ◽  
Maria Jose Rodriguez Puras ◽  
Amadeo J Wals Rodriguez ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Anaerobic Threshold ◽  
Functional Capacity ◽  
Exercise Test ◽  
Univariate Analysis ◽  
Clinical Situation ◽  
Cardiopulmonary Exercise Test ◽  
Vo2 Max ◽  
Cardiopulmonary Exercise

Abstract Introduction: Cardiopulmonary exercise test (CPET) allows quantification of functional capacity of patients with Fontan. The objective of this study was to determine the role of CPET parameters in predicting a higher maximum oxygen consumption (VO2 max) and to analyse the role of CPET parameters in predicting an unfavourable outcome. Methods: A retrospective, cross-sectional, descriptive study was carried out on 57 patients with Fontan, who had undergone incremental CPET with cycloergometer between 2010 and 2020. Determinants of VO2 max and determinants of clinical deterioration were analysed. Results: In the univariate analysis, the variables significantly related to VO2 max were: age, sex, body mass index (BMI), years of Fontan evolution, intracardiac Fontan, oxygen consumption at anaerobic threshold (VO2AT), CO2 equivalents at anaerobic threshold (VE/VCO2) and chronotropic insufficiency. The multiple linear regression model that best fitted the relationship between VO2 max and independent variables (correlation coefficient 0.73) included sex (correlation index 3.35; p = 0.02), BMI (−0.27; p = 0.02), chronotropic failure (−2.79; p = 0.01) and VO2AT (0.92; p < 0.0001). In the univariate analysis of the prognostic CPET variables related to an unfavourable clinical situation, significance was only obtained with chronotropic insufficiency (p = 0.003). In multivariate analysis, chronotropic insufficiency maintains its association [p= 0.017, OR = 4.65 (1.3–16.5)]. Conclusions: In conclusion, together with the anthropometric parameters universally related to VO2 max, chronotropic insufficiency and VO2AT are the main determinants of functional capacity in patients with Fontan. Moreover, chronotropic insufficiency is closely related to unfavourable clinical evolution. Our data would support the intensive treatment of chronotropic insufficiency in order to improve the quality of life and the clinical situation of patients with Fontan.

scholarly journals Cardiopulmonary Exercise Test in Patients with Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (11) ◽  
pp. 2312
Author(s):  
Adrián Bayonas-Ruiz ◽  
Francisca Muñoz-Franco ◽  
Vicente Ferrer ◽  
Carlos Pérez-Caballero ◽  
María Sabater-Molina ◽  
...  
Keyword(s):  
Systematic Review ◽  
Oxygen Consumption ◽  
Hypertrophic Cardiomyopathy ◽  
Functional Capacity ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Test ◽  
Cycle Ergometer ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Cardiopulmonary Exercise

Background: Patients with chronic diseases frequently adapt their lifestyles to their functional limitations. Functional capacity in Hypertrophic Cardiomyopathy (HCM) can be assessed by stress testing. We aim to review and analyze the available data from the literature on the value of Cardiopulmonary Exercise Test (CPET) in HCM. Objective measurements from CPET are used for evaluation of patient response to traditional and new developing therapeutic measurements. Methods: A systematic review of the literature was conducted in PubMed, Web of Science and Cochrane in Mar-20. The original search yielded 2628 results. One hundred and two full texts were read after the first screening, of which, 69 were included for qualitative synthesis. Relevant variables to be included in the review were set and 17 were selected, including comorbidities, body mass index (BMI), cardiac-related symptoms, echocardiographic variables, medications and outcomes. Results: Study sample consisted of 69 research articles, including 11,672 patients (48 ± 14 years old, 65.9%/34.1% men/women). Treadmill was the most common instrument employed (n = 37 studies), followed by upright cycle-ergometer (n = 16 studies). Mean maximal oxygen consumption (VO2max) was 22.3 ± 3.8 mL·kg−1·min−1. The highest average values were observed in supine and upright cycle-ergometer (25.3 ± 6.5 and 24.8 ± 9.1 mL·kg−1·min−1; respectively). Oxygen consumption in the anaerobic threshold (ATVO2) was reported in 18 publications. Left ventricular outflow tract gradient (LVOT) > 30 mmHg was present at baseline in 31.4% of cases. It increased to 49% during exercise. Proportion of abnormal blood pressure response (ABPRE) was higher in severe (>20 mm) vs. mild hypertrophy groups (17.9% vs. 13.6%, p < 0.001). Mean VO2max was not significantly different between severe vs. milder hypertrophy, or for obstructive vs. non-obstructive groups. Occurrence of arrhythmias during functional assessment was higher among younger adults (5.42% vs. 1.69% in older adults, p < 0.001). Twenty-three publications (9145 patients) evaluated the prognostic value of exercise capacity. There were 8.5% total deaths, 6.7% cardiovascular deaths, 3.0% sudden cardiac deaths (SCD), 1.2% heart failure death, 0.6% resuscitated cardiac arrests, 1.1% transplants, 2.6% implantable cardioverter defibrillator (ICD) therapies and 1.2 strokes (mean follow-up: 3.81 ± 2.77 years). VO2max, ATVO2, METs, % of age-gender predicted VO2max, % of age-gender predicted METs, ABPRE and ventricular arrhythmias were significantly associated with major outcomes individually. Mean VO2max was reduced in patients who reached the combined cardiovascular death outcome compared to those who survived (−6.20 mL·kg−1·min−1; CI 95%: −7.95, −4.46; p < 0.01). Conclusions: CPET is a valuable tool and can safely perform for assessment of physical functional capacity in patients with HCM. VO2max is the most common performance measurement evaluated in functional studies, showing higher values in those based on cycle-ergometer compared to treadmill. Subgroup analysis shows that exercise intolerance seems to be more related to age, medication and comorbidities than HCM phenotype itself. Lower VO2max is consistently seen in HCM patients at major cardiovascular risk.

scholarly journals Low-technology exercise test in the preoperative evaluation of lung resection candidates

2016 ◽  
Vol 73 (2) ◽  
Author(s):  
A. Brunelli ◽  
C. Pompili ◽  
M. Salati
Keyword(s):  
Oxygen Consumption ◽  
Exercise Test ◽  
Screening Test ◽  
Lung Resection ◽  
Cardiopulmonary Exercise Test ◽  
Stair Climbing ◽  
Functional Evaluation ◽  
Exercise Tests ◽  
Walking Test ◽  
Cardiopulmonary Exercise

Exercise tests are increasingly used in the preoperative functional evaluation of lung resection candidates. Low-technology exercise tests include six minute walking, shuttle walking and stair climbing. Conflicting evidence has been reported regarding 6 minute walking test. This test should not be used to select patients for lung resection. An incremental shuttle walk test is easier to replicate than 6 minute walking test. Most patients achieving 25 shuttles or 400 m have a maximum oxygen consumption measured at cardiopulmonary exercise test greater than 15 l/Kg/min. Although this test tends to underestimate performance at the lower range compared to peak oxygen consumption it can be used a screening test before lung resection. Excluding patients from operation based on this test alone is however not recommended and a formal cardiopulmonary exercise test should be always used in those walking less than 400 m. Stair climbing has been extensively studied in thoracic surgery. Several studies have found that poor performance in this test is indicative of cardiopulmonary complications and mortality after lung resection. In particular, climbing less than 12 m represents very high risk, whereas climbing more than 22 m is associated with a favourable outcome. Recent guidelines recommend referring all patients climbing lower than 22 m to cardiopulmonary exercise test. Stair climbing can be used as a screening test in cases cardiopulmonary exercise test is not readily available. In general, patients climbing more than 22 m can proceed to surgery without further evaluation.

Improvement of functional capacity in sacubitril-valsartan treated patients assessed by cardiopulmonary exercise test

2019 ◽  
Vol 75 (8) ◽  
pp. 732-736 ◽  
Author(s):  
Gabriella Malfatto ◽  
Silvia Ravaro ◽  
Sergio Caravita ◽  
Claudia Baratto ◽  
Antonio Sorropago ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise

scholarly journals Prognostic power of anaerobic threshold parameters in patients with transposition of the great arteries and systemic right ventricle

2019 ◽  
Vol 29 (12) ◽  
pp. 1445-1451
Author(s):  
António V. Gonçalves ◽  
Tânia Mano ◽  
Ana Agapito ◽  
Sílvia A. Rosa ◽  
Lídia de Sousa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Right Ventricle ◽  
Anaerobic Threshold ◽  
Exercise Test ◽  
Area Under The Curve ◽  
Systemic Circulation ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise ◽  
Test Parameters

AbstractIntroduction:Both transposition of the great arteries (TGA) previously submitted to a Senning/Mustard procedure and congenitally corrected TGA (cc-TGA) have the systemic circulation supported by the morphological right ventricle, thereby rendering these patients to heart failure events risk. The aim of this study was to evaluate cardiopulmonary exercise test parameters for stratifying the risk of heart failure events in TGA patients.Methods:Retrospective evaluation of adult TGA patients with systemic circulation supported by the morphological right ventricle submitted to cardiopulmonary exercise test in a tertiary centre. Patients were followed up for at least 1 year for the primary endpoint of cardiac death or heart failure hospitalisation. Several cardiopulmonary exercise test parameters were analysed as potential predictors of the combined endpoint and their predictive power were compared (area under the curve).Results:Cardiopulmonary exercise test was performed in 44 TGA patients (8 cc-TGA), with a mean age of 35.1 ± 8.4 years. The primary endpoint was reached by 10 (22.7%) patients, with a mean follow-up of 36.7 ± 26.8 months. Heart rate at anaerobic threshold had the highest area under the curve value (0.864), followed by peak oxygen consumption (pVO2) (0.838). Heart rate at anaerobic threshold ≤95 bpm and pVO2 ≤20 ml/kg/min had a sensitivity of 87.5 and 80.0% and a specificity of 82.4 and 76.5%, respectively, for the primary outcome.Conclusion:Heart rate at anaerobic threshold ≤95 bpm had the highest predictive power of all cardiopulmonary exercise test parameters analysed for heart failure events in TGA patients with systemic circulation supported by the morphological right ventricle.

scholarly journals Focal Myocarditis after Mild COVID-19 Infection in Athletes

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1519
Author(s):  
Ivana P. Nedeljkovic ◽  
Vojislav Giga ◽  
Marina Ostojic ◽  
Ana Djordjevic-Dikic ◽  
Tamara Stojmenovic ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Sudden Cardiac Death ◽  
Magnetic Resonance ◽  
Functional Capacity ◽  
Exercise Test ◽  
Cardiac Death ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise ◽  
Physical Laboratory ◽  
Submaximal Effort

COVID-19 infection in athletes usually has a milder course, but in the case of complications, myocarditis and even sudden cardiac death may occur. We examined an athlete who felt symptoms upon returning to training after asymptomatic COVID-19 infection. Physical, laboratory, and echocardiography findings were normal. The cardiopulmonary exercise test was interrupted at submaximal effort due to severe dyspnea in the presence of reduced functional capacity in comparison to previous tests. Cardiac magnetic resonance (CMR) detected the focal myocarditis. After three months of recovery, CMR still revealed the presence of focal myocarditis and the persistence of decreased functional capacity. This case raises the question of screening athletes even after asymptomatic forms of COVID-19 infection.

Preoperative cardiopulmonary exercise testing

2021 ◽  
pp. 133-137
Author(s):  
William J.M. Kinnear ◽  
James H. Hull
Keyword(s):  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Exercise Test ◽  
Surgical Planning ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise ◽  
Good Outcome ◽  
Clinical Problems

This chapter discusses how the results of a cardiopulmonary exercise test (CPET) can be used for preoperative surgical planning. A low preoperative maximum oxygen uptake (VO2max) is associated with a poor outcome. The lower the VO2max, the worse the prognosis. Use of the anaerobic threshold is less reliable. The CPET may identify clinical problems which can be optimized prior to surgery. Pre-habilitation can improve the chances of a good outcome from surgery.

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