scholarly journals P1556 Significance of combined cardiopulmonary and echocardiographic stress test to distinguish the hemodynamic and metabolic responses of hypertensive patients with or without heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N R Pugliese ◽  
M Mazzola ◽  
N De Biase ◽  
A Natali ◽  
L Gargani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Stress ◽  
Metabolic Responses ◽  
Preserved Ejection Fraction ◽  
Metabolic Characteristics ◽  
Cardiopulmonary Exercise ◽  
Content Difference

Abstract Background Arterial hypertension (HT) is one of the main risk factors for the development of heart failure with preserved ejection fraction (HFpEF). However, little is known regarding the hemodynamic and metabolic responses of patients with HT during the stress test. Purpose We assessed the hemodynamic and metabolic characteristics of HT subjects and patients with HFpEF and HT (HFpEF-HT) by combining cardiopulmonary exercise test (CPET) and exercise stress echocardiography (ESE). Methods We studied 170 consecutive subjects, undergoing a symptom-limited graded ramp bicycle CPET-ESE: 52 stable (NYHA I-III) outpatients with HFpEF-HT (69 ± 13 years; 44 males, 85%), 86 well-controlled HT subjects (66 ± 10 years; 72 males, 84%) and 32 age and sex-matched healthy controls (59 ± 15 years; 24 males, 75%). During the exercise, we assessed oxygen consumption (VO2), cardiac output (CO) systemic vascular resistance (SVR) and arterial-venous oxygen content difference (AVO2diff). Results Peak systolic blood pressure was significantly more elevated in HT subjects (205.7 ± 23 mmHg) than controls (190.9 ± 29 mmHg; p = 0.005) and patients with HFpEF-HT (177.5 ± 26 mmHg; p = 0.03). HT patients exhibited a peak VO2 (18.7 ± 2 ml/min/kg) that was higher than HFpEF-HT patients (15.2 ± 2 ml/min/kg; p < 0.0001), but lower than controls (24.4 ± 7.3 ml/min/kg; p < 0.0001). Peak CO was significantly more elevated in HT (12.3 ± 0.4 ml/min) and controls (13.3 ± 0.6 ml/min) than in HFpEF-HT (9.8 ± 0.4 ml/min; p < 0.0001). Both HFpEF-HT and HT patients displayed a significantly reduced peak AVO2diff (13.3 ± 1 and 13.5 ± 1 vs 16.9 ± 1 mL/dL; p < 0.0001) and increased SVR compared to controls (1066 ± 36 and 1054 ± 33 vs 904 ± 42 dyne·s/cm; p = 0.01). Conclusions CPET-ESE was valuable to characterise the hemodynamic and metabolic responses of patients with HT (Figure). HT subjects present a decreased AVO2diff similar to HFpEF patients, suggesting an early peripheral dysfunction, probably related to the impaired reduction of SVR during exercise. Abstract P1556 Figure.

scholarly journals Estimating pVO2 and prognosis through cardiac exercise stress test in a heart failure population

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J.P.L De Almeida ◽  
J Milner ◽  
J Rosa ◽  
R Coutinho ◽  
M Ferreira ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Testing ◽  
Exercise Test ◽  
Stress Test ◽  
Pearson Correlation ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Stress Test ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Stress ◽  
Cardiopulmonary Exercise

Abstract Background Compared with the cardiac exercise stress test, more commonly used to assess the presence of ischemia, the cardiopulmonary exercise test has the advantage of providing expired gas analysis. According to current guidelines, cardiopulmonary exercise testing should be considered to stratify the risk of adverse events and to provide measures of survival improvement in heart failure populations. However, cardiac exercise stress test is more readily available and widespread than cardiopulmonary exercise testing. We aimed to compare prognostic information given by estimated pVO2 – which can be obtained from cardiac exercise stress test – and real measured pVO2 – which requires cardiopulmonary exercise test – in a heart failure population. Methods We conducted a retrospective analysis of 214 patients with HF underwent cardiac exercise stress test and accessed their 5 year survival. Non-urgent transplanted (UNOS Status 2) patients were censored alive on the date of the transplant. Duringthe cardiopulmonary exercise test, cardiac exercise stress test data simultaneously collected. Based on protocol stage achieved, estimated METs were used to calculate estimated pVO2 (pVO2 = estimated METs x 3.5). Estimated and real pVO2 were correlated using Pearson correlation and the age-adjusted prognostic power of each was determined using Cox proportional hazardsanalysis. Results 164 patients were male (77%) and the mean age of the population was 56±10 years. 78 (36%) patients had an ischemic etiology. Within 5 years from testing, 46 patients died (21.5%) and 55 patients (26%) were transplanted. Naughton modified (n=165) was the most commonly used protocol, followed by Naughton (n=39) and Bruce (n=10). Estimated pVO2 and measured pVO2 correlated significantly (R=0.66, p<0.01) (Figure 1). Both estimated (HR=0.91, 95% CI 0.86–0.95, p<0.01) and measured pVO2 (HR=0.86, 95% CI 0.80–0.91, p<0.01) strongly predicted prognosis in this population. Conclusions Estimated pVO2 correlated with measured pVO2 and strongly predicted prognosis in this heart failure population. Because it can be obtained from conventional cardiac exercise testing, it may become an alternative prognostic tool to cardiopulmonary testing. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Measured vs estimated pVO2

P331Effect of exercise stress test on platelet function in patients with recent acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Dalcoquio ◽  
M A Santos ◽  
L S Alves ◽  
F B B Arantes ◽  
L Ferreira-Santos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Platelet Function ◽  
Stress Test ◽  
Area Under The Curve ◽  
Exercise Stress Test ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Stress ◽  
Platelet Aggregability ◽  
Cardiopulmonary Exercise

Abstract Background Exercise-based cardiac rehabilitation for coronary artery disease (CAD) is associated with lower cardiovascular mortality. On the other hand, acute strenuous exercise has been linked to cardiovascular complications such as acute myocardial infarction (AMI) and sudden cardiac death. One of the pathophysiological mechanisms involved in these outcomes might be an increase in platelet aggregability after exercise. Although previous studies showed higher platelet aggregability after exercise among stable CAD patients on aspirin treatment, there is no data regarding the effect of exercise on platelet activity in post-AMI patients on dual anti-platelet therapy (DAPT). Purpose To evaluate the effect of high-intensity exercise on platelet aggregability in sedentary post-AMI patients on DAPT. Methods Platelet function was analyzed immediately before and after maximal cardiopulmonary exercise test (CPET) on cycle ergometer utilizing a personalized ramp protocol and aiming to achieving peak exercise in around 10 min. The CPET was done within 31±4 days after uncomplicated AMI. Platelet aggregability was assessed by Multiplate®ADPtest (MP-ADP) and Multiplate® ASPItest (MP-ASPI) measured as area under the curve (AUC). Reticulated platelets were measured concomitantly to MP-ADP e MP-ASPI using a fully automated flow cytometer (Sysmex XN-2000®) to determine absolute immature platelet count (IPC) per 103/microliter. Continuous variables were expressed as means ±standard deviation or as median and 25th–75th percentiles if not Gaussian distributed. Comparisons between the pre- and post-CPET assessments were performed using Wilcoxon signed rank test. Results We analyzed 81 sedentary patients (mean age 58.3±10.1 years-old, 76.5% men) after AMI (50.6% with ST-elevation myocardial infarction, mean left ventricular ejection fraction after index event 55±11.7%, 98.8% on statin and 85.5% on beta-blocker treatment). Platelet aggregability, either by MP-ADP or MP-ASPI, and IPC were significantly increased after CPET (table). Platelet function after CPET Before CPET After CPET p-value Multiplate® ADPtest (AUC) – median (25th–75th percentiles) 32.0 (22.0–48.5) 37.0 (26.0–55.2) 0.003 Multiplate® ASPItest (AUC) – median (25th–75th percentiles) 17.0 (12.7–22.0) 22.0 (16.7–28.0) <0.001 Immature platelet count (103/microliter) – median (25th–75th percentiles) 9.5 (6.8–13.8) 9.6 (6.6–16.5) 0.006 CPET: cardiopulmonary exercise test; AUC: area under the curve. Conclusion On this post-AMI population, platelet was hyperactivated after exercise stress test despite the use of DAPT. These findings suggest that, even when properly treated, post-AMI patients might be at higher risk of ischemic complications after high-intensity exercises, reinforcing the importance of tailoring exercise prescription in this population. Acknowledgement/Funding Sao Paulo Research Foundation, FAPESP

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