scholarly journals Prognostic value of cardiopulmonary exercise testing in valvular heart disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Cortina Camarero ◽  
M Sarrion Catala ◽  
V Suberviola Sanchez-Caballero ◽  
C Beltran Herrera ◽  
E Gomez Mariscal ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Prognostic Value ◽  
Cardiopulmonary Exercise Testing ◽  
Symptom Development ◽  
Ventilatory Efficiency ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2 ◽  
Echocardiographic Parameters

Abstract Introduction Cardiopulmonary exercise testing (CEPT) is not routinely used for the assessment of valvular heart disease (VHD) patients. The cutoff values of percentage of predicted peak VO2 and ventilatory efficiency parameters that carry out a bad prognosis have been predominantly validated in heart failure. The aim of this study was to analyze the prognostic value of CPET parameters in a broad population of VHD patients. Methods 163 patients (51% female) with moderate or severe VHD who underwent a CEPT (n=197) at their physician's discretion from 2017 until 2019 were included. We calculated the net reclassification index of CPET, compared to the classical clinical or echocardiographic parameters, regarding the need for surgical indication. Also, the predictive value of CPET for death and symptom development during follow-up was estimated using regression analysis. Results At inclusion, all patients were asymptomatic or with minimal equivocal symptoms. Aortic valvular lesions were the most common (47%), followed by mitral valvular disease (44%). There was a predominance of severe valvular heart disease (71%) and most of the CEPTs were performed on a treadmill (74%). The percentage of predicted peak VO2 was 76±18% and at anaerobic threshold was 61±18%. The mean follow-up time was 15±10 months. There were 5 deaths (3%) and 24 patients became symptomatic. The net reclassification index of CPET over either clinical or echocardiographic parameters was 46%. The CEPT parameters that predicted increased risk of death were VE/VCO2 slope (p=0.009), % of predicted peak VO2 (p=0.049) and Eq CO2 at anaerobic threshold (p=0.047). None of the CEPT parameters was predictive of symptom development during follow-up, however, in the subgroup of patients who became clearly symptomatic, the ventilatory efficiency parameters were similar to the cut off values that confer bad prognosis (see Table in Figure). Conclusion In our series, CPET added prognostic mortality value to patients with VHD. The cut off values used for patients with HF can also be applied in a VHD population. In addition, CEPT clearly improved the clinical decision for surgical referral. Nevertheless, these results need to be validated in a broader population. FUNDunding Acknowledgement Type of funding sources: None.

P2750Why should cardiopulmonary exercise testing be routinely used for assessing patients with valvular heart disease?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Cortina ◽  
M Sarrion ◽  
C Beltran ◽  
V Suberviola ◽  
S Briongos ◽  
...  
Keyword(s):  
Heart Disease ◽  
Exercise Testing ◽  
Valvular Heart Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Surrogate Marker ◽  
Systolic Pulmonary Artery Pressure ◽  
Total N ◽  
Ventilatory Efficiency ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2

Abstract Introduction The role of cardiopulmonary exercise testing (CPET) is unquestionable to assess prognosis in heart failure. In patients with valvular heart disease (VHD), the functional capacity (FC) is crucial to aid in the right timing of surgery. The aim of this study was to compare the assessment of the FC by CPET and NYHA and the correlation between ventilatory efficiency parameters and resting systolic pulmonary artery pressure (SPAP). Methods We studied 100 VHD patients (57% female) who underwent a CPET. We calculated the real METS (RM) as indexed peak VO2/3.5 (1 MET=3.5 ml O2/kg/min) and compared to estimated METS (EM) derived by the time of exercise. An agreement analysis between RM, EM and NYHA was calculated. The correlation among VE/Vslope CO2, EqCO2at anaerobic threshold (AT), PETCO2, partial pressure end-tidal CO2 at AT and SPAP was analyzed. Results The results are shown in Table and Figure. The RM and the EM were 4.7±1.7 and 5.5±3, respectively (p<0.01) with a low agreement (ICC=0.6, p<0.01). The agreement between NYHA and the classification obtained from peak % of predicted peak VO2 was very low (weighted kappa =0.06, p=0.28). In patients with severe mitral VHD, the ventilatory efficiency parameters were correlated with SPAP (PETCO2 (AT), r=−0.7, p=0.002; EqCO2 (AT), r=0.5, p=0.04:VE/Vslope CO2, r=0.3, p 0.2), whereas in those with severe aortic VHD, these correlations were much lower (PETCO2 (AT), r=−0.3, p=0.13; EqCO2 (AT), r=0.2, p=0.15; VE/Vslope CO2, r=0.18, p 0.31). Total (n=100) Mitral regurgitation (n=35) Aortic regurgitation (n=23) Age 65 (29–86) 66 (30–84) 65 (11–87) LVEF (%) 62±6 63±6 61±7 SPAP (mmHg) 40±11 39±11 36±8 NYHA I (60%), II (33%), III (7%) I (63%), II (29%), III (9%) I (63%), II (33%), III (4%) Indexed peak VO2 (ml/min/kg) 16±6 17±6 19±8 Peak % predicted VO2 73±18 74±17 79±18 Predicted VO2 AT (%) 58±19 54±19 61±22 Eq CO2 AT 33±6 32±7 32±5 VE/VSlope CO2 33±6 32±7 33±8 PetCO2 AT 34±4 36±4 36±5 Type and degree of VHD Conclusions NYHA scale and estimation of METS derived from the time of exercise clearly overestimated the FC of our population. In our series, the ventilatory inefficiency in patients with mitral VHD could be a surrogate marker of advanced disease and could lead to an earlier intervention.

scholarly journals Endurance Training Improves Oxygen Uptake and Endurance Capacity in Patients With Moderate to Severe Valvular Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Karin Vonbank ◽  
Daniel Haubenberger ◽  
Raphael Rosenhek ◽  
Matthias Schneider ◽  
Stefan Aschauer ◽  
...  
Keyword(s):  
Heart Disease ◽  
Oxygen Uptake ◽  
Endurance Training ◽  
Valvular Heart Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Endurance Capacity ◽  
Working Capacity ◽  
Endurance Test ◽  
Cardiopulmonary Exercise

Aim: Peak oxygen uptake (peakVO2) is one of the strongest predictors of survival in patients with valvular heart disease. The purpose of this study was to determine whether endurance training improves peakVO2 and endurance capacity in patients with moderate-severe aortic and mitral valve disease.Methods: 30 patients with moderate-severe valvular heart disease were randomly assigned to 12 weeks of endurance training (TG) (n = 16) or standard care (SC) (n = 14). PeakVO2 and maximum working capacity (Wattmax) were assessed by cardiopulmonary exercise testing, as well as submaximal endurance test at 80% of peakVO2 at baseline and after 12 weeks.Results: There was a significant improvement in peakVO2 from 27.2 ± 5.9 ml/kg to 30.4 ± 6.3 ml/kg (P &lt; 0.001) in TG compared to the SC (peakVO2 from 24.6 ± 4.4 to 24.7 ± 3.8) and in the Wattmax from 151.8 ± 41.0 Watt to 171.2 ± 49.7 Watt in the TG compared to the SC (152.9 ± 35.6 Watt to 149.2 ± 28.4 Watt). The endurance capacity increased significantly from 17.0 ± 9.4 min to 32.8 ± 16.8 min (p = 0.003) in the TG compared to the SC (11.7 ± 6.2 min to 11.2 ± 7.6 min). The heart rate during the endurance test decreased in the TG from 154 ± 14 b/min to 142 ± 20 b/min for the same workload. No changes could be seen in the SC.Conclusion: Endurance training in patients with moderate to severe valvular heart disease increased significantly the peakVO2 as well as the endurance capacity.

Do we need cardiopulmonary exercise to determine the optimal time for intervention in valvular heart disease?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Cortina ◽  
M Sarrion ◽  
C Beltran ◽  
V Suberviola ◽  
A Sanchez ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Nyha Class ◽  
Cardiopulmonary Exercise Testing ◽  
Surrogate Marker ◽  
Exercise Duration ◽  
Surgical Indication ◽  
Optimal Time ◽  
Kappa Index ◽  
Cardiopulmonary Exercise

Abstract Introduction Cardiopulmonary exercise testing (CPET) is underused in many clinical conditions other than HF. In valvular heart disease (VHD), CEPT can aid in choosing the right timing for surgery. The goals of this study were to compare the assessment of functional capacity (FC) by CEPT and NYHA scale, and to analyze the relationship between ventilatory efficiency (VE) parameters and time to surgery. Methods 197 CPET were performed in 163 patients with moderate or severe VHD (51% female). Real METS (RM) were calculated as indexed peak VO2/3.5 (1 MET = 3.5 ml O2/kg/min) and compared to estimated METS (EM) derived by the exercise duration. An agreement analysis between RM, EM and NYHA was performed. The association among VE/VCO2 slope, pet CO2 at anaerobic threshold (AT), OUES and time to surgical indication was also studied using Cox logistic regression analysis. Results See Table. The RM and EM were 4,7±1,7and 6,2±2,9, respectively (p&lt;0.01), and the correlation was low (ICC=0,7, p&lt;0.001). The agreement between NYHA class and % of peak predicted V02 was very low (kappa index = 0.1, p&lt;0.001). VE parameters were predictive of an earlier surgical indication: petCO2 AT (p=0.02), VE/VCO2 slope (p=0.069), OUES (p=0.014). Conclusions In asymptomatic VHD patients, the surgical indication should not rely solely in their FC assessed by either NYHA scale or EM derived by duration of exercise. In our series, these parameters clearly overestimated the FC of the population. Also, the ventilatory inefficiency may be a surrogate marker of advanced disease and lead to a closer surveillance for an earlier intervention. Real and estimated METS by type of VHD Funding Acknowledgement Type of funding source: None

scholarly journals Effect of Smartphone-Based Telemonitored Exercise Rehabilitation among Patients with Coronary Heart Disease

2019 ◽  
Vol 13 (4) ◽  
pp. 659-667
Author(s):  
Yanxin Song ◽  
Chuan Ren ◽  
Ping Liu ◽  
Liyuan Tao ◽  
Wei Zhao ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Blood Lipid ◽  
Control Group ◽  
Exercise Rehabilitation ◽  
Echocardiographic Parameters ◽  
Exercise Compliance ◽  
The Difference

AbstractThe aim of this study was to investigate the effects of telemonitored exercise rehabilitation on patients with coronary heart disease (CHD) in China. Ninety-six patients with stable CHD were included and analyzed (48 in telemonitored group and 48 in control group). All patients received routine follow-up, and patients in telemonitored group participated in smartphone-based telemonitored cardiac rehabilitation. Patients’ demographic information, medical history, diagnosis and treatment of CHD, and laboratory results were collected. The difference of cardiopulmonary exercise testing (CPET), blood test, and echocardiographic parameters; exercise habits; control rate of blood lipid and blood glucose; and incidence of adverse events between the two groups during 6 months of follow-up was analyzed. After intervention, the subjects in the telemonitored group performed significantly better in VO2peak, exercise compliance, and some other parameters than those in the control group. Telemonitored exercise rehabilitation is an effective rehabilitation mode for CHD patients in China.

Cardiopulmonary Exercise Testing in Combined Pulmonary Fibrosis and Emphysema

Respiration ◽  
2021 ◽  
pp. 369-377
Author(s):  
Michael Westhoff ◽  
Patric Litterst ◽  
Ralf Ewert
Keyword(s):  
Body Weight ◽  
Pulmonary Fibrosis ◽  
Sensitivity And Specificity ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Arterial Oxygen ◽  
Peak Exercise ◽  
Cutoff Value ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2

Background: Combined pulmonary fibrosis and emphysema (CPFE) is a distinct entity among fibrosing lung diseases with a high risk for lung cancer and pulmonary hypertension (PH). Notably, concomitant PH was identified as a negative prognostic indicator that could help with early diagnosis to provide important information regarding prognosis. Objectives: The current study aimed to determine whether cardiopulmonary exercise testing (CPET) can be helpful in differentiating patients having CPFE with and without PH. Methods: Patients diagnosed with CPFE in 2 German cities (Hemer and Greifswald) over a period of 10 years were included herein. CPET parameters, such as peak oxygen uptake (peak VO2), functional dead space ventilation (VDf/VT), alveolar-arterial oxygen difference (AaDO2), arterial-end-tidal CO2 difference [P(a-ET)CO2] at peak exercise, and the minute ventilation-carbon dioxide production relationship (VE/VCO2 slope), were compared between patients with and without PH. Results: A total of 41 patients with CPET (22 with PH, 19 without PH) were analyzed. Right heart catheterization was performed in 15 of 41 patients without clinically relevant complications. Significant differences in peak VO2 (861 ± 190 vs. 1,397 ± 439 mL), VO2/kg body weight/min (10.8 ± 2.6 vs. 17.4 ± 5.2 mL), peak AaDO2 (72.3 ± 7.3 vs. 46.3 ± 14.2 mm Hg), VE/VCO2 slope (70.1 ± 31.5 vs. 39.6 ± 9.6), and peak P(a-ET)tCO2 (13.9 ± 3.5 vs. 8.1 ± 3.6 mm Hg) were observed between patients with and without PH (p < 0.001). Patients with PH had significantly higher VDf/VT at rest, VT1, and at peak exercise (65.6 ± 16.8% vs. 47.2 ± 11.6%; p < 0.001) than those without PH. A cutoff value of 44 for VE/VCO2 slope had a sensitivity and specificity of 94.7 and 72.7%, while a cutoff value of 11 mm Hg for P(a-ET)CO2 in combination with peak AaDO2 >60 mm Hg had a specificity and sensitivity of 95.5 and 84.2%, respectively. Combining peak AaDO2 >60 mm Hg with peak VO2/body weight/min <16.5 mL/kg/min provided a sensitivity and specificity of 100 and 95.5%, respectively. Conclusion: This study provided initial data on CPET among patients having CPFE with and without PH. CPET can help noninvasively detect PH and identify patients at risk. AaDO2 at peak exercise, VE/VCO2 slope, peak P(a-ET)CO2, and peak VO2 were parameters that had high sensitivity and, when combined, high specificity.

scholarly journals Clinical outcomes of Japanese atrial fibrillation patients with combined valvular heart disease: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Doi ◽  
K Ishigami ◽  
Y Aono ◽  
S Ikeda ◽  
Y Hamatani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Incidence Rate ◽  
Clinical Outcomes ◽  
Valvular Heart Disease ◽  
Cardiac Death ◽  
Clinical Characteristics ◽  
Valve Disease ◽  
The Impact

Abstract Background We previously reported that valvular heart disease (VHD) was not at the significant risk of stroke/systemic embolism (SE), but was associated with an increased risk of hospitalization for heart failure (HF) in Japanese atrial fibrillation patients. However, the impact of combined VHD on clinical outcomes has been little known. Purpose The aim of this study is to investigate the prevalence of combined VHD and its clinical characteristics and impact on outcomes such as stroke/SE, all-cause death, cardiac death and hospitalization for HF. Method The Fushimi AF Registry is a community-based prospective survey of AF patients in one of the wards of our city which is a typical urban district of Japan. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. In the entire cohort, echocardiography data were available for 3,574 patients. 68 AF patients with prosthetic heart valves were excluded and we compared clinical characteristics and outcomes between 488 single VHD (103 Aortic valve disease (AVD), 315 mitral valve disease (MVD), 70 tricuspid valve disease (TVD)) and 158 combined VHD (46 AVD and MVD, 11 AVD and TVD, 66 MVD and TVD, 35 AVD and MVD and TVD). Result Compared with single VHD, patients with combined VHD were older (combined vs. single VHD: 78.5 vs. 76.0 years, respectively; p&lt;0.01), more likely to have persistent/permanent type AF (73.4% vs. 63.9%, p=0.02) and prescription of warfarin (63.1% vs. 53.8%, p=0.04). Combined VHD was less likely to have diabetes mellitus (13.9% vs. 23.6%, p=0.01) and dyslipidemia (26.6% vs. 40.4%, p&lt;0.01). Sex, body weight, hypertension, pre-existing HF were comparable between the two groups. During the median follow-up of 1,474 days, the incidence rate of stroke/SE was not significantly different between the two groups (1.58 vs. 1.89 per 100 person-years, respectively, log rank p=0.10). The incidence rate of all-cause death (7.35 vs. 5.33, p=0.65), cardiac death (1.20 vs. 0.99, p=0.91) and hospitalization for HF (5.55 vs. 4.43, p=0.53) were also not significantly different. We previously reported AVD had significant impacts on cardiac adverse outcomes in AF patients, and we further analyzed event rates between combined VHD including AVD (AVD and MVD/TVD) and without AVD (MVD and TVD). Combined VHD with AVD group had higher incidence rate of all-cause death (10.7 vs. 5.79, p=0.03) than that without AVD group. However, the incidence rate of stroke/SE (1.98 vs. 1.56, p=0.59), cardiac death (0.98 vs. 1.14, p=0.68), hospitalization for HF (8.03 vs. 5.38, p=0.17) were not significantly different between the two groups. Conclusion As compared with single VHD, the risk of stroke/SE, all-cause death, cardiac death and hospitalization for HF in combined VHD was not significantly different. Among patients with combined VHD, those having AVD had higher incidence rate of all-cause death than those without AVD. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001380
Author(s):  
Rasmus Bo Hasselbalch ◽  
Mia Marie Pries-Heje ◽  
Sarah Louise Kjølhede Holle ◽  
Thomas Engstrøm ◽  
Merete Heitmann ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Primary Outcome ◽  
Multislice Ct ◽  
Cost Effective ◽  
University Hospital ◽  
Before And After ◽  
History Of ◽  
Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

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