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

scholarly journals Cardiopulmonary Exercise Test in heart failure: A Sine qua non

2020 ◽  
Vol 9 (2) ◽  
pp. 1-8 ◽  
Author(s):  
Stefanos Sakellaropoulos ◽  
Dimitra Lekaditi ◽  
Stefano Svab
Keyword(s):  
Heart Failure ◽  
Exercise Test ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Critical Evaluation ◽  
Research Area ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Intolerance ◽  
Reduced Ejection Fraction ◽  
Cardiopulmonary Exercise

A robust literature, over the last years, supports the indication of cardiopulmonary exercise testing (CPET) in patients with cardiovascular diseases. Understanding exercise physiology is a crucial component of the critical evaluation of exercise intolerance. Shortness of breath and exercise limitation is often treated with an improper focus, partly because the pathophysiology is not well understood in the frame of the diagnostic spectrum of each subspecialty. A vital field and research area have been cardiopulmonary exercise test in heart failure with preserved/reduced ejection fraction, evaluation of heart failure patients as candidates for LVAD-Implantation, as well as for LVAD-Explantation and ultimately for heart transplantation. All the CPET variables provide synergistic prognostic discrimination. However, Peak VO2 serves as the most critical parameter for risk stratification and prediction of survival rate.

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

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 &lt; 0.0001), but lower than controls (24.4 ± 7.3 ml/min/kg; p &lt; 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 &lt; 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 &lt; 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.

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.

scholarly journals P942 Outcome prediction by exercise stress echocardiography and cardiopulmonary exercise testing assessment in patients with heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Sakata ◽  
H Mitsuda ◽  
J Ito ◽  
A Isaka ◽  
A Gouda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Testing ◽  
Cardiac Dysfunction ◽  
Stress Echocardiography ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Stress ◽  
Cardiac Resynchronization ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2 ◽  
Patients With Heart Failure

Abstract Background Cardiopulmonary exercise testing (CPX) is essential to the assessment of functional impairment and prognosis in patients with heart failure (HF). Peak oxygen consumption (peak VO2) continues to be considered the gold standard for assessing prognosis in HF. The minute ventilation-carbon dioxide production (VE-VCO2) slope has recently demonstrated prognostic significance in patients with HF. Ergometer stress echocardiography (Erg-Echo) is useful to evaluate the exercise-induced pulmonary hypertension and the potential cardiac dysfunction that are difficult to evaluate in the resting state. Objective The aim of this study is to evaluate the relationship between CPX and Erg-echo indices, and the usefulness of Erg-echo to determine the severity of cardiac dysfunction and the prognosis in patients with HF. Methods We studied 58 patients with HF (age 65.2 ± 11.9 years) and performed CPX and Erg-Echo. The peak VO2 and the VE-VCO2 slope were measured by CPX. Cardiac output (CO) and estimated mean pulmonary artery pressure (mPAP) were measured by Erg-Echo at rest and peak exercise load, and the change ratio (ΔmPAP / ΔCO) were calculated. We evaluated the clinical outcome during a1 year period. Results The ΔmPAP / ΔCO was significantly correlated with the peak VO2 (R = -0.6767, P &lt;0.0001) and the VE-VCO2 slope (R = 0.6809, P &lt;0.0001). Cardiovascular events (1 patient of cardiovascular death, 8 patients of re-hospitalization due to HF, 4 patients of myocardial ischemia, 2 patients of Cardiac Resynchronization Therapy (CRT) devices implantation, 1 patient of ventricular tachycardia) developed in 16 of the 58 patients (27.5%: Group CE) during the 1 year. The peak VO2 was significantly lower (12.1 ± 2.5 vs. 16.1 ± 3.1ml/min/kg, P &lt;0.0001) and the VE-VCO2 slope was significantly higher (41.1 ±. 12.3 vs. 31.8 ± 6.1ml/ml, P &lt;0.0001) in Group CE compared to the other 42 patients (Group N). The ΔmPAP was significantly higher (19.1 ± 4.4 vs. 14.9 ± 6.4, P = 0.0408) and the ΔCO was significantly lower (2.4 ± 1.2 vs. 4.1 ± 2.0, P = 0.0078), and the ΔmPAP / ΔCO was significantly higher (9.7 ± 4.6 vs. 4.4 ± 2.4, P &lt;0.0001) in Group CE compared to Group N. Conclusions The ΔmPAP/ ΔCO by Erg-Echo is useful to evaluate the severity of cardiac dysfunction and the prognosis of HF patients.

scholarly journals Equações utilizadas para a predição de frequência cardíaca máxima na população pediátrica não atlética: uma revisão sistemática

2019 ◽  
Vol 29 (4) ◽  
pp. 34286 ◽  
Author(s):  
Andressa Schenkel Spitznagel ◽  
Dyovana Silva Dos Santos ◽  
Karolini Reis Branco ◽  
Daniele Schiwe ◽  
Vinícius Da Silva Lessa De Oliveira ◽  
...  
Keyword(s):  
Heart Rate ◽  
Children And Adolescents ◽  
Exercise Testing ◽  
Exercise Test ◽  
Methodological Quality ◽  
Stress Test ◽  
Cardiopulmonary Exercise Testing ◽  
Maximum Heart Rate ◽  
Predictive Equations ◽  
Cardiopulmonary Exercise

AIMS: To evaluate the applicability of the predictive equations of maximum heart rate during exercise tests in non-athlete children and adolescents.METHODS: It is a systematic review, carried out through Pubmed, Lilacs, Scielo and PEDro. We included studies comparing the maximum heart rate measured and estimated by predictive equations during stress tests in non-athlete children and adolescents. The following search strategy was used: Exercise test OR Exercise testing OR Cardiopulmonary exercise test OR Cardiopulmonary exercise testing OR Peak oxygen uptake OR Maximal oxygen consumption OR Exercise tolerance OR Exercise capacity AND Heart rate OR Heart rates OR Pulse rate OR Pulse rates OR Heart rate control OR Cardiac chronotropic OR Predictive value test AND Predictive equations. The methodological quality was assessed by the Agency for Health Care Research and Quality scale.RESULTS: Of a total of 858 articles located, only four were included. The articles totaled 325 participants (seven to 18 years). All studies measured the maximum heart rate by cardiopulmonary stress test. While no study recommended (04/04=100%; 01/01=100%) the formulas “220 - age” and “207 - 0.7 x age”, the equations “208 - (0.7 x age)” and “200 - 0.48 x age” were adequate in 02/03 (66.6%) articles and 01/01 (100%) document, respectively. The methodological quality was considered high in all articles evaluated, ranging from 76 to 97 points.CONCLUSIONS: The findings seem to suggest that the formula “208 - (0.7 x age)” was the most tested and adequate equation to a large extent for estimating maximum heart rate in non-athlete children and adolescents. However, further studies are still needed to confirm these results.

Cardiopulmonary exercise test

2020 ◽  
pp. 151-162
Author(s):  
Luca Moderato ◽  
Massimo Francesco Piepoli
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Exercise Testing ◽  
Global Assessment ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise Test ◽  
Metabolic Responses ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise ◽  
Process And Outcome

Cardiopulmonary exercise testing (CPET) is a safe and reproducible diagnostic tool for the global assessment of cardiovascular (CV), ventilatory, and metabolic responses to exercise. It can be extremely useful for understanding the reasons for dyspnoea, fatigue, and exercise limitation, and for differentiating between cardiac and pulmonary disorders. CPET can also help the clinician to optimize the decision-making process and outcome prediction, especially in heart failure (HF) patients.

Do rebreathing manoeuvres for non-invasive measurement of cardiac output during maximum exercise test alter the main cardiopulmonary parameters?

2019 ◽  
Vol 26 (15) ◽  
pp. 1616-1622 ◽  
Author(s):  
Carlo Vignati ◽  
Marco Morosin ◽  
Laura Fusini ◽  
Beatrice Pezzuto ◽  
Emanuele Spadafora ◽  
...  
Keyword(s):  
New York ◽  
Cardiac Output ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Testing ◽  
Heart Association ◽  
Cardiopulmonary Exercise Test ◽  
Cardiopulmonary Exercise

Background Inert gas rebreathing has been recently described as an emergent reliable non-invasive method for cardiac output determination during exercise, allowing a relevant improvement of cardiopulmonary exercise test clinical relevance. For cardiac output measurements by inert gas rebreathing, specific respiratory manoeuvres are needed which might affect pivotal cardiopulmonary exercise test parameters, such as exercise tolerance, oxygen uptake and ventilation vs carbon dioxide output (VE/VCO2) relationship slope. Method We retrospectively analysed cardiopulmonary exercise testing of 181 heart failure patients who underwent both cardiopulmonary exercise testing and cardiopulmonary exercise test+cardiac output within two months (average 16 ± 15 days). All patients were in stable clinical conditions (New York Heart Association I–III) and on optimal medical therapy. Results The majority of patients were in New York Heart Association Class I and II (78.8%), with a mean left ventricular ejection fraction of 31 ± 10%. No difference was found between the two tests in oxygen uptake at peak exercise (1101 (interquartile range 870–1418) ml/min at cardiopulmonary exercise test vs 1103 (844–1389) at cardiopulmonary exercise test-cardiac output) and at anaerobic threshold. However, anaerobic threshold and peak heart rate, peak workload (75 (58–101) watts and 64 (42–90), p < 0.01) and carbon dioxide output were significantly higher at cardiopulmonary exercise testing than at cardiopulmonary exercise test+cardiac output, whereas VE/VCO2 slope was higher at cardiopulmonary exercise test+cardiac output (30 (27–35) vs 33 (28–37), p < 0.01). Conclusion The similar anaerobic threshold and peak oxygen uptake in the two tests with a lower peak workload and higher VE/VCO2 slope at cardiopulmonary exercise test+cardiac output suggest a higher respiratory work and consequent demand for respiratory muscle blood flow secondary to the ventilatory manoeuvres. Accordingly, VE/VCO2 slope and peak workload must be evaluated with caution during cardiopulmonary exercise test+cardiac output.

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