P2742Right ventricular stroke volume during dobutamine stress magnetic resonance compared to lung perfusion and peak oxygen uptake after arterial switch operation for transposition of the great arteries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M P Frick ◽  
S Ostermayer ◽  
S Hamada ◽  
A Kirschfink ◽  
N Marx ◽  
...  
Keyword(s):  
Oxygen Uptake ◽  
Low Dose ◽  
Arterial Switch Operation ◽  
Dobutamine Stress ◽  
Peak Oxygen Uptake ◽  
High Dose ◽  
Pulmonary Perfusion ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2 ◽  
High Dose Dobutamine

Abstract Objectives Abnormal pulmonary perfusion due to stenosis of the central pulmonary arteries is common after neonatal arterial switch operation (ASO) for transposition of the great arteries (TGA). We conducted a monocentric prospective study in young adults after neonatal ASO for TGA to evaluate the effects of abnormal pulmonary perfusion on the increase of the right ventricular stroke volume (RVSV) during dobutamine stress magnetic resonance (DSMR) and on cardiopulmonary exercise capacity. Methods 68 unselected patients (age 18–29 years) underwent CMR at rest and under dobutamine stress (10 to 40 μg/kg/min). RVSV, pulmonary blood flow distribution (PBFD) and peak flow velocity were derived from phase contrast mapping in the main, right and left pulmonary artery (PA) at rest and each stress level. A cardiopulmonary exercise test (CPET) was performed at the same day. All patients reached maximal exercise effort according to heart rate and respiratory exchange rate. Results PBFD at rest: 9/68 patients (13%, ASO-S) had abnormal pulmonary perfusion at rest, defined as PBFD >2:1 (right/left or left/right) and/or relevant stenosis of the main PA (Vmax >2.5 m/s). 59/68 patients (87%, ASO-N) had normal pulmonary perfusion. PBFD under DSMR: (1) In the whole patient group, there was no increase of PBFD under stress compared to PBFD at rest. On an individual patient level, no relevant worsening of abnormal PBFD was found. (2) Under low dose dobutamine, ASO-S had a significantly lower RVSV-increase (RVSVstress/RVSVrest) compared to ASO-N (see figure). However, under high dose dobutamine, this effect was no longer significant (see figure). (3) The RVSV-increase under low and high dose dobutamine did not correlate with peak oxygen uptake during CPET, neither in the total group nor in the subgroups (see table). Peak oxygen uptake was not significantly different between ASO-N and ASO-S (p=0,72). RVSV-increase compared to CPET peak VO2% ASO-total ASO-S ASO-N RVSV-increase/peak VO2% RVSV-increase/peak VO2% RVSV-increase/peak VO2% low dose dobu high dose dobu low dose dobu high dose dobu low dose dobu high dose dobu Pearson correlation coefficient −0.02 −0.05 0.01 −0.22 −0.05 −0.04 p-value 0.90 0.71 0.98 0.56 0.71 0.78 Figure 1 Conclusion (1) Patients with relevant stenosis of main PA and/or abnormal peripheral blood flow distribution (ASO-S) exhibit a reduced RVSV-increase under low dose dobutamine compared to patients without stenosis (ASO-N). This effect was not present under high dose dobutamine stress. (2) These findings did not correlate with peak oxygen uptake during CPET, an objective parameter of cardiopulmonary exercise capacity. (3) Therefore, a conservative proceeding rather than surgery or catheter intervention should be considered, especially in asymptomatic adult patients. Acknowledgement/Funding Supported by Kinderherzen, Fördergemeinschaft Deutsche Kinderherzzentren e.V.

scholarly journals Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

2020 ◽  
Author(s):  
Matt Morgan ◽  
Laura Jones ◽  
Laura Tan ◽  
Suzanne Carey-Jones ◽  
Nathan Riddell ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Low Cost ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Wearable Device ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2

Abstract Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery. Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices. Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 male) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R=0.57 (CI 0.29-0.76), R=0.59 (CI 0.31-0.77) and R=0.62 (CI 0.35-0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01-0.64), R = 0.39 (CI 0.04-0.66) and R = 0.42 (CI 0.07-0.68) respectively) and peak work (R = 0.56 (CI 0.27-0.75), R = 0.48 (CI 0.17-0.70) and R = 0.50 (CI 0.2-0.72) respectively). Receiver Operator Curve (ROC) analysis for direct and self-reported measures of 7 day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work. Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment. Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24/1/2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.

Magnetic resonance stress tagging in ischemic heart disease

2005 ◽  
Vol 288 (6) ◽  
pp. H2708-H2714 ◽  
Author(s):  
Ingo Paetsch ◽  
Daniela Föll ◽  
Adam Kaluza ◽  
Roger Luechinger ◽  
Matthias Stuber ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Low Dose ◽  
Rotation Velocity ◽  
Dobutamine Stress ◽  
High Dose ◽  
Global Parameter ◽  
Myocardial Tagging ◽  
Time To Peak ◽  
Diastolic Parameter ◽  
High Dose Dobutamine

High-dose dobutamine magnetic resonance stress testing has been shown to be superior to dobutamine stress echocardiography for diagnosis of coronary artery disease (CAD). We determined the feasibility of quantitative myocardial tagging during low- and high-dose dobutamine stress and tested the ability of global systolic and diastolic quantitative parameters to identify patients with significant CAD. Twenty-five patients suspected of having significant CAD were examined with a standard high-dose dobutamine/atropine stress magnetic resonance protocol (1.5-T scanner, Philips). All patients underwent invasive coronary angiography as the standard of reference for the presence ( n = 13) or absence ( n = 12) of significant CAD. During low-dose dobutamine stress, systolic (circumferential shortening, systolic rotation, and systolic rotation velocity) and diastolic (velocity of circumferential lengthening and diastolic rotation velocity) parameters changed significantly in patients without CAD (all P < 0.05 vs. rest) but not in patients with CAD. Identification of patients without and with CAD during low-dose stress was possible using the diastolic parameter of “time to peak untwist.” At high-dose stress, none of the global systolic or diastolic parameters showed the potential to identify the presence of significant CAD. With myocardial tagging, a quantitative analysis of systolic and diastolic function was feasible during low- and high-dose dobutamine stress. In our study, the diastolic parameter of time to peak untwist as assessed during low-dose dobutamine stress was the most promising global parameter for identification of patients with significant CAD. Thus quantitative myocardial tagging may become a tool that reduces the need for high-dose dobutamine stress.

scholarly journals Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Laura Jones ◽  
Laura Tan ◽  
Suzanne Carey-Jones ◽  
Nathan Riddell ◽  
Richard Davies ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Low Cost ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Wearable Device ◽  
Cardiopulmonary Exercise

Abstract Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery. Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices. Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 males) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R = 0.57 (CI 0.29–0.76), R = 0.59 (CI 0.31–0.77) and R = 0.62 (CI 0.35–0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01–0.64), R = 0.39 (CI 0.04–0.66) and R = 0.42 (CI 0.07–0.68) respectively) and peak work (R = 0.56 (CI 0.27–0.75), R = 0.48 (CI 0.17–0.70) and R = 0.50 (CI 0.2–0.72) respectively). Receiver operator curve (ROC) analysis for direct and self-reported measures of 7-day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work. Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment. Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24 January 2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.

scholarly journals Risk stratification in heart failure with mild reduced ejection fraction

2020 ◽  
Vol 27 (2_suppl) ◽  
pp. 59-64
Author(s):  
Damiano Magrì ◽  
Giovanna Gallo ◽  
Gianfranco Parati ◽  
Mariantonietta Cicoira ◽  
Michele Senni
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Oxygen Uptake ◽  
Risk Stratification ◽  
Exercise Test ◽  
Peak Oxygen Uptake ◽  
Cardiopulmonary Exercise Test ◽  
Recent Contribution ◽  
Reduced Ejection Fraction ◽  
Cardiopulmonary Exercise

Heart failure with mid-range ejection fraction represents a heterogeneous and relatively young heart failure category accounting for nearly 20–30% of the overall heart failure population. Due to its complex phenotype, a reliable clinical picture of heart failure with mid-range ejection fraction patients as well as a definite risk stratification are still relevant unsolved issues. In such a context, there is growing interest in a comprehensive functional assessment by means of a cardiopulmonary exercise test, yet considered a cornerstone in the clinical management of patients with heart failure and reduced ejection fraction. Indeed, the cardiopulmonary exercise test has also been found to be particularly useful in the heart failure with mid-range ejection fraction category, several cardiopulmonary exercise test-derived parameters being associated with a poor outcome. In particular, a recent contribution by the metabolic exercise combined with cardiac and kidney indexes research group showed an independent association between the peak oxygen uptake and pure cardiovascular mortality in a large cohort of recovered heart failure with mid-range ejection fraction patients. Contextually, the same study supplied an easy approach to identify a high-risk heart failure with mid-range ejection fraction subset by using a combination of peak oxygen uptake and ventilatory efficiency cut-off values, namely 55% of the maximum predicted and 31, respectively. Thus, looking at the above-mentioned promising results and waiting for specific trials, it is reasonable to consider cardiopulmonary exercise test assessment as part of the heart failure with mid-range ejection fraction work-up in order to identify those patients with an unfavourable functional profile who probably deserve a close clinical follow-up and, probably, more aggressive therapeutic strategies.

scholarly journals Mismatch between self-estimated and objectively assessed exercise capacity in patients with congenital heart disease varies in regard to complexity of cardiac defects

2020 ◽  
pp. 1-7
Author(s):  
Julius M. Woile ◽  
Stefan Dirks ◽  
Friederike Danne ◽  
Felix Berger ◽  
Stanislav Ovroutski
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Oxygen Uptake ◽  
Exercise Capacity ◽  
Congenital Heart ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Subjective Rating ◽  
Cardiac Defects ◽  
Cardiopulmonary Exercise

Abstract Aim: Regular evaluation of physical capacity takes a crucial part in long-term follow-up in patients with congenital heart disease (CHD). This study aims to examine the accuracy of self-estimated exercise capacity compared to objective assessments by cardiopulmonary exercise testing in patients with CHD of various complexity. Methods: We conducted a single centre, cross-sectional study with retrospective analysis on 382 patients aged 8–68 years with various CHD who completed cardiopulmonary exercise tests. Peak oxygen uptake was measured. Additionally, questionnaires covering self-estimation of exercise capacity were completed. Peak oxygen uptake was compared to patient’s self-estimated exercise capacity with focus on differences between complex and non-complex defects. Results: Peak oxygen uptake was 25.5 ± 7.9 ml/minute/kg, corresponding to 75.1 ± 18.8% of age- and sex-specific reference values. Higher values of peak oxygen uptake were seen in patients with higher subjective rating of exercise capacity. However, oxygen uptake in patients rating their exercise capacity as good (mean oxygen uptake 78.5 ± 1.6%) or very good (mean oxygen uptake 84.8 ± 4.8%) was on average still reduced compared to normal. In patients with non-complex cardiac defects, we saw a significant correlation between peak oxygen uptake and self-estimated exercise capacity (spearman-rho −0.30, p < 0.001), whereas in patients with complex cardiac defects, no correlation was found (spearman-rho −0.11, p < 0.255). Conclusion: The mismatch between self-estimated and objectively assessed exercise capacity is most prominent in patients with complex CHD. Registration number at Charité Universitätsmedizin Berlin Ethics Committee: EA2/106/14.

Dobutamine enhances both contractile function and energy reserves in hypoperfused canine right ventricle

2000 ◽  
Vol 279 (6) ◽  
pp. H2975-H2985 ◽  
Author(s):  
Kun Don Yi ◽  
H. Fred Downey ◽  
Xiaoming Bian ◽  
Min Fu ◽  
Robert T. Mallet
Keyword(s):  
Low Dose ◽  
Mechanical Performance ◽  
Contractile Function ◽  
Utilization Efficiency ◽  
High Dose ◽  
Energy Reserves ◽  
Phosphorylation Potential ◽  
Arterial Blood ◽  
Improved Function ◽  
High Dose Dobutamine

Although the β1-adrenergic agent dobutamine is used clinically to provide inotropic support to the failing myocardium, it could jeopardize the myocardium by depleting energy reserves. This investigation delineated the contractile and energetic effects of low versus high dobutamine doses in the hypoperfused right ventricular (RV) myocardium. The right coronary artery (RCA) of anesthetized dogs was cannulated for controlled perfusion with arterial blood, and regional RV contractile function was measured. RCA perfusion pressure was lowered from 100 mmHg baseline to 40 mmHg, and flow fell by 54%. At 15-min hypoperfusion, dobutamine was infused into the RCA at either 0.01 (low-dose dobutamine) or 0.06 μg · kg−1· min−1(high-dose dobutamine) for 15 min. Regional power (systolic segment shortening × isometric developed force × heart rate) stabilized at 63% of baseline during hypoperfusion. Low-dose dobutamine restored power to baseline but did not increase RV myocardial O2consumption (MV˙o2) and thus increased myocardial O2utilization efficiency (O2UE:power/MV˙o2). At 5 min, high-dose dobutamine enhancement of power was similar to that of low-dose dobutamine, but by 15 min, power and O2UE fell to untreated levels. Remarkably, low-dose dobutamine tripled cytosolic phosphorylation potential; in contrast, high-dose dobutamine lowered phosphorylation potential to 45% of the untreated value. Analyses of glucose uptake and glycolytic intermediates revealed sustained enhancement of glycolysis by low-dose dobutamine, but glycolysis became limited at glyceraldehyde 3-phosphate dehydrogenase during high-dose dobutamine treatment. In summary, low-dose dobutamine improved mechanical performance and efficiency of the hypoperfused RV myocardium while increasing myocardial energy reserves, but high-dose dobutamine failed to sustain improved function and depleted energy reserves. Dobutamine is capable of improving both contractile function and cellular energetics in the hypoperfused RV myocardium, but dosage should be carefully selected.

Sign in / Sign up

Export Citation Format

Share Document