scholarly journals Can categorised values of maximal oxygen uptake discriminate patterns of exercise dysfunction in pectus excavatum: a prospective cohort study?

2021 ◽  
Vol 8 (1) ◽  
pp. e000940
Author(s):  
Christopher M R Satur ◽  
Ian Cliff ◽  
Nicholas Watson

Cohort studies of patients with pectus excavatum have inadequately characterised exercise dysfunction experienced. Cardiopulmonary exercise test data were delineated by maximal oxygen uptake values >80%, which was tested to examine whether patterns of exercise physiology were distinguished.MethodsSeventy-two patients considered for surgical treatment underwent assessment of pulmonary function and exercise physiology with pulmonary function tests and cardiopulmonary exercise test between 2006 and 2019. Seventy who achieved a threshold respiratory gas exchange ratio of >1.1 were delineated by maximal oxygen uptake >80%, (group A, n=33) and <80% (group B, n=37) and comparison of constituent physiological parameters performed.ResultsThe cohort was 20.8 (±SD 6.6) years of age, 60 men, with a Haller’s Index of 4.1 (±SD 1.4). Groups A and B exhibited similar demography, pulmonary function test results and Haller’s index values. Exercise test parameters of group B were lower than group A; work 79.2% (±SD 11.3) versus 97.7 (±SD 10.1), anaerobic threshold 38.1% (±SD 7.8) versus 49.7% (±SD 9.1) and O2 pulse 77.4% (±SD 9.8) versus 101.8% (±SD 11.7), but breathing reserve was higher, 54.9% (±SD 13.1) versus 44.2% (±SD 10.8), p<0.001 for each. Both groups exhibited similar incidences of carbon dioxide retention at peak exercise. A total of 65 (93%) exhibited abnormal values of at least one of four exercise test measures.ConclusionThis study showed that patients with pectus excavatum exhibited multiple physiological characteristics of compromised exercise function. It is the first study that defines differing patterns of exercise dysfunction and provides evidence that patients with symptomatic pectus excavatum should be considered for surgical treatment.

CHEST Journal ◽  
2014 ◽  
Vol 146 (4) ◽  
pp. 681A
Author(s):  
Alev Gurgun ◽  
Pervin Korkmaz Ekren ◽  
Hale Karapolat ◽  
Pelin Ozdemir ◽  
Zehra Toreyin ◽  
...  

2020 ◽  
Vol 34 (S1) ◽  
pp. 1-1
Author(s):  
Reginaldo Ceolin-Nascimento ◽  
Felipe Xerez Cepeda ◽  
José Roberto DeMoura ◽  
Fernanda Cristina Ferreira Camargo ◽  
Lucas Fortes-Queiroz ◽  
...  

2020 ◽  
Vol 9 (2) ◽  
pp. 1-8 ◽  
Author(s):  
Stefanos Sakellaropoulos ◽  
Dimitra Lekaditi ◽  
Stefano Svab

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.


2020 ◽  
Vol 27 (2_suppl) ◽  
pp. 59-64
Author(s):  
Damiano Magrì ◽  
Giovanna Gallo ◽  
Gianfranco Parati ◽  
Mariantonietta Cicoira ◽  
Michele Senni

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.


Author(s):  
William J.M. Kinnear ◽  
James H. Hull

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.


Author(s):  
William J.M. Kinnear ◽  
James H. Hull

This chapter outlines the approach to producing a cardiopulmonary exercise test (CPET) report. A CPET is rarely diagnostic and should be looked at in the context of the clinical background and what key question is being asked. Cardiovascular, ventilatory, and gas exchange responses are looked at in turn, then reviewed in a systematic and iterative way. If the maximum oxygen uptake (VO2max) is within the normal range, abnormalities seen in other parameters should be interpreted cautiously.


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