Abstract 2195: Significant Relation of Arterial Stiffening to Hyperventilatory Response to Exercise in Patients with Coronary Artery Disease

Exercise intolerance is a common feature of patients with coronary artery disease (CAD). Enhanced ventilatory response is determinants of exercise capacity and marker of a poor prognosis irrespective of LV systolic function. Pulse wave velocity (PWV), which is a reliable marker of arterial stiffness, modulates left ventricular (LV) function and is related to exercise capacity in CAD patients; however, the relationship of PWV to ventilatory response to exercise in CAD patients has not been fully elucidated. In this study, we examined PWV and cardiopulmonary exercise testing (CPX) in CAD patients and evaluated the relationship between PWV and ventilatory response to exercise. We studied 81 CAD patients (69±8yo, 64men). All subjects underwent symptom limited CPX. Ventilatory response to exercise was determined by VE/VCO 2 slope. We also measured PWV using an automated device (form ABI/PWV, Colin, Japan) prior to CPX. LV function was assessed by echocardiogram. In univariate analysis, PWV was related to VE/VCO 2 slope (r=0.34, p<0.01). PWV was also associated with exercise time (r=−0.22, p<0.05), time to ST depression (r=−0.32, p<0.01) and peak VO 2 (r=−0.44, p<0.01). The relationship between PWV and VE/VCO 2 was still significant after adjustment for age, sex and blood pressure. Patients with high PWV (over 1800cm/sec, n=29) had higher BNP (140±214 vs 59±66 pg/ml, p<0.05) and lower E/A ratio (0.7±0.2 vs. 0.9±0.3, p<0.05) than those with low PWV (under 1800cm/sec, n=52). In exercise testing, patients with high PWV had higher VE/VCO 2 slope (30.9±2.6 vs. 29.0±3.4, p<0.01), shorter time to ST depression than patients with low PWV (352±79 vs. 403±59 sec, p<0.01), whereas severity of CAD, defined as number of diseased vessels, was comparable between the two groups. Arterial stiffening is associated with enhanced ventilatory response to exercise in CAD patients. Diastolic dysfunction and lowered threshold of myocardial ischemia associated with arterial stiffening are probably involved in the hyperventilatory response to exercise in CAD patients.

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Body surface distribution of ST depression during exercise testing in patients with coronary artery disease

The American Journal of Cardiology ◽

10.1016/0002-9149(80)90984-4 ◽

1980 ◽

Vol 45 (2) ◽

pp. 469

Author(s):

G.M. Vincent ◽

R.L. Lux ◽

D. Davis ◽

F. Yanowitz ◽

M. Merchant

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Exercise Testing ◽

Body Surface ◽

Surface Distribution ◽

St Depression ◽

Artery Disease

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Increased diastolic blood pressure response to exercise testing when coronary artery disease is suspected. An indication of severity.

Heart ◽

10.1136/hrt.53.6.598 ◽

1985 ◽

Vol 53 (6) ◽

pp. 598-602 ◽

Cited By ~ 14

Author(s):

F Akhras ◽

J Upward ◽

G Jackson

Keyword(s):

Blood Pressure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Diastolic Blood Pressure ◽

Exercise Testing ◽

Blood Pressure Response ◽

Pressure Response ◽

Artery Disease ◽

Response To Exercise

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Correlation of B-Type Natriuretic Peptide Level with Severity of Coronary Artery Disease in Non St Elevated Acute Coronary Syndrome with Normal Left Ventricular Function

University Heart Journal ◽

10.3329/uhj.v12i1.34019 ◽

2017 ◽

Vol 12 (1) ◽

pp. 17-22

Author(s):

Sohel Mahmud ◽

AKM Fazlur Rahman ◽

SM Ahsan Habib ◽

Chaudhury Meshkat Ahmed ◽

SM Mustafa Zaman ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Left Ventricular ◽

Lv Function ◽

Syntax Score ◽

Coronary Syndrome ◽

Vessel Disease ◽

Normal Left Ventricular ◽

Artery Disease ◽

The Relationship

Background: Coronary artery disease (CAD) is predicted to be the most common cause of death and disability globally by 2020. In Bangladesh, for better management of coronary artery disease and to reduce the burden of acute coronary events patients with non ST elevated acute coronary syndrome (NSTEACS) should be focused. B-type natriuretic peptide (BNP) can be suggested as a tool to predict severity of coronary atherosclerotic lesion even with normal left ventricular (LV) function and thus to categorize the patients for appropriate referral and invasive evaluation.Aims: This study is designed to assess the relationship between level of BNP and severity of coronary artery disease assessed with SYNTAX score in NSTE-ACS patients with normal LV function. Methods: This cross sectional observational study was conducted at UCC, BSMMU during the period of May 2014 to April 2015 among the patients with non ST elevated myocardial infarction (NSTEMI) and unstable angina. 116 patients were enrolled by non-random purposive sampling who was admitted for coronary angiogram. All the data were recorded in structured questionnaire including details of medical history, coronary risk factors and physical findings. In NSTE-ACS patients with normal LV function venous blood samples were collected for BNP and later SYNTAX scoring was assessed during coronary angiogram. The relationship between level of BNP and SYNTAX score in patients with both UA and NSTE-MI was assessed statistically to evaluate the validity of BNP as a tool to predict severity of coronary atherosclerotic lesions among the patients with NSTE-ACS.Results: The mean age was 57.84±8.82 years. Among the 116 patients, highest frequency of patients was in the age group 51-60 years 55(47.4%) .In which 88(75.9%) were male. Male:Female ratio is 3.1:1.The percentage of risk factors was higher in NSTEMI group and difference with UA was statistically significant (p <0.05). Serum BNP in UA 64.9±13.07 and in NSTEMI 107.2±11.53. The mean difference of serum BNP between two groups is statistically significant. In UA group the SYNTAX score was found 13.2±11.1 and in NSTEMI 19.9±13.5 which is statistically significant. In UA group maximum patients were found two vessel disease and in NSTEMI maximum patients in three vessel disease. 70.0% of patients of three vessel disease had e 80pg/ml of BNP. The association is statistically significant (p< 0.05). Higher the level of BNP reflect higher the vessel involvement and SYNTAX score irrespective of UA and NSTEMI.Conclusion: Our study reveals BNP is a candidate for entry into the setting of principal risk scores. Our findings indicate that the level of BNP may reflect the severity of ischemic insult even when irreversible injury and systolic dysfunction have not occurred.University Heart Journal Vol. 12, No. 1, January 2016; 17-22

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Cardiopulmonary Exercise Testing and Impedance Cardiography in The Assessment of Exercise Capacity of Patients with Coronary Artery Disease

10.21203/rs.3.rs-587245/v1 ◽

2021 ◽

Author(s):

Małgorzata Kurpaska ◽

Paweł Krzesiński ◽

Grzegorz Gielerak Prof ◽

Karina Gołębiewska ◽

Katarzyna Piotrowicz

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Exercise Capacity ◽

Exercise Testing ◽

Impedance Cardiography ◽

Cardiopulmonary Exercise Testing ◽

Hemodynamic Parameters ◽

Cardiopulmonary Exercise ◽

Artery Disease ◽

Response To Exercise

Abstract Background Patients with coronary artery disease (CAD) are characterized by different levels of physical capacity, which depends not only on the anatomical advancement of atherosclerosis, but also on the individual cardiovascular hemodynamic response to exercise. The aim of this study was to evaluate the relationship between parameters of exercise capacity assessed via cardiopulmonary exercise testing (CPET) and impedance cardiography (ICG) hemodynamics in patients with CAD. Methods Exercise capacity was assessed in 54 patients with CAD (41 men, aged 59.5 ± 8.6 years) within 6 weeks after revascularization by means of oxygen uptake (VO2), assessed via CPET, and hemodynamic parameters (heart rate (HR), stroke volume (SV), cardiac output (CO), left cardiac work index (LCWi)), measured by ICG. Correlations between these parameters at anaerobic threshold (AT) and at the peak of exercise as well as their changes (Δpeak–rest, Δpeak–AT) were evaluated. Results A large proportion of patients exhibited reduced exercise capacity, with 63% not reaching 80% of predicted peak VO2. Clinically relevant correlations were noted between the absolute peak values of VO2 vs. HR, VO2 vs. CO, and VO2 vs. LCWi (R = 0.45, p = 0.0005; R = 0.33, p = 0.015; and R = 0.40, p = 0.003, respectively). There was no correlation between AT VO2 and hemodynamic parameters at the AT time point. Furthermore ΔVO2(peak–AT) correlated with ΔHR(peak–AT), ΔCO(peak–AT) and ΔLCWi(peak–AT) (R = 0.52, p < 0.0001, R = 0.49, p = 0.0001; and R = 0.49, p = 0.0001, respectively). ΔVO2(peak–rest) correlated with ΔHR(peak–rest), ΔCO(peak–rest), and ΔLCWi(peak–rest) (R = 0.47, p < 0.0001; R = 0.41, p = 0.002; and R = 0.43, p = 0.001, respectively). Conclusion ICG is a reliable method of assessing the cardiovascular response to exercise in patients with CAD. Some ICG parameters show definite correlations with parameters of cardiovascular capacity of proven clinical utility, such as peak VO2.

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