Abstract MP44: Assessment and Comparison of Six minute Walk Distance in Patients Undergoing Pharmacological Stress Test

Background: Stress testing is widely used for diagnosis, risk stratification and prognosis of patients (pts). Although a normal stress study identifies pts at low risk, compared to exercise stress (Ex), those undergoing pharmacological stress test (PST) are at a higher risk of mortality. We studied the feasibility of a six minute walk test (SMWT) and compared the six-minute walk distance (SMWD) among Ex and PST. Methods: 328 consecutive patients [Ex=186 (57%); PST= 142 (43%)] referred for stress testing at our hospital were enrolled. Demographic and clinical information was collected. Each patient underwent a SMWT according to American Thoracic Society guidelines. Results: Patients in PST were older (62±14 vs. 57±12; p=0.001), had a higher BMI (36±30 vs. 29±6; p0.01), diabetes (46% vs. 25%; p<0.001) and hyperlipidemia (55% vs. 38%; p=0.01). We found a low SMWD achieved in PST (209 m ± 131) vs. Ex (366 m ± 107; p<0.001). When compared to age-gender matched healthy volunteer data, we found a significantly lower predicted SMWD in all patients suspected of CAD, with the lowest predicted SMWD in PST. (Figure) On multivariate analyses, patients undergoing PST had the highest risk (HR=10.1) of achieving lowest tertile of percent predicted SMWD, followed by female gender (HR=2.0), history of CHF, higher BMI. Only patients above 80 yrs of age had significant higher likelihood of undergoing pharmacological stress mode (OR = 7.2; 95CI =1.7 - 30.1; p=0.008). After including the interaction term for age and pharmacological stress mode, low SMWD among PST was seen in both older and young patients (p for interaction=0.46). Conclusion: SMWT is feasible in patients referred for PST. Patients with known or suspected CAD achieve a low percent predicted SMWD. This is the first study to show objective evidence of deconditioning in PST irrespective of co-morbidities. Future studies are needed to evaluate the prognostic significance of SMWT in patients undergoing pharmacological stress test.

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Abstract P326: Myocardial Ischemia and Mobilization of Circulating Progenitor Cells

Circulation ◽

10.1161/circ.135.suppl_1.p326 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Muhammad Hammadah ◽

Ayman Samman Tahhan ◽

Ibhar Almheid ◽

Bryan Ross Kindya ◽

Mazen Ghafeer ◽

...

Keyword(s):

Myocardial Infarction ◽

Myocardial Perfusion ◽

Myocardial Ischemia ◽

Progenitor Cells ◽

Linear Models ◽

Stress Test ◽

Exercise Stress ◽

Previous Myocardial Infarction ◽

Pharmacological Stress ◽

Pharmacological Stress Test

Background: Circulating progenitor cells (CPCs) are involved in vascular repair and regeneration. Low levels of CPCs in patients with CAD have been linked to adverse cardiovascular outcomes. The response of CPCs to transient myocardial ischemia in patients with CAD has not been studied before. We aimed to investigate the CPC response to exercise provoked myocardial ischemia (demand ischemia), and compare it to myocardial ischemia detected during pharmacological stress test (flow mismatch). Methods: 570 patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging during exercise (69%), or pharmacological stress (31%). myocardial ischemia was defined as a new or worsening impairment in myocardial perfusion using a 17-segment model. CD34+ CPCs were enumerated by flow cytometry at rest and 30 min after stress testing. The change in CPC count was compared between patients with and without myocardial ischemia using mixed linear models. Results: Mean age was 63±9 years, 76% males, 36% with previous myocardial infarction. The incidence of myocardial ischemia was 31% and 41% during exercise and pharmacological stress test, respectively. No difference was observed in resting CPC between patients undergoing exercise vs pharmacological stress test, nor between patients with or without myocardial ischemia. However, patients who developed myocardial ischemia during exercise stress had a significant decrease in CPC with stress in comparison to those without myocardial ischemia (-12% vs 4%, respectively, p=0.006). Furthermore, the change in CPCs was inversely correlated with the magnitude of myocardial ischemia (R=-0.13, p=0.023), suggesting a greater CPC reduction with larger ischemic burden. These findings remained significant even after adjustment for age, gender, race, BMI, previous myocardial infarction, resting levels of CPCs and hematocrit change with stress. No difference was observed in CPC response to pharmacological stress test (change of -1% vs 3%, for patients with and without myocardial ischemia, respectively, p=0.96). Conclusion: Exercise stress-induced myocardial ischemia is associated with a decrease in CPC counts, likely due to increased homing of stem cells to the ischemic myocardium. Whether the extent of CPC uptake has prognostic implication, or whether the CPC response can be altered with intervention needs further investigation.

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Theophylline and Caffeine as Alternatives During an Aminophylline Shortage

Annals of Pharmacotherapy ◽

10.1177/1060028018806624 ◽

2018 ◽

Vol 53 (3) ◽

pp. 316-320 ◽

Cited By ~ 2

Author(s):

Emily L. Singleton ◽

Nancy Le ◽

Genevieve Lynn Ness

Keyword(s):

Stress Testing ◽

Stress Test ◽

Pharmacological Stress ◽

Drug Shortage ◽

Reversal Agent ◽

Cardiac Stress ◽

Reversal Agents ◽

Diagnosis And Prognosis ◽

Pharmacological Stress Testing ◽

Pharmacological Stress Test

The latest aminophylline shortage has prompted a need for alternative reversal agents for pharmacological stress testing. Cardiac stress testing is common for diagnosis and prognosis in patients with coronary heart disease. Options for pharmacological stress test agents include adenosine, regadenoson, dipyridamole, and dobutamine, whereas aminophylline is the recommended reversal agent. Adenosine and dobutamine can be used as alternatives to regadenoson and dipyridamole to decrease or eliminate the use of aminophylline. Alternatives to aminophylline include theophylline and caffeine. It is important to efficiently identify alternatives during a drug shortage to maintain optimal patient outcomes.

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Study of efficacy and safety of pharmacological stress tests in nuclear cardiology

Vojnosanitetski pregled ◽

10.2298/vsp0903193b ◽

2009 ◽

Vol 66 (3) ◽

pp. 193-198 ◽

Cited By ~ 2

Author(s):

Branislav Baskot ◽

Saso Rafajlovski ◽

Andjelka Ristic-Angelkov ◽

Slobodan Obradovic ◽

Branko Gligic ◽

...

Keyword(s):

Side Effects ◽

Stress Testing ◽

Stress Test ◽

Stress Tests ◽

Pharmacological Stress ◽

Safety And Efficacy ◽

Low Level ◽

Low Intensity ◽

Pharmacological Stress Test ◽

Low Intensity Exercise

Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonly used technique in the assessment of coronary artery disease. Many patients who cannot adequately perform exercise stress testing may nevertheless undergo pharmacological tests, most commonly with the vasodilator agents (adenosine and dipyridamole), as well as the positive inotropic agent dobutamine. Patients undergoing vasodilators stress testing with either dipyridamole or adenosine also perform simultaneous low-intensity exercise. The aim of this study was to compare various pharmacological stress tests alone or in combination with low intensity exercise as preparation for MPS in reagard to incidence of adverse effects, quality of diagnostic image and the acquisition initial time. Methods. A total of 2 205 patients underwent pharmacological stress tests. Pharmacological stress test with adenosine was applied in 493 patients. In 405 of them we performed concomitant low level exercise (50 W) by bicycle ergometar (AdenoEX). In 88 of them we performed adenosine abbreviated protocol (AdenoSCAN). In 1 526 patients we performed pharmacological stress test with dipyridamole. In 871 of them we performed concomitant low level exercise (50 W) by bicycle ergometar (DipyEX), and in 775 we used only dipyridamole protocol (DipySCAN). In 186 patients we used pharmacological stress test with dobutamine. We followed side effects of adenosine, dipyiridamole and dobutamine, compared results between protocols with concomitant low level exercise and vasodilatators only. We also compared image quality, and suggested time of acquisition after stress test. Results. We found numerous side effects especially with adenosine, but these effects were short-lived and not required active interventions. Benefit with concomitant exercise in booth AdenoEX and DipyEX included decreased side effects (AdenoEX vs AdenoSCAN 62% vs 87%, respectively, and DipyEX vs DipySCAN 37% vs 59%, respectively) improved safety and patients tolerance, improved target-to-background ratios because of less subdiaphragmal activity, and earlier acquisition time. Because of producing a lot of arrhythmias (in 49% of patients) dobutamin was considered a last choice for pharmacological stress testing. Conclusion. Safety and efficacy of vasodilatators (adenosine, dipyridamole) pharmacological stress tests are good, but with concomitant exercise even better. The safety and efficacy of adenosin are better than those of dipyridamole. AdenoEX protocol provides good safety and patients tolerance. In light of these benefits we recommend AdenoEX whenever possible. Dobutamine is the last pharmacological toll for MPS.

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1H NMR serum metabolomic profiling of patients at risk of cardiovascular diseases performing stress test

Scientific Reports ◽

10.1038/s41598-020-74880-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Camila Lema ◽

Mireia Andrés ◽

Santiago Aguadé-Bruix ◽

Marta Consegal ◽

Antonio Rodriguez-Sinovas ◽

...

Keyword(s):

Cardiovascular Diseases ◽

Exercise Test ◽

Stress Testing ◽

Stress Test ◽

Serum Lactate ◽

Exercise Stress ◽

Pharmacological Stress ◽

Definitive Answer ◽

H Nmr ◽

Pharmacological Testing

Abstract Cardiovascular diseases are the leading cause of death worldwide. Changes in lifestyle and/or pharmacological treatment are able to reduce the burden of coronary artery diseases (CAD) and early diagnosis is crucial for the timely and optimal management of the disease. Stress testing is a good method to measure the burden of CAD but it is time consuming and pharmacological testing may not fully mimic exercise test. The objectives of the present project were to characterize the metabolic profile of the population undergoing pharmacological and exercise stress testing to evaluate possible differences between them, and to assess the capacity of 1H NMR spectroscopy to predict positive stress testing. Pattern recognition was applied to 1H NMR spectra from serum of patients undergoing stress test and metabolites were quantified. The effects of the stress test, confounding variables and the ability to predict ischemia were evaluated using OPLS-DA. There was an increase in lactate and alanine concentrations in post-test samples in patients undergoing exercise test, but not in those submitted to pharmacological testing. However, when considering only pharmacological patients, those with a positive test result, showed increased serum lactate, that was masked by the much larger amount of lactate associated to exercise testing. In conclusion, we have established that pharmacological stress test does not reproduce the dynamic changes observed in exercise stress. Although there is promising evidence suggesting that 1H NMR based metabolomics could predict stress test results, further studies with much larger populations will be required in order to obtain a definitive answer.

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Faculty Opinions recommendation of Validation of 6-minute walk distance as a surrogate end point in pulmonary arterial hypertension trials.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717963542.793465451 ◽

2012 ◽

Author(s):

Luke Howard

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Walk Distance ◽

End Point ◽

Pulmonary Arterial ◽

Minute Walk Distance ◽

Minute Walk

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Characteristics and health status of patients with and without confirmed HFpEF

European Heart Journal ◽

10.1093/ehjci/ehaa946.3139 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Deaton ◽

F Forsyth ◽

J Mant ◽

D Edwards ◽

R Hobbs ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Cohort Study ◽

Health Status ◽

Functional Impairment ◽

Funding Source ◽

Walk Distance ◽

Minute Walk Distance ◽

Minute Walk

Abstract Aims Patients with heart failure with preserved ejection fraction (HFpEF) are usually older and multi-morbid and diagnosis can be challenging. The aims of this cohort study were to confirm diagnosis of HFpEF in patients with possible HFpEF recruited from primary care, to compare characteristics and health status between those with and without HFpEF, and to determine factors associated with health status in patients with HFpEF. Methods Patients with presumed HFpEF were recruited from primary care practices and underwent clinical assessment and diagnostic evaluation as part of a longitudinal cohort study. Health status was measured by Montreal Cognitive Assessment (MOCA), 6-minute walk test, symptoms, and the Kansas City Cardiomyopathy Questionnaire (KCCQ), and quality of life (QoL) by EQ-5D-5L visual analogue scale (VAS). Results 151 patients (mean age 78.5±8.6 years, 40% women, mean EF 56% + 9.4) were recruited and 93 (61.6%) were confirmed HFpEF (those without HFpEF had other HF and cardiac diagnoses). Patients with and without HFpEF did not differ by age, MOCA, blood pressure, heart rate, NYHA class, proportion with atrial fibrillation, Charlson Comorbidity Index, or NT-ProBNP levels. Patients with HFpEF were more likely to be women, overweight or obese, frail, and to be more functionally impaired by 6 minute walk distance and gait speed than those without. Although not statistically significant, patients with HFpEF had clinically significant differences (>5 points) on the physical limitations, symptom burden and clinical summary subscales of the KCCQ, but did not differ by other subscales or by EQ-5D-5L VAS (70±17 vs 73±19, p=0.385). More patients with HFpEF reported daytime dyspnoea (63% vs 46%, p=0.035) and fatigue (81% vs 61%, p=0.008), but not other symptoms compared to those without HFpEF. For both groups BMI was moderately negatively correlated with KCCQ subscale scores, and 6 minute walk distance was positively correlated with KCCQ subscales. Conclusions Nearly 40% were not confirmed as HFpEF indicating the challenges of diagnosis. Patients with confirmed HFpEF differed by sex, overweight/obesity, frailty, functional impairment, and symptoms but not by age or comorbidities from those without HFpEF. These differences were reflected in some subscale scores of the KCCQ, but not how patients reported their quality of life on the KCCQ QoL subscale and EQ-5D-5L VAS. Older patients with HFpEF reported relatively high QoL despite poor health status by functional impairment, frailty and symptoms. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research School of Primary Care Research

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Predictors of reduced 6-minute walk distance after COVID-19: a cohort study in Mexico

Pulmonology ◽

10.1016/j.pulmoe.2021.03.004 ◽

2021 ◽

Author(s):

Alyson W. Wong ◽

Stephanie López-Romero ◽

Esperanza Figueroa-Hurtado ◽

Saul Vazquez-Lopez ◽

Kathryn M. Milne ◽

...

Keyword(s):

Cohort Study ◽

Walk Distance ◽

Minute Walk Distance ◽

Minute Walk

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42 Is Mitochondrial Function Measured by 31P Magnetic Resonance Spectroscopy Associated with Physical Performance in Older People with Functional Impairment?

Age and Ageing ◽

10.1093/ageing/afab030.03 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

R R Chungath ◽

M D Witham ◽

C L Clarke ◽

A Hutcheon ◽

S Gandy ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Spectroscopy ◽

Older People ◽

Physical Performance ◽

Functional Impairment ◽

Resonance Spectroscopy ◽

Walk Distance ◽

31P Magnetic Resonance Spectroscopy ◽

Minute Walk Distance ◽

Minute Walk

Abstract Background Mitochondrial dysfunction has been proposed as a therapeutic target to improve muscle strength and endurance, but the contribution that mitochondrial dysfunction makes to impaired skeletal muscle performance in older people remains unclear. We studied the relationship between phosphocreatine recovery rate (a measure of skeletal muscle mitochondrial function) and physical performance in older people. Methods We analysed data from the Allopurinol in Functional Impairment (ALFIE) trial. Participants aged 65 and over, who were unable to walk 400 m in six minutes, underwent 31P magnetic resonance spectroscopy of the calf after exercise at baseline and at 20 weeks follow up. The phosphocreatine recovery half-life time (t-half) was derived as a measure of mitochondrial function. Participants also undertook the 6-minute walk distance, the Short Physical Performance Battery test (SPPB), and had muscle mass measured using bio-impedance analysis. Bivariate correlations and multivariable regression analyses were conducted to determine associations between t-half and baseline factors. Results One hundred and seventeen people underwent baseline 31P magnetic resonance spectroscopy, mean age 80.4 years (SD 6.0); 56 (48%) were female. Mean 6-minute walk was 291 m (SD 80) and mean SPPB score was 8.4 (SD 1.9). T-half was significantly correlated with SPPB score (r = 0.22, p = 0.02) but not with 6-minute walk distance (r = 0.10, p = 0.29). In multivariable linear regression, muscle mass and weight, but not t-half, were independently associated with SPPB score and with 6-minute walk distance. The change in t-half between baseline and 20 weeks was not significantly associated with the change in SPPB (r = 0.03, p = 0.79) or with the change in 6-minute walk distance (r = −0.11, p = 0.28). Conclusion Muscle mass, but not phosphocreatine recovery time, was associated with Short Physical Performance Battery score and 6-minute walk distance in this cohort of older people with functional impairment.

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