Abstract 12942: Association of Exercise Performance With Hemodynamic and Imaging Parameters in Fontan Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alyson R Pierick ◽  
Michael Kelleman ◽  
Megan Stark ◽  
Danish Vaiyani ◽  
Robert Whitehill ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Stress Test ◽  
Fontan Operation ◽  
Retrospective Chart Review ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Surveillance Program ◽  
Primary Analysis ◽  
Lateral Tunnel ◽  
Fontan Patients

Introduction: The Fontan operation results in hemodynamic, anatomic and functional alterations in single ventricle (SV) heart disease. Studies have shown that SV patients have reduced exercise capacity. We sought to determine hemodynamic and anatomic associations with exercise capacity in our Fontan cohort. Methods: We performed a retrospective chart review of all patients born 2002-2012 who underwent Fontan palliation and followed in our Fontan Surveillance Program. Surveillance cardiac magnetic resonance (cMR), cardiac catheterization (cath), and exercise stress test (EST) data were collected. Primary analysis was association of cMR and cath data on EST outcomes including percent-predicted maximum oxygen consumption (ppVO 2 max) and oxygen pulse (ppO 2 Pulse). Results: A total of 222 patients were included, 45.5% with a systemic left ventricle (LV). Hypoplastic left heart syndrome was the underlying cardiac diagnosis in 1/3 of patients. The vast majority of the Fontan procedures performed were fenestrated, 44% extracardiac conduits and 42% with a lateral tunnel graft. A total of 185 cMRs, 274 caths, and 136 ESTs were performed. The median respiratory exchange ratio and ppVO 2 max were 1.11 L/sec and 73% respectively, with a preserved ppO 2 Pulse of 93.5%. Results of correlational analysis are shown in the table. Over serial ESTs, patients with a single RV had a more gradual, but not significant decline in ppVO 2 max than patients with a single LV, r s -0.321 and -0.544 respectively (p = 0.28). Conclusions: While hemodynamic parameters do not correlate with EST functional endpoints, anatomic factors such as the Nakata index are associated with EST performance. Surveillance of Fontan patients should include regular cMR to assess for subtle changes in ejection fraction, pulmonary artery diameter and differential pulmonary blood flow. Multicenter longitudinal studies with protocolized timing are needed to further elucidate correlates of good exercise capacity.

Abstract 15765: Clinical Significance of Submaximal Parameters of Exercise Stress Test in Characterizing Post-Fontan Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daphney Kernizan ◽  
Gina DAloisio ◽  
Bradley Robinson ◽  
Takeshi Tsuda
Keyword(s):  
Exercise Capacity ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Cycle Ergometer ◽  
Exercise Stress ◽  
Peak Oxygen Consumption ◽  
Peak Exercise ◽  
Fontan Patient ◽  
Significant Difference ◽  
Fontan Patients

Background: Fontan patients have diminished exercise capacity relative to healthy peers. Peak oxygen consumption (pVO2) is a useful marker for maximum exercise capacity, though it may not be achievable in certain patients. We studied clinical validity of submaximal parameters in exercise stress test (EST) in post-Fontan patients. Methods: We retrospectively analyzed EST of post-Fontan patients and age-matched controls by cycle ergometer. We obtained peak values of heart rate (pHR), VO2, oxygen pulse (pOP), respiratory quotient (pRQ), and work rate (pWR). Submaximal parameters included ventilatory anaerobic threshold (VAT), slopes of VO2/HR changes (ΔVO2/ΔHR) and HR/WR changes (ΔHR/ΔWR), and oxygen uptake efficiency slope (OUES). Data are shown as mean ± standard deviation. Results: Twenty four single right ventricle (SRV), 12 single left ventricle (SLV), and 24 controls were studied (Table 1).pHR, pVO2, pOP, and pWR were significantly lower in Fontan patients than in controls, but with no significant difference between SRV and SLV. ΔVO2/ΔHR and OUES were significantly lower in Fontan group than controls, whereas VAT and pRQ were comparable in all three groups. VAT was preserved in Fontan groups. Lower slope of ΔVO2/ΔHR and decreased OUES in the Fontan group suggests an intrinsic exercise limitation or limited stroke volume (SV) increase. This was compensated by a higher HR response up to AT, exhibited by the higher slope of ΔHR/ΔWR despite lower pHR in the Fontan group. Conclusions: Peak exercise parameters were significantly lower in Fontan patients although pRQ and VAT were comparable among the three groups. The lower ΔVO2/ΔHR and pOP in Fontan patients suggest limited SV reserve in response to exercise. A combination of lower ΔVO2/ΔHR and higher ΔHR/ΔWR characterizes Fontan patient. Inclusion of submaximal exercise parameters brings additional value in specifying the physiological responses to exercise.

Average Exercise Capacity in Men and Women >75 Years of Age Undergoing a Bruce Protocol Exercise Stress Test

2021 ◽  
Author(s):  
Bradley S. Lander ◽  
Aimee M. Layton ◽  
Robert P. Garofano ◽  
Allan Schwartz ◽  
David J. Engel ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Men And Women ◽  
Bruce Protocol

scholarly journals Assessing the utility of screening electrocardiograms in pediatric patients following COVID-19

2021 ◽  
pp. 1-19
Author(s):  
Ari J. Gartenberg ◽  
Travus J. White ◽  
Khoi Dang ◽  
Maully Shah ◽  
Stephen M. Paridon ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Stress Test ◽  
Severe Disease ◽  
Retrospective Chart Review ◽  
Exercise Stress Test ◽  
Primary Care Providers ◽  
Exercise Stress ◽  
Care Providers ◽  
Premature Ventricular Contractions ◽  
Small Cohort

Abstract Objective: To determine the utility of screening electrocardiograms after SARS-CoV-2 infection among pediatric patients in detecting myocarditis related to COVID-19. Study Design: A retrospective chart review was performed at a large pediatric academic institution to identify patients with prior SARS-CoV-2 infection who received a screening electrocardiogram by their primary care providers and were subsequently referred for outpatient cardiology consultation due to an abnormal electrocardiogram. The outcomes were the results from their cardiology evaluations, including testing and final diagnoses. Results: Among 46 patients, during their preceding COVID-19 illness, the majority had mild symptoms, four were asymptomatic, and one had moderate symptoms. The median length of time from positive SARS-CoV-2 test to screening electrocardiogram was 22 days, and many electrocardiogram findings that prompted cardiology consultation were normal variants in asymptomatic adolescent athletes. Patients underwent frequent additional testing at their cardiology appointments: repeat electrocardiogram (72%), echocardiogram (59%), Holter monitor (11%), exercise stress test (7%), and cardiac MRI (2%). Five patients were incidentally diagnosed with congenital heart disease or structural cardiac abnormalities, and three patients had conduction abnormalities (premature atrial contractions, premature ventricular contractions, borderline prolonged QTc), although potentially incidental to COVID-19. No patients were diagnosed with myocarditis or ventricular dysfunction. Conclusion: In a small cohort of pediatric patients with prior COVID-19, who were primarily either asymptomatic or mildly symptomatic, subsequent screening electrocardiograms identified various potential abnormalities prompting cardiology consultation, but no patient was diagnosed with myocarditis. Larger multi-center studies are necessary to confirm these results and to evaluate those with more severe disease.

scholarly journals Exaggerated blood pressure response at mild exertional intensity is associated with lower exercise capacity and worsening of cardiac structural and functional profile

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.K Woznicka ◽  
M Kabaj ◽  
W Kosowski ◽  
J Zachwyc ◽  
R Pehcerczyk ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Exercise Capacity ◽  
Exercise Intensity ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Study Cohort ◽  
Funding Source ◽  
Cardiac Morphology

Abstract   Even with normal blood pressure (BP) measured at rest, some individuals may experience excessive BP elevation with exercise, termed as an “exaggerated BP response to exercise” (ExBPR). The most common definition of ExBPR is SBP ≥210 mm Hg in men and ≥190 mm Hg in women at peak exercise intensity (ExBPR-PI). However, evidence exists that increase in SBP ≥150 mm Hg at an early stage of exercise stress test (i.e. at mild exercise intensity, ExBPR-MI) can effectively identify hypertension not diagnosed by conventional methods. No studies exploring the pathophysiological significance of ExBPR-MI have been undertaken to date. Aim To investigate the association of ExBPR-MI with exercise capacity and cardiac morpho-functional characteristics. Methods A group of 109 subjects (mean age 52±13 yrs) with and without a pre-established diagnosis of hypertension, having clinical indications for an exercise stress test, with seated clinic BP <140/90 mm Hg, underwent resting echocardiographic imagining and cardiopulmonary exercise testing using a ramped Bruce protocol. Results Based on the BP response at 3 minutes of exercise, the population was divided into two subsets: ExBPR-MI+ and ExBPR-MI− (SBP ≥ and <150 mmHg, respectively). The ExBPR-MI+ group was characterized by lower peak oxygen uptake, higher LV mass and left atrial size, and more impaired LV diastolic function (lower E/A and e', and higher E/e'). When the study cohort was stratified using peak BP response, significant differences indicating an adverse impact of ExBPR-PI were demonstrated only for LV diastolic parameters but not for peak VO2 and cardiac morphology indices (Table 1). Conclusions ExBPR-MI predisposes to reduced exercise capacity and detrimental alterations in cardiac morphology and function. As mild exercise intensity is more frequently present during routine daily activities than peak exercise intensity, ExBPR-MI may be a more important pathophysiological contributor to target organ damage than peak BP response, and may represent a potential new target for preventive and therapeutic measures. Table 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Centre Poland

Abstract 15780: The Utility of Exercise Stress Testing in the Evaluation of Ischemia Among Pediatric Patients With Exertional Chest Pain

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicholas Robles ◽  
Shailendra Upadhyay
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Pediatric Patients ◽  
Stress Test ◽  
Retrospective Chart Review ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Z Score ◽  
Coronary Artery Abnormalities ◽  
Myocardial Perfusion Study

Introduction: Exertional chest pain (CP) regularly prompts performing an exercise stress test (EST) out of concern for exercise-induced ischemia. We aimed to study the diagnostic utility of EST in the evaluation of ischemia among pediatric patients without previously diagnosed congenital heart disease (CHD) who present with exertional CP and to correlate EST results with available cardiac imaging findings. Methods: Retrospective chart review of all pediatric patients who underwent EST for exertional CP from Jan 2015 to Dec 2019 at our institution. Exercise stress test was performed on treadmill utilizing Bruce protocol. Analysis included demographic medical records and all available cardiac testing. Results: A total of 106 patients (56 males; 53%) were included. Cohort mean age, height, and weight were 15.1 ± 2.6 years (range: 7.3 - 19.6yr), 165 ± 12.7 cm, and 67.5 ± 26.2 kg. ST-T wave changes were noted in 8 patients (7.5%), 7 of which were non-specific and read as normal ESTs. One (0.94%) EST was suggestive of ischemic changes. His echocardiogram (echo) showed mild thickening of papillary muscles and ventricular septum. A follow-up exercise myocardial perfusion study showed no abnormality. Echo was performed on 86/106 (81%) patients. Of these, 23/86 (27%) had incidental abnormalities on echo; none contributed to the patients’ CP. Five patients (5/86; 5.8%) had notable coronary artery abnormalities on echo; all had normal ESTs. Two of these were confirmed by Cardiac CTA: 1) Left Main Coronary Artery (LMCA) arising from non-coronary cusp, and 2) dilated LMCA (Z-score 4.67) with slight dilation of Left Anterior Descending (Z-score 2.54). In the other 3 of 5 ( prominent LMCA, possible CA fistula, RCA with more leftward origin ) further coronary evaluations were not performed. Conclusions: Incidental non-specific echo abnormalities are common among pediatric patients who undergo EST for exertional CP. EST was negative in patients with coronary artery abnormalities. ESTs have a low yield in identifying cardiac abnormalities among pediatric patients without previously diagnosed CHD undergoing evaluation for exertional CP. Larger studies are needed to better evaluate the utility of EST in patients with coronary artery anomalies.

scholarly journals Older Age at Completion of Fontan Procedure Is Associated with Improved Percentage of Predicted Maximum Oxygen Uptake

2015 ◽  
Vol 42 (4) ◽  
pp. 333-340 ◽  
Author(s):  
Elijah H. Bolin ◽  
Shiraz A. Maskatia ◽  
Amanda L. Tate ◽  
Christopher J. Petit
Keyword(s):  
Oxygen Consumption ◽  
Exercise Capacity ◽  
Stress Test ◽  
Fontan Procedure ◽  
Predictor Variable ◽  
Exercise Stress Test ◽  
Older Age ◽  
Surgical Strategy ◽  
Exercise Stress ◽  
Maximum Oxygen Consumption

We tested the hypothesis that later completion of the Fontan procedure is associated with improved exercise capacity in the current period of staged single-ventricle palliation. We performed a retrospective study, in Fontan patients, of exercise stress test data from April 2003 through March 2011. Patients were included if they had received staged palliations in accordance with current surgical strategy, defined as the performance of a superior cavopulmonary connection at ≤1 year of age, followed in subsequent years by Fontan completion. Patients with a pacemaker or respiratory exchange ratio <1 were excluded. Early and late Fontan groups were created on the basis of whether Fontan completion had been performed at <4 or ≥ 4 years of age. The primary predictor variable was age at Fontan completion, and the primary marker of exercise performance was the percentage of predicted maximum oxygen consumption. During the study period, 55 patients were identified (mean age, 11.7 ± 2.8 yr). Older age at Fontan completion correlated positively with higher percentages of predicted maximum oxygen consumption (R=0.286, P=0.034). Patients in whom Fontan completion was performed at ≥4 years of age had higher percentages of predicted maximum oxygen consumption than did those in whom completion was at <4 years of age (84.4 ± 21.5 vs 72.9 ± 18.1; P=0.041). Later Fontan completion might be associated with improved exercise capacity in patients palliated in accordance with contemporary surgical strategy.

scholarly journals Cardiac Rehabilitation and Physical Performance in Patients after Myocardial Infarction: Preliminary Research

2021 ◽  
Vol 10 (11) ◽  
pp. 2253
Author(s):  
Agnieszka Grochulska ◽  
Sebastian Glowinski ◽  
Aleksandra Bryndal
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Physical Performance ◽  
Stress Test ◽  
Maximal Oxygen Consumption ◽  
Exercise Stress Test ◽  
Health Condition ◽  
Exercise Stress ◽  
Test Time ◽  
Before And After

(1) Background: Cardiovascular diseases, in particular, myocardial infarction (MI), are the main threats to human health in modern times. Cardiac rehabilitation (CR), and especially increased physical activity, significantly prevent the consequences of MI. The aim of this study was to assess physical performance in patients after MI before and after CR. (2) Methods: 126 patients after MI were examined. They were admitted to the cardiac rehabilitation ward twice: in the 3rd month after MI, and then in the 6th month after the last rehabilitation session. CR lasted 20 treatment days (4 weeks with 5 treatment days and 2 days’ break). The exercise stress test on the treadmill and a 6-minute walk test (6MWT) were used to assess physical performance. Patients were assigned to an appropriate rehabilitation model due to their health condition. (3) Results: In the studied group, the exercise stress test time and the metabolic equivalent of task (MET), the maximal oxygen consumption (VO2max), and 6MWT score increased significantly (p = 0.0001) at two time-points of observation. (4) Conclusion: CR significantly improves physical performance in patients after MI.

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