scholarly journals EXPRESS: The association of six minute walk work and other clinical measures to cardiopulmonary exercise test parameters in pulmonary vascular disease

2021 ◽  
pp. 204589402110590
Author(s):  
Lucy Robertson ◽  
Katrina Oates ◽  
Andrew Fletcher ◽  
Karl Sylvester
Keyword(s):  
Pulmonary Vascular Disease ◽  
Clinical Parameters ◽  
Predictive Equations ◽  
Peak Vo2 ◽  
Variable Level ◽  
Test Parameters ◽  
O2 Pulse ◽  
Clinical Measures ◽  
Minute Walk ◽  
Level Of Agreement

In pulmonary vascular disease (PVD) exercise abnormalities can include reduced exercise capacity, reduced oxygen pulse (O2 pulse) and elevated VE/VCO2. The association of clinical measures such as 6 minute walk work (6MWW), haemodynamics, lung function and echocardiogram to peak VO2, O2 pulse and VE/VCO2 has not been fully investigated in PVD Aims: To determine the relationship of 6MWW and other clinical measures to peak VO2, peak O2 pulse and VE/VCO2. Additionally, to investigate the ability to predict peak VO2 from 6MWW and other clinical parameters. Methods: Clinical data was retrospectively analysed from 63 chronic thromboembolic pulmonary hypertension (CTEPH) and 54 chronic thromboembolic disease (CTED) patients. 6 minute walk test measures, haemodynamics, lung function and echocardiographic measures were correlated with peak VO2, peak O2 pulse and VE/VCO2. Predictive equations were developed to predict peak V̇O2 in both CTEPH and CTED cohorts and subsequently validated. Results: A number of clinical parameters correlated to peak VO2, peak O2 pulse and VE/VCO2. 6MWW and TLCO demonstrated the strongest correlation to peak VO2 and peak O2 pulse. The validation of the predictive equations showed a variable level of agreement between measured peak VO2 and calculated peak VO2 from the predictive equations. Conclusion: 6MWW and additionally a number of clinical test parameters were associated to peak VO2, peak O2 pulse and VE/VCO2. 6MWW and TLCO were particularly highly correlated to peak VO2 and similarly to peak O2 pulse. The validation of the predictive equations showed a variable level of agreement and therefore may have limited clinical applicability.

scholarly journals A Within-Sample Comparison of Two Innovative Neuropsychological Tests for Assessing ADHD

2020 ◽  
Vol 11 (1) ◽  
pp. 36
Author(s):  
Anna Baader ◽  
Behnaz Kiani ◽  
Nathalie Brunkhorst-Kanaan ◽  
Sarah Kittel-Schneider ◽  
Andreas Reif ◽  
...  
Keyword(s):  
Neuropsychological Tests ◽  
Rating Scales ◽  
Clinical Symptoms ◽  
Clinical Sample ◽  
Clinical Parameters ◽  
Performance Tests ◽  
Hyperactivity Disorder ◽  
Continuous Performance Tests ◽  
Interesting Correlation ◽  
Clinical Measures

New innovative neuropsychological tests in attention deficit hyperactivity disorder ADHD have been proposed as objective measures for diagnosis and therapy. The current study aims to investigate two different commercial continuous performance tests (CPT) in a head-to-head comparison regarding their comparability and their link with clinical parameters. The CPTs were evaluated in a clinical sample of 29 adult patients presenting in an ADHD outpatient clinic. Correlational analyses were performed between neuropsychological data, clinical rating scales, and a personality-based measure. Though inattention was found to positively correlate between the two tests (r = 0.49, p = 0.01), no association with clinical measures and inattention was found for both tests. While hyperactivity did not correlate between both tests, current ADHD symptoms were positively associated with Nesplora Aquarium’s motor activity (r = 0.52 to 0.61, p < 0.05) and the Qb-Test’s hyperactivity (r = 0.52 to 0.71, p < 0.05). Conclusively, the overall comparability of the tests was limited and correlation with clinical parameters was low. While our study shows some interesting correlation between clinical symptoms and sub-scales of these tests, usage in clinical practice is not recommended.

Abstract 12949: Aerobic Exercise After an ICD: Results of the 6 Month Follow-Up in the Anti-Arrhythmic Effects of Exercise After an ICD Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Cynthia M Dougherty ◽  
Robb Glenny ◽  
Peter Kudenchuk ◽  
Robert Burr
Keyword(s):  
Exercise Training ◽  
Aerobic Exercise ◽  
Aerobic Training ◽  
Cardiopulmonary Exercise Testing ◽  
Aerobic Exercise Training ◽  
Cardiopulmonary Function ◽  
Exercise Maintenance ◽  
Peak Vo2 ◽  
O2 Pulse

Introduction: The Anti-Arrhythmic Effects of Exercise Trial reported that aerobic exercise training for 8 weeks after an implantable cardioverter defibrillator (ICD) significantly improved the primary outcome of cardiopulmonary function without ICD shocks or adverse events. This is a report on the longer term outcomes at 24 weeks of exercise maintenance that was continued after aerobic training. Hypothesis: When 8 weeks of aerobic exercise training is followed by aerobic exercise maintenance (50% reduction in the amount of walking), cardiopulmonary function [peak VO2, EX time, VO2 at AT, O2 pulse, METS, Maximum HR] will be maintained without an increase in ICD shocks or hospitalizations. Methods: 160 subjects (80/group) with a prior ICD implant (40% primary and 60% secondary prevention), mean age 55 +12 years, 78% male, 84% Caucasian, 100% beta-blocked, and mean EF%=40%, entered a RCT comparing aerobic exercise to usual care (UC). At baseline, 8 and 24 weeks, participants completed cardiopulmonary exercise testing using a modified Balke treadmill protocol. Aerobic training= 8 weeks of home walking 1 hour/day on 5 days/week at 60-80% of maximum HR using the Karvonen formula, was followed by aerobic maintenance (EX)= 16 weeks of home walking for 150 min/week. ICD shocks and hospitalizations were verified with medical records. Analysis of variance was used to determine group x time effects on study outcomes. Results: Aerobic maintenance significantly increased peak VO2 ml/kg/min, p<0.000 (EX 26.9+7.7, UC 23.4+6.0), EX minutes, p<0.000 (EX 16:27+ 6:36; UC 13:24+4:33), VO2 at AT ml/kg/min, p=0.001 (EX 23.0+6.8; UC 19.8+5.8), O2 pulse p=0.01 (EX 18.7+5.5; UC 16.8+4.9), and METS, p<0.001 (EX 7.6+2.2; UC 6.7+1.8). Maximum HR was unchanged. The number of ICD shocks related to exercise was =1: 3 in UC and 1 in exercise received an ICD shock or ATP during follow-up. There were 11 hospitalizations in each group, none were related to exercise. Conclusions: Aerobic exercise maintenance for 16 weeks that followed aerobic exercise training for 8 weeks, maintained gains in cardiopulmonary function despite reducing the amount of walking by half (300 min vs. 150 min). Aerobic exercise in patients with an ICD is safe without increasing the number of ICD shocks or hospitalizations.

scholarly journals The Modified Borg Dyspnea Scale does not predict hospitalization in pulmonary arterial hypertension

2017 ◽  
Vol 7 (2) ◽  
pp. 384-390 ◽  
Author(s):  
Debasree Banerjee ◽  
Jane Kamuren ◽  
Grayson L. Baird ◽  
Amy Palmisciano ◽  
Ipsita Krishnan ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Functional Class ◽  
World Health ◽  
Pulmonary Vascular Disease ◽  
Common Symptom ◽  
Class Iii ◽  
Patient Reported ◽  
Pulmonary Arterial ◽  
Minute Walk

Background Breathlessness is the most common symptom reported by patients with pulmonary arterial hypertension (PAH). The Modified Borg Dyspnea Scale (MBS) is routinely obtained during the six-minute walk test in the assessment of PAH patients, but it is not known whether the MBS predicts clinical outcomes such as hospitalizations in PAH. Methods We performed a retrospective study of World Health Organization (WHO) Group 1 PAH patients followed at our center. The dates of the first three MBS and hospitalizations that occurred within three months of a documented MBS were collected. Marginal Cox hazard regression modeling was used to assess for a relationship between MBS and all-cause as well as PAH-related hospitalization. Results A total of 50 patients were included; most (92%) were functional class III/IV, 44% and 65% were treatment-naïve prior to their first MBS and hospitalization, respectively. The first recorded MBS was inversely correlated with the first recorded six-minute walk distance (6MWD) (r = –0.41, P < 0.01) but did not track with WHO functional class (r = 0.07, P = 0.63). MBS did not predict all-cause (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.76–1.08; P = 0.28) or PAH-related hospitalization (HR, 1.04; 95% CI, 0.89–1.23; P = 0.61), though there was a strong relationship between 6MWD and PAH-related hospitalization ( P = 0.01). These findings persisted after multivariable adjustment. Conclusions Breathlessness as assessed by MBS does not predict all-cause or PAH-related hospitalization. Robust and validated patient-reported outcomes are needed in pulmonary vascular disease.

scholarly journals Various Methods for Assessing Static Lower Extremity Alignment: Implications for Prospective Risk-Factor Screenings

2013 ◽  
Vol 48 (2) ◽  
pp. 248-257 ◽  
Author(s):  
Anh-Dung Nguyen ◽  
Michelle C. Boling ◽  
Carrie A. Slye ◽  
Emily M. Hartley ◽  
Gina L. Parisi
Keyword(s):  
Body Mass Index ◽  
Tracking System ◽  
Intraclass Correlation ◽  
Limb Length ◽  
Electromagnetic Tracking ◽  
Knee Alignment ◽  
Digital Photographs ◽  
Clinical Measures ◽  
Electromagnetic Tracking System ◽  
Level Of Agreement

Context: Accurate, efficient, and reliable measurement methods are essential to prospectively identify risk factors for knee injuries in large cohorts. Objective: To determine tester reliability using digital photographs for the measurement of static lower extremity alignment (LEA) and whether values quantified with an electromagnetic motion-tracking system are in agreement with those quantified with clinical methods and digital photographs. Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: Thirty-three individuals participated and included 17 (10 women, 7 men; age = 21.7 ± 2.7 years, height = 163.4 ± 6.4 cm, mass = 59.7 ± 7.8 kg, body mass index = 23.7 ± 2.6 kg/m2) in study 1, in which we examined the reliability between clinical measures and digital photographs in 1 trained and 1 novice investigator, and 16 (11 women, 5 men; age = 22.3 ± 1.6 years, height = 170.3 ± 6.9 cm, mass = 72.9 ± 16.4 kg, body mass index = 25.2 ± 5.4 kg/m2) in study 2, in which we examined the agreement among clinical measures, digital photographs, and an electromagnetic tracking system. Intervention(s): We evaluated measures of pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length, and tibia length. Clinical measures were assessed using clinically accepted methods. Frontal- and sagittal-plane digital images were captured and imported into a computer software program. Anatomic landmarks were digitized using an electromagnetic tracking system to calculate static LEA. Main Outcome Measure(s): Intraclass correlation coefficients and standard errors of measurement were calculated to examine tester reliability. We calculated 95% limits of agreement and used Bland-Altman plots to examine agreement among clinical measures, digital photographs, and an electromagnetic tracking system. Results: Using digital photographs, fair to excellent intratester (intraclass correlation coefficient range = 0.70–0.99) and intertester (intraclass correlation coefficient range = 0.75–0.97) reliability were observed for static knee alignment and limb-length measures. An acceptable level of agreement was observed between clinical measures and digital pictures for limb-length measures. When comparing clinical measures and digital photographs with the electromagnetic tracking system, an acceptable level of agreement was observed in measures of static knee angles and limb-length measures. Conclusions: The use of digital photographs and an electromagnetic tracking system appears to be an efficient and reliable method to assess static knee alignment and limb-length measurements.

P6323Exercise capacity as predictor for anaemia or iron deficiency in patients with chronic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Ebner ◽  
G Dinopoulos ◽  
R Evertz ◽  
T Garfias Macedo ◽  
B Godoy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Iron Deficiency ◽  
Exercise Capacity ◽  
Left Ventricular ◽  
World Health ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Peak Vo2 ◽  
Minute Walk

Abstract Background Anaemia and iron deficiency (ID) are important factors for muscle function and exercise capacity in patients with chronic heart failure (HF). Their interaction in HF remains to be defined. Methods A total of 280 out-patients with stable chronic HF were enrolled with mean age of 67.0±10.7 years, 21%female, mean left ventricular ejection fraction (LVEF) was 38.9±13.4%, mean Body Mass Index (BMI) 29.3±5.5 kg/m2]. Anaemia was defined according to World Health Organization criteria [Haemoglobin (Hb) <13 g/dL in men and <12 g/dL in women]. ID was defined as ferritin <100 μg/L or ferritin <100 <300 μg/L than with transferrin saturation (TSAT) <20%. Exercise capacity was assessed by spiroergometry (peakVO2), 6 minute walk test (6MWT), short physical performance battery test (SPPB), hang grip strength (HGS) and leg force (LF). All patients were followed up for a mean of 8 month. Results A total of 89 (32%) chronic HF patients had anaemia and 142 (51%) had iron deficiency at baseline. Patients with anaemia showed significant lower exercise capacity compared to patients without anaemia (peak VO2: 15.3±4.6 vs. 18.5±4.8 kg/min p<0.0001, 6MWT: 365.2±135.5 vs. 461.6±127.4 m p<0.0001, SPPB: 9.4±2.3 vs. 11.0±1.6 total points p<0.0001, HGS: 32.5±10.0 vs. 38.8±12.4 kg p<0.0001, LF: 31.4±11.0 vs. 41.3±21.6 kg p<0.0001). The same we found in patients with ID compared to patients without ID (peak VO2: 16.3±5.1 vs. 18.6±4.5 kg/min p=0.001, 6MWT: 400.0±140.8 vs. 458.8±128.4 m p=0.0008, SPPB: 10.0±2.1 vs. 10.9±1.7 total points p=0.0003, HGS: 34.5±11.9 vs. 39.3±11.7 kg p=0.001, LF: 35.7±23.4 vs. 40.5±13.6 kg p=0.04). After a Follow up of mean 8 month 53 patients develop a new onset of either anaemia (n=24) or ID (n=29). Logistic regression analysis showed that gender, 6 minute walk distance, SPPB, HGS and presence of diabetes mellitus at baseline are significantly associated with the development of anaemia or ID (all p<0.05). The strongest predictor was lower SPPB (p=0.0008). Interestingly known determinates lower peak VO2, higher age, higher NYHA class, Creatinine, and hsCRP were not predictive in our cohort to develop anaemia or ID after 8 month (all p>0.05). Conclusion Both anaemia and ID are strongly associated with reduced exercise capacity in patients with HF. The effect of anaemia and iron deficiency together is stronger than that of anemia and ID alone. Reduced SPPB, 6MWT, and HGS are important risk factors for the development of anaemia or ID.

Abstract 17002: Assessment of Exercise Function in Children With Hypertrophic Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Robert Przybylski ◽  
Mark E Alexander ◽  
Steven D Colan ◽  
Christa Miliaresis ◽  
Jonathan Rhodes
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Performance ◽  
Normal Values ◽  
Ventricular Outflow Tract ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Peak Vo2 ◽  
O2 Pulse ◽  
Established Population

Introduction: Hypertrophic cardiomyopathy (HCM) accounts for nearly half of pediatric cardiomyopathies. While impaired exercise function has been described in adults with HCM, little is known about exercise function in children with HCM. Hypothesis: Children with HCM have impaired exercise function. Methods: A retrospective cohort study was performed. Pts <21 years with a diagnosis of HCM with a cardiopulmonary exercise test (CPET) between November 1, 2002 and May 31, 2019 were included. Pts with syndromic HCM were excluded. CPETs with respiratory exchange ratio <1.09 were excluded. We compared indices of exercise performance to established population normal values using one-sample T-tests. In pts with multiple CPETs, we compared indices of exercise performance from the first to last CPET using paired T-tests. Results: We identified 124 pts with 240 CPETs. The average age at time of CPET was 14.8 ± 3.0 years. Average %predicted peak VO2 (78 ± 20%) was significantly less than the population average (p <0.01), though there was wide variability (range 35-152% predicted). Peak VO2 was <85% predicted in 67%, <50% predicted in 7%, and absolute peak VO2 was <25 cc/kg/min in 30% of tests. However, %predicted peak VO2 was >100% in 13% of tests. The %predicted peak O2 pulse (88 ± 21%; p <0.01; a surrogate for the forward stroke volume at peak exercise) and the %predicted peak heart rate (88.0 ± 12%; p <0.01) were significantly lower than established population normal values. In 63 pts with multiple CPETs, significant declines in %predicted peak VO2 (83 ± 20% v. 75 ± 19%; p <0.01) and O2 pulse (92 ± 22% v. 86 ± 21%; p <0.01) were observed at an average interval of 4.5 years. We found no statistically significant association between %predicted peak VO2 and interventricular septal thickness, resting left ventricular outflow tract gradient or echocardiographic indices of diastolic left ventricular function. Conclusions: Exercise function is at least moderately impaired in a substantial portion of children with HCM and this impairment tends to worsen over time. However, there is a significant subset of patient with remarkably well-preserved exercise function. Echocardiographic measurements did not correlate with exercise function in our cohort.

scholarly journals Tools of the Trade: How Do You Perform and Interpret an Exercise Test?

2019 ◽  
Vol 18 (2) ◽  
pp. 47-55
Author(s):  
Franz P. Rischard ◽  
Barry A. Borlaug
Keyword(s):  
Cardiopulmonary Exercise Testing ◽  
Response To Therapy ◽  
Pulmonary Vascular Disease ◽  
Clear Understanding ◽  
Valuable Insight ◽  
Adaptation To Stress ◽  
The Individual ◽  
Cardiopulmonary System ◽  
Insight Into ◽  
Minute Walk

Background: Most pulmonary vascular disease (PVD) is poorly modifiable and incurable even with effective therapy. Therefore, adaptation to stress, the reserve of the cardiopulmonary system, is important for assessment of patient function and prognosis. Methods that assess the adaptation to stress, especially exercise, provide valuable insight into diagnosis, prognosis, and response to therapy. Implications for Clinicians: We provide a comprehensive review of the indications, methodology, and interpretation, as well as practical information of the forms of provocative testing in PVD. We include 6-minute walk testing, noninvasive cardiopulmonary exercise testing (CPET), invasive CPET, and additional forms, including volume loading. Conclusions: Through a clear understanding of the methodology in the assessment of PVD, the clinician can determine which of these “tools of the trade” are best suited to the individual patient and situation.

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