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.

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 A Method for Predicting the Main Indicators of Cardiopulmonary Stress Testing for Patients with Chronic Heart Failure

2020 ◽  
Vol 23 (1) ◽  
pp. 96-104
Author(s):  
A. S. Krasichkov ◽  
E. Mbazumutima ◽  
F. Shikama ◽  
E. M. Nifontov
Keyword(s):  
Heart Failure ◽  
Oxygen Consumption ◽  
Chronic Heart Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Significant Risk ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Peak Oxygen Consumption ◽  
Prognostic Information

Introduction. Cardiopulmonary stress test provides significant diagnostic and prognostic information of the condition of patients with cardiovascular and pulmonary diseases. There is a serious problem, that final phase of stress testing is a physically difficult exercise for a person. There is a significant risk of occurrence and development of pathological conditions of the patient's cardiovascular system. One of the solutions is the development of methods for assessing the biological parameters of the patients at the end of a load protocol based on data from the initial stages of the test.Aim. Development of a method for finding an estimate of the maximum heart rate (HR) and of the peak oxygen consumption (OC) for the patients with chronic heart failure at the end of a cardiorespiratory exercise stress test, based on the results of the study obtained at the first initial stages of the test.Materials and methods. For the study, 149 anonymized records of rhythmograms and data of changes in the oxygen consumption of the patients with chronic heart failure were used. The patients underwent a cardiopulmonary stress test by a bicycle ergometer using step-by-step load protocol (the load power increase at each stage was 10 W, the duration of the load stage was 1 min)Results. Based on the analysis of the data obtained, a method for assessing the peak values of HR and of PC of the patients with chronic heart failure was developed.Conclusion. The relative error of the proposed estimate of the HR peak in most cases was no more than 10 %, which allows it to be used for practical purposes. It was established that when performing 70 % of the stress protocol, the error of the proposed estimate of the OC peak in most cases did not exceed 20 %. More research is needed to improve the accuracy of the assessment for using in medical applications aimed to the modernization of methods and equipment for stress testing of the patients.

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 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.

P4431Cardiopulmonary exerscise stress tests vs standard exercise stress tests in the rational prescription of physical activity in men

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Stuto ◽  
B Armaro ◽  
E Cosentino ◽  
G Canonico ◽  
A Ambu ◽  
...  
Keyword(s):  
Physical Activity ◽  
Oxygen Consumption ◽  
Heart Disease ◽  
Direct Measurement ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Sustained Load ◽  
Stress Tests ◽  
Group B

Abstract Background The standard exercise stress test (ET) provides direct measurement of the load tolerated by the subject, but the cardiopulmonary exercise stress test (CPET) in addition to the measurement of the work load also provides direct measurement of the corresponding oxygen consumption. Objective The aim of the present study was to estimate the differences between the estimated oxygen consumption based on the load (ET) and the one directly measured with the CPET, and to highlight and quantify the inaccuracies of the indirect estimate of oxygen consumption and its consequences on the rational prescription of physical activity. Material and method The tests performed on 7544 males from January 2007 to October 2018 were analyzed. For each test the sustained load, the consumption of direct oxygen, and the estimated oxygen consumption based on the load sustained with the use of a formula provided by the American College of Sports Medicine and reported below: VO2max (ml/kg/min) = (10.51 x Watt) + (6.35 x weight in kg) − (10.49 x Età) + 519.3. The total population of the subjects examined was divided into two groups: Group A: 1358 subjects without signs of heart disease, and Group B: 6186 subjects with heart disease. Results In the total population the oxygen consumption (VO2) estimated on the basis of the load was overestimated in 22% of subjects, underestimated in 55% of subjects and overlapping in 23% of subjects. In Group B the calculated VO2 was overestimated in 38%, underestimated in 54% and overlapping in 8% of the subjects. In group A the calculated VO2 was overestimated in 33%, underestimated in 54% and overlapping in 9% of subjects. Conclusions In subjects with heart disease the VO2 calculated on the basis of the sustained load is overestimated or underestimated in 92% of subjects. The CPET through direct measurement of oxygen consumption provides a precise estimate of functional capacity, an essential prerequisite for a correct rational prescription of physical activity. Because of this peculiarity, the CPET is absolutely irreplaceable in cardiac patients in which a correct rational prescription of physical activity is crucial.

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