Validity of Maximal Exercise Testing in People With Multiple Sclerosis and Low to Moderate Levels of Disability

Background Cardiopulmonary exercise testing can be considered the gold standard for assessing cardiorespiratory fitness. Little is known about the criteria for maximal exercise testing in people with multiple sclerosis (MS) and how these criteria behave across different levels of neurological disability. Objective The study objectives were to determine the criteria for maximal exercise testing across various levels of disability and to assess concomitant subgroup differences in measures related to the participant, disease, and function. Design This was a cross-sectional study. Methods Cardiopulmonary exercise testing was conducted with a sample of 56 participants with MS. Analysis of variance was used to assess the criteria in participants with MS and low, mild, and moderate levels of disability. Results Mean peak oxygen consumption (V̇o2peak) was 21.4 (SD=7.1) mL·kg−1·min−1. An oxygen consumption (V̇o2) plateau was seen in 37.5% of participants. A respiratory exchange ratio of 1.10 or greater was achieved by 69.6% of the participants, a maximal heart rate within 90% of their age-predicted maximal heart rate was achieved by 48.2% of the participants, and 23.2% of the participants perceived their exertion to be 18 or greater on the Borg Scale of Perceived Exertion (scores of 6–20). The values for achieved heart rate and incidence of a V̇o2 plateau were significantly lower in participants with moderate levels of disability than in those with mild levels of disability. Limitations The primary limitations of this study were its cross-sectional nature and relatively small sample of participants with moderate levels of disability. Conclusion The findings suggest that the outcome of cardiopulmonary exercise testing in people with MS and low to mild levels of disability (Expanded Disability Status Scale scores of ≤4.0) is a valid measure of cardiorespiratory fitness, whereas the outcome in people with moderate levels of disability (Expanded Disability Status Scale scores of >4.0) is most likely symptom limited.

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Estimating Equations for Cardiopulmonary Exercise Testing Variables in Fontan Patients: Derivation and Validation Using a Multicenter Cross-Sectional Database

Pediatric Cardiology ◽

10.1007/s00246-014-1020-5 ◽

2014 ◽

Vol 36 (2) ◽

pp. 393-401 ◽

Cited By ~ 4

Author(s):

Ryan J. Butts ◽

Carolyn T. Spencer ◽

Lanier Jackson ◽

Martha E. Heal ◽

Geoffrey Forbus ◽

...

Keyword(s):

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Estimating Equations ◽

Cross Sectional ◽

Cardiopulmonary Exercise ◽

Fontan Patients

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Impairments in Blood Pressure Regulation and Cardiac Baroreceptor Sensitivity Among Patients With Heart Failure Supported With Continuous-Flow Left Ventricular Assist Devices

Circulation Heart Failure ◽

10.1161/circheartfailure.120.007448 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Christine Sailer ◽

Hannah Edelmann ◽

Cullen Buchanan ◽

Pedro Giro ◽

Matthew Babcock ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Left Ventricular ◽

Advanced Heart Failure ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Baroreceptor Sensitivity ◽

Cardiopulmonary Exercise

Background: Continuous-flow (CF) left ventricular assist devices (LVADs) improve outcomes for patients with advanced heart failure (HF). However, the lack of a physiological pulse predisposes to side-effects including uncontrolled blood pressure (BP), and there are little data regarding the impact of CF-LVADs on BP regulation. Methods: Twelve patients (10 males, 60±11 years) with advanced heart failure completed hemodynamic assessment 2.7±4.1 months before, and 4.3±1.3 months following CF-LVAD implantation. Heart rate and systolic BP via arterial catheterization were monitored during Valsalva maneuver, spontaneous breathing, and a 0.05 Hz repetitive squat-stand maneuver to characterize cardiac baroreceptor sensitivity. Plasma norepinephrine levels were assessed during head-up tilt at supine, 30 o and 60 o . Heart rate and BP were monitored during cardiopulmonary exercise testing. Results: Cardiac baroreceptor sensitivity, determined by Valsalva as well as Fourier transformation and transfer function gain of Heart rate and systolic BP during spontaneous breathing and squat-stand maneuver, was impaired before and following LVAD implantation. Norepinephrine levels were markedly elevated pre-LVAD and improved—but remained elevated post-LVAD (supine norepinephrine pre-LVAD versus post-LVAD: 654±437 versus 323±164 pg/mL). BP increased during cardiopulmonary exercise testing post-LVAD, but the magnitude of change was modest and comparable to the changes observed during the pre-LVAD cardiopulmonary exercise testing. Conclusions: Among patients with advanced heart failure with reduced ejection fraction, CF-LVAD implantation is associated with modest improvements in autonomic tone, but persistent reductions in cardiac baroreceptor sensitivity. Exercise-induced increases in BP are blunted. These findings shed new light on mechanisms for adverse events such as stroke, and persistent reductions in functional capacity, among patients supported by CF-LVADs. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03078972.

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Reevaluating Cardiopulmonary Exercise Testing Modality in Resynchronized Heart Failure Patients: Relevance of Heart Rate-Adaptive Pacing

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2015.06.233 ◽

2015 ◽

Vol 21 (8) ◽

pp. S74

Author(s):

Livia Goldraich ◽

Heather J. Ross ◽

Farid Foroutan ◽

Juarez Braga ◽

Mike Walker ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Heart Failure Patients ◽

Cardiopulmonary Exercise ◽

Rate Adaptive

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Mechanisms of Exercise Capacity Improvement after Cardiac Rehabilitation Following Myocardial Infarction Assessed with Combined Stress Echocardiography and Cardiopulmonary Exercise Testing

Journal of Clinical Medicine ◽

10.3390/jcm10184083 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4083

Author(s):

Krzysztof Smarz ◽

Tomasz Jaxa-Chamiec ◽

Beata Zaborska ◽

Maciej Tysarowski ◽

Andrzej Budaj

Keyword(s):

Myocardial Infarction ◽

Heart Rate ◽

Cardiac Rehabilitation ◽

Exercise Capacity ◽

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Oxygen Extraction ◽

Peak Exercise ◽

Cardiopulmonary Exercise ◽

Peak Vo2

Cardiac rehabilitation (CR) is indicated in all patients after acute myocardial infarction (AMI) to improve prognosis and exercise capacity (EC). Previous studies reported that up to a third of patients did not improve their EC after CR (non-responders). Our aim was to assess the cardiac and peripheral mechanisms of EC improvement after CR using combined exercise echocardiography and cardiopulmonary exercise testing (CPET-SE). The responders included patients with an improved EC assessed as a rise in peak oxygen uptake (VO2) ≥ 1 mL/kg/min. Peripheral oxygen extraction was calculated as arteriovenous oxygen difference (A-VO2Diff). Out of 41 patients (67% male, mean age 57.5 ± 10 years) after AMI with left ventricular ejection fraction (LVEF) ≥ 40%, 73% improved their EC. In responders, peak VO2 improved by 27% from 17.9 ± 5.2 mL/kg/min to 22.7 ± 5.1 mL/kg/min, p < 0.001, while non-responders had a non-significant 5% decrease in peak VO2. In the responder group, the peak exercise heart rate, early diastolic myocardial velocity at peak exercise, LVEF at rest and at peak exercise, and A-VO2Diff at peak exercise increased, the minute ventilation to carbon dioxide production slope decreased, but the stroke volume and cardiac index were unchanged after CR. Non-responders had no changes in assessed parameters. EC improvement after CR of patients with preserved LVEF after AMI is associated with an increased heart rate response and better peripheral oxygen extraction during exercise.

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Chronotropic incompetence in paediatric heart transplant recipients with prior congenital heart disease

Cardiology in the Young ◽

10.1017/s1047951119000714 ◽

2019 ◽

Vol 29 (5) ◽

pp. 667-671 ◽

Cited By ~ 1

Author(s):

Nikki M. Singh ◽

Rohit S. Loomba ◽

Joshua R. Kovach ◽

Steven J. Kindel

Keyword(s):

Heart Rate ◽

Exercise Testing ◽

Heart Transplant ◽

Heart Rate Response ◽

Cardiopulmonary Exercise Testing ◽

Exercise Duration ◽

Cardiopulmonary Exercise Test ◽

Primary Diagnosis ◽

Chronotropic Incompetence ◽

Cardiopulmonary Exercise

AbstractBackground:Cardiopulmonary exercise testing has been used to measure functional capacity in children who have undergone a heart transplant. Cardiopulmonary exercise testing results have not been compared between children transplanted for a primary diagnosis of CHD and those with a primary diagnosis of cardiomyopathy despite differences in outcomes. This study is aimed to compare cardiopulmonary exercise testing performance between these two groups.Methods:Patients who underwent heart transplant with subsequent cardiopulmonary exercise testing at least 6 months after transplant at our institution were identified. They were then divided into two groups based on primary cardiac diagnosis: CHD or cardiomyopathy. Patient characteristics, echocardiograms, cardiac catheterisations, outcomes, and cardiopulmonary exercise test results were compared between the two groups.Results:From the total of 35 patients, 15 (43%) had CHD and 20 (57%) had cardiomyopathy. Age at transplant, kidney disease, lung disease, previous rejection, coronary vasculopathy, catheterisation, and echocardiographic data were similar between the groups. Mean time from transplant to cardiopulmonary exercise testing, exercise duration, and maximum oxygen consumption were similar in both groups. There was a difference in heart rate response with CHD heart rate response of 63 beats per minute compared to cardiomyopathy group of 78 (p = 0.028). Patients with CHD had more chronotropic incompetence than those with cardiomyopathy (p = 0.036).Conclusion:Primary diagnosis of CHD is associated with abnormal heart rate response and more chronotropic incompetence compared to those transplanted for cardiomyopathy.

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