scholarly journals The Fitter the Better? Cardiopulmonary Exercise Testing Can Predict Pulmonary Exacerbations in Cystic Fibrosis

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 527
Author(s):  
Asterios Kampouras ◽  
Elpis Hatziagorou ◽  
Thomas Kalantzis ◽  
Vasiliki Avramidou ◽  
Kalliopi Kontouli ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Exercise Testing ◽  
Cox Regression ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Exercise ◽  
Cox Regression Analysis ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Exacerbations

Background: The role of cardiopulmonary exercise testing (CPET) in the assessment of prognosis in CF (cystic fibrosis) is crucial. However, as the overall survival of the disease becomes better, the need for examinations that can predict pulmonary exacerbations (PEx) and subsequent deterioration becomes evident. Methods: Data from a 10-year follow up with CPET and spirometry of CF patients were used to evaluate whether CPET-derived parameters can be used as prognostic indexes for pulmonary exacerbations in patients with CF. Pulmonary exacerbations were recorded. We used a survival analysis through Cox Regression to assess the prognostic role of CPET parameters for PeX. CPET parameters and other variables such as sputum culture, age, and spirometry measurements were tested via multivariate cox models. Results: During a 10-year period (2009–2019), 78 CF patients underwent CPET. Cox regression analysis revealed that VO2peak% (peak Oxygen Uptake predicted %) predicted (hazard ratio (HR), 0.988 (0.975, 1.000) p = 0.042) and PetCO2 (end-tidal CO2 at peak exercise) (HR 0.948 (0.913, 0.984) p = 0.005), while VE/VO2 and (respiratory equivalent for oxygen at peak exercise) (HR 1.032 (1.003, 1.062) p = 0.033) were significant predictors of pulmonary exacerbations in the short term after the CPET. Additionally, patients with VO2peak% predicted <60% had 4.5-times higher relative risk of having a PEx than those with higher exercise capacity. Conclusions: CPET can provide valuable information regarding upcoming pulmonary exacerbation in CF. Patients with VO2peak <60% are at great risk of subsequent deterioration. Regular follow up of CF patients with exercise testing can highlight their clinical image and direct therapeutic interventions.

scholarly journals The fitter the better? Cardiopulmonary Exercise Testing can predict pulmonary exacerbations in Cystic Fibrosis

2020 ◽  
Author(s):  
Asterios Kampouras ◽  
Elpis Hatziagorou ◽  
Thomas Kalantzis ◽  
Vasiliki Avramidou ◽  
Kalliopi Kontouli ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Exacerbations

Abstract 17154: Cardiopulmonary Exercise Testing and Prognosis in HFpEF: the Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Clinton A Brawner ◽  
Ali Shafiq ◽  
Heather A Aldred ◽  
Raakesh Hassan ◽  
Stephanie Vasko ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Cox Regression ◽  
Cardiopulmonary Exercise Testing ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Cardiac Transplant ◽  
Reduced Ejection Fraction ◽  
Cardiopulmonary Exercise ◽  
Prognostic Utility

The prognostic utility of cardiopulmonary exercise testing (CPX) in patients with heart failure and reduced ejection fraction (HFrEF) has received much attention. However, there are limited data on the value of CPX in patients with HF and preserved EF (HFpEF). Purpose: Among patients with HFpEF, describe the association between select CPX measures and prognosis for the composite endpoint of mortality, left ventricular assist device (LVAD), or cardiac transplant (CT). Methods: Patients with a CPX between 1997 and 2010 and confirmed HFrEF (EF ≤ 40%; n= 1,201) or HFpEF (EF ≥ 50%; n= 192) were identified. Patients with HFpEF (n= 189, age= 54 ± 14 y, 43% female, EF = 56 ± 5%) were matched (propensity score) to patients with HFrEF (n= 189, age= 54 ± 13 y, 43% female, EF = 22 ± 9%) based on age, gender, history of coronary artery disease, and body mass index. Endpoint data was obtained through 2011. The association between select CPX measures and the endpoint was assessed using Cox regression with adjustment for age, gender, EF, and beta-blocker therapy. Results: There were 53 events (28%; median follow-up = 5.1 y) among the HFpEF group and 88 events (47%; median follow-up = 3.6 y) among the HFrEF group. Results from the Cox regression analyses are shown in the Table. Percent predicted peak VO 2 was one of the best predictors of the endpoint in both HFpEF and HFrEF with similar hazard ratios. Although significantly related to the endpoint among HFrEF, V E -VCO 2 slope and peak P ET CO 2 were not significant among HFpEF. Conclusions: These data support the use of % predicted peak VO 2 to risk stratify patients with HFpEF and suggest that the prognostic utility of some CPX measures developed in HFrEF may not be relevant in HFpEF. Additional research is needed to define the association between CPX measures and prognosis specifically for patients with HFpEF.

scholarly journals Toward the Establishment of New Clinical Endpoints for Cystic Fibrosis: The Role of Lung Clearance Index and Cardiopulmonary Exercise Testing

2021 ◽  
Vol 9 ◽  
Author(s):  
Elpis Hatziagorou ◽  
Asterios Kampouras ◽  
Vasiliki Avramidou ◽  
Ilektra Toulia ◽  
Elisavet-Anna Chrysochoou ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Future Research ◽  
Lung Clearance ◽  
Clinical Endpoints ◽  
Cardiopulmonary Exercise ◽  
Lung Clearance Index ◽  
Test Outcomes

As Cystic Fibrosis (CF) treatment advances, research evidence has highlighted the value and applicability of Lung Clearance Index and Cardiopulmonary Exercise Testing as endpoints for clinical trials. In the context of these new endpoints for CF trials, we have explored the use of these two test outcomes for routine CF care. In this review we have presented the use of these methods in assessing disease severity, disease progression, and the efficacy of new interventions with considerations for future research.

scholarly journals Prognostic value of cardiopulmonary exercise testing in patients with systemic sclerosis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ralf Ewert ◽  
Till Ittermann ◽  
Dirk Habedank ◽  
Matthias Held ◽  
Tobias J. Lange ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Exercise Testing ◽  
Prognostic Value ◽  
Cox Regression ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Walking Distance ◽  
Interstitial Tissue ◽  
Cox Regression Analysis ◽  
Cardiopulmonary Exercise

Abstract Background Systemic sclerosis (SSc) is a severe rheumatic disease of the interstitial tissue, in which heart and lung involvement can lead to disease-specific mortality. Our study tests the hypothesis that in addition to established prognostic factors, cardiopulmonary exercise testing (CPET) parameters, particularly peak oxygen uptake (peakVO2) and ventilation/carbon dioxide (VE/VCO2)-slope, can predict survival in patients with SSc. Subjects and methods We retrospectively assessed 210 patients (80.9% female) in 6 centres over 10 years with pulmonary testing and CPET. Survival was analysed with Cox regression analysis (adjusted for age and gender) by age, comorbidity (Charlson-Index), body weight, body-mass index, extensive interstitial lung disease, pulmonary artery pressure (measured by echocardiography and invasively), and haemodynamic, pulmonary and CPET parameters. Results Five- and ten-year survival of SSc patients was 93.8 and 86.9%, respectively. There was no difference in survival between patients with diffuse (dcSSc) and limited cutaneous manifestation (lcSSc; p = 0.3). Pulmonary and CPET parameters were significantly impaired. Prognosis was worst for patients with pulmonary hypertension (p = 0.007), 6-min walking distance < 413 m (p = 0.003), peakVO2 < 15.6 mL∙kg− 1∙min− 1, and VE/VCO2-slope > 35. Age (hazard ratio HR = 1.23; 95% confidence interval CI: 1.14;1.41), VE/VCO2-slope (HR = 0.9; CI 0.82;0.98), diffusion capacity (Krogh factor, HR = 0.92; CI 0.86;0.98), forced vital capacity (FVC, HR = 0.91; CI 0.86;0.96), and peakVO2 (HR = 0.87; CI 0.81;0.94) were significantly linked to survival in multivariate analyses (Harrell’s C = 0.95). Summary This is the first large study with SSc patients that demonstrates the prognostic value of peakVO2 < 15.6 mL∙kg− 1∙min− 1 (< 64.5% of predicted peakVO2) and VE/VCO2-slope > 35.

scholarly journals G377 The role of cardiopulmonary exercise testing in children with cystic fibrosis

2015 ◽  
Vol 100 (Suppl 3) ◽  
pp. A154.1-A154
Author(s):  
E Weir ◽  
P Burns ◽  
D Young ◽  
JY Paton ◽  
A Devenny
Keyword(s):  
Cystic Fibrosis ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise

Abstract 13808: Implementation of Cardiopulmonary Exercise Testing and Its Impact on 2-year Outcomes in Acute Coronary Syndrome From Mie ACS Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hiroaki Murakami ◽  
Naoki Fujimoto ◽  
Akihiro Takasaki ◽  
Tairo Kurita ◽  
Kozo Hoshino ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Discharge ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Cardiopulmonary Exercise ◽  
Number Of Patients ◽  
Myocardial Infraction

Introduction: Cardiopulmonary exercise testing (CPET) determines intensity for exercise rehabilitation which may improve outcomes in patients with acute coronary syndrome (ACS). However, it is unclear how many patients are given exercise education based on CPET around hospital discharge. Purposes: To assess the implementation of CPET and to evaluate the impacts of clinical parameters including CPET variables on 2-year outcomes in ACS patients. Methods: We enrolled 3146 ACS patients without hemodialysis (age, 68±12 yrs; 78% male) 30 days after onset using data from Mie ACS registry, a prospective and multicenter registry, between 2013 and 2017. We compared clinical characteristics in patients with and without CPET at hospital discharge. Prognostic factors including CPET variables during the 2-year follow-up were determined. Results: Forty percent of the hospitals had CPET equipment. Out of 3146, 431 patients (12%) underwent CPET and were given CPET-based exercise education. Implementation of CPET was associated with younger age, male, ST-elevation myocardial infraction, and higher peak creatine phosphokinase (p≤0.03). While, hospitalization length <7 days or >21 days was inversely associated with CPET. During the 2-year follow-up, 198 all-cause deaths (6%) and 103 heart failure (HF) hospitalization were observed. Multivariate Cox regression analysis demonstrated that age, male, hospitalization length >21 days, Killip ≥2, mechanical circulatory and/or ventilator support were positive predictors of all-cause death. While, CPET around hospital discharge (hazard ratio, 0.52; 95%CI, 0.27-0.99, p<0.05) and hemoglobin level were independent negative predictors of all-cause death. Although patients with CPET tended to have greater myocardial damage, they did not have increased rate of HF hospitalization or major adverse cardiovascular events (MACE). When analyzed only in patients with CPET, peak oxygen uptake was the only independent predictor for all-cause death. Conslusions: The number of patients who underwent CPET at discharge was small in our registry. Although the rate of HF hospitalization and MACE were similar in patients with and without CPET, CPET and CPET-based exercise education did reduce all-cause mortality in ACS patients.

Cardiopulmonary Exercise Testing in Combined Pulmonary Fibrosis and Emphysema

Respiration ◽  
2021 ◽  
pp. 369-377
Author(s):  
Michael Westhoff ◽  
Patric Litterst ◽  
Ralf Ewert
Keyword(s):  
Body Weight ◽  
Pulmonary Fibrosis ◽  
Sensitivity And Specificity ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Arterial Oxygen ◽  
Peak Exercise ◽  
Cutoff Value ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2

Background: Combined pulmonary fibrosis and emphysema (CPFE) is a distinct entity among fibrosing lung diseases with a high risk for lung cancer and pulmonary hypertension (PH). Notably, concomitant PH was identified as a negative prognostic indicator that could help with early diagnosis to provide important information regarding prognosis. Objectives: The current study aimed to determine whether cardiopulmonary exercise testing (CPET) can be helpful in differentiating patients having CPFE with and without PH. Methods: Patients diagnosed with CPFE in 2 German cities (Hemer and Greifswald) over a period of 10 years were included herein. CPET parameters, such as peak oxygen uptake (peak VO2), functional dead space ventilation (VDf/VT), alveolar-arterial oxygen difference (AaDO2), arterial-end-tidal CO2 difference [P(a-ET)CO2] at peak exercise, and the minute ventilation-carbon dioxide production relationship (VE/VCO2 slope), were compared between patients with and without PH. Results: A total of 41 patients with CPET (22 with PH, 19 without PH) were analyzed. Right heart catheterization was performed in 15 of 41 patients without clinically relevant complications. Significant differences in peak VO2 (861 ± 190 vs. 1,397 ± 439 mL), VO2/kg body weight/min (10.8 ± 2.6 vs. 17.4 ± 5.2 mL), peak AaDO2 (72.3 ± 7.3 vs. 46.3 ± 14.2 mm Hg), VE/VCO2 slope (70.1 ± 31.5 vs. 39.6 ± 9.6), and peak P(a-ET)tCO2 (13.9 ± 3.5 vs. 8.1 ± 3.6 mm Hg) were observed between patients with and without PH (p < 0.001). Patients with PH had significantly higher VDf/VT at rest, VT1, and at peak exercise (65.6 ± 16.8% vs. 47.2 ± 11.6%; p < 0.001) than those without PH. A cutoff value of 44 for VE/VCO2 slope had a sensitivity and specificity of 94.7 and 72.7%, while a cutoff value of 11 mm Hg for P(a-ET)CO2 in combination with peak AaDO2 >60 mm Hg had a specificity and sensitivity of 95.5 and 84.2%, respectively. Combining peak AaDO2 >60 mm Hg with peak VO2/body weight/min <16.5 mL/kg/min provided a sensitivity and specificity of 100 and 95.5%, respectively. Conclusion: This study provided initial data on CPET among patients having CPFE with and without PH. CPET can help noninvasively detect PH and identify patients at risk. AaDO2 at peak exercise, VE/VCO2 slope, peak P(a-ET)CO2, and peak VO2 were parameters that had high sensitivity and, when combined, high specificity.

Risk stratification in hf with mid-range LVEF: the role of cardiopulmonary exercise testing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B.M.L Rocha ◽  
G.J Lopes Da Cunha ◽  
P.M.D Lopes ◽  
P.N Freitas ◽  
F Gama ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Exercise Testing ◽  
Primary Endpoint ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiopulmonary Exercise

Abstract Background Cardiopulmonary exercise testing (CPET) is recommended in the evaluation of selected patients with Heart Failure (HF). Notwithstanding, its prognostic significance has mainly been ascertained in those with left ventricular ejection fraction (LVEF) &lt;40% (i.e., HFrEF). The main goal of our study was to assess the role of CPET in risk stratification of HF with mid-range (40–49%) LVEF (i.e., HFmrEF) compared to HFrEF. Methods We conducted a single-center retrospective study of consecutive patients with HF and LVEF &lt;50% who underwent CPET from 2003–2018. The primary composite endpoint of death, heart transplant or HF hospitalization was assessed. Results Overall, 404 HF patients (mean age 57±11 years, 78.2% male, 55.4% ischemic HF) were included, of whom 321 (79.5%) had HFrEF and 83 (20.5%) HFmrEF. Compared to the former, those with HFmrEF had a significantly higher mean peak oxygen uptake (pVO2) (20.2±6.1 vs 16.1±5.0 mL/kg/min; p&lt;0.001), lower median minute ventilation/carbon dioxide production (VE/VCO2) [35.0 (IQR: 29.1–41.2) vs 39.0 (IQR: 32.0–47.0); p=0.002) and fewer patients with exercise oscillatory ventilation (EOV) (22.0 vs 46.3%; p&lt;0.001). Over a median follow-up of 28.7 (IQR: 13.0–92.3) months, 117 (28.9%) patients died, 53 (13.1%) underwent heart transplantation, and 134 (33.2%) had at least one HF hospitalization. In both HFmrEF and HFrEF, pVO2 &lt;12 mL/kg/min, VE/VCO2 &gt;35 and EOV identified patients at higher risk for events (all p&lt;0.05). In Cox regression multivariate analysis, pVO2 was predictive of the primary endpoint in both HFmrEF and HFrEF (HR per +1 mL/kg/min: 0.81; CI: 0.72–0.92; p=0.001; and HR per +1 mL/kg/min: 0.92; CI: 0.87–0.97; p=0.004), as was EOV (HR: 4.79; CI: 1.41–16.39; p=0.012; and HR: 2.15; CI: 1.51–3.07; p&lt;0.001). VE/VCO2, on the other hand, was predictive of events in HFrEF but not in HFmrEF (HR per unit: 1.03; CI: 1.02–1.05; p&lt;0.001; and HR per unit: 0.99; CI: 0.95–1.03; p=0.512, respectively). ROC curve analysis demonstrated that a pVO2 &gt;16.7 and &gt;15.8 mL/kg/min more accurately identified patients at lower risk for the primary endpoint (NPV: 91.2 and 60.5% for HFmrEF and HFrEF, respectively; both p&lt;0.001). Conclusions CPET is a useful tool in HFmrEF. Both pVO2 and EOV independently predicted the primary endpoint in HFmrEF and HFrEF, contrasting with VE/VCO2, which remained predictive only in latter group. Our findings strengthen the prognostic role of CPET in HF with either reduced or mid-range LVEF. Funding Acknowledgement Type of funding source: None

scholarly journals Pulmonary Capillary Hemangiomatosis: The Role of Invasive Cardiopulmonary Exercise Testing

2015 ◽  
Vol 5 (3) ◽  
pp. 580-586 ◽  
Author(s):  
Hilary M. DuBrock ◽  
Richard L. Kradin ◽  
Josanna M. Rodriguez-Lopez ◽  
Richard N. Channick
Keyword(s):  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Capillary ◽  
Pulmonary Capillary Hemangiomatosis

Abstract 13745: Severity of Functional Mitral Regurgitation During Maximal Exercise Testing in Heart Failure: Additional Value of Combining Echocardiography with Cardiopulmonary Exercise Testing

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Greta Generati ◽  
Francesco Bandera ◽  
Marta Pellegrino ◽  
Valentina Labate ◽  
Eleonora Alfonzetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Functional Mitral Regurgitation ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Hemodynamic ◽  
Increased Risk

Background: In heart failure (HF) patients the severity of mitral regurgitation (MR) at rest has a well established prognostic value and its increase during exercise further adds to an increased risk. Our goal was to define the relationship between the degree of exercise MR severity with cardiopulmonary and echocardiographic related phenotypes in a cohort of HF patients. Methods: 71 HF reduced ejection fraction patients (mean age 67±11; male 72%; ischemic etiology 61%; NYHA class I, II, III and IV 13%, 36%, 39% and 12%, mean ejection fraction 33±9%) underwent cardiopulmonary exercise test (CPET) on tiltable cycle-ergometer combined with echocardiography at rest and during exercise. The population was divided into two groups according to the degree of functional peak MR: no to mild/moderate MR (no MR, MR1+ and MR2+) vs moderate/severe MR (MR3+ and MR4+). Results: A good correlation (ρ coefficient= 0.49) was found between the degree of dynamic MR and PASP at peak exercise. Despite similar echocardiographic profile at rest patients with significant peak MR (MR≥3+) had worse exercise performance (lower peak VO2, O2 pulse and workload) and impaired ventilatory efficiency (higher VE/VCO2 slope). Conclusions: In HF patients the severity of exercise-induced MR is associated with the most unfavorable performance and pulmonary hemodynamic response. A combined approach with CPET and echocardiographic assessment can help to early unmask and target functional MR and its related unfavorable phenotypes.

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