scholarly journals Cardiopulmonary Exercise Testing in Repaired Tetralogy of Fallot: Multiparametric Overview and Correlation with Cardiac Magnetic Resonance and Physical Activity Level

2022 ◽  
Vol 9 (1) ◽  
pp. 26
Author(s):  
Benedetta Leonardi ◽  
Federica Gentili ◽  
Marco Alfonso Perrone ◽  
Fabrizio Sollazzo ◽  
Lucia Cocomello ◽  
...  
Keyword(s):  
Physical Activity ◽  
Multivariate Analysis ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Exercise Testing ◽  
Exercise Tolerance ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2 ◽  
O2 Pulse

Patients with repaired Tetralogy of Fallot (rToF) typically report having preserved subjective exercise tolerance. Chronic pulmonary regurgitation (PR) with varying degrees of right ventricular (RV) dilation as assessed by cardiac magnetic resonance imaging (MRI) is prevalent in rToF and may contribute to clinical compromise. Cardiopulmonary exercise testing (CPET) provides an objective assessment of functional capacity, and the International Physical Activity Questionnaire (IPAQ) can provide additional data on physical activity (PA) achieved. Our aim was to assess the association between CPET values, IPAQ measures, and MRI parameters. All rToF patients who had both an MRI and CPET performed within one year between March 2019 and June 2021 were selected. Clinical data were extracted from electronic records (including demographic, surgical history, New York Heart Association (NYHA) functional class, QRS duration, arrhythmia, MRI parameters, and CPET data). PA level, based on the IPAQ, was assessed at the time of CPET. Eighty-four patients (22.8 ± 8.4 years) showed a reduction in exercise capacity (median peak VO2 30 mL/kg/min (range 25–33); median percent predicted peak VO2 68% (range 61–78)). Peak VO2, correlated with biventricular stroke volumes (RVSV: β = 6.11 (95%CI, 2.38 to 9.85), p = 0.002; LVSV: β = 15.69 (95% CI 10.16 to 21.21), p < 0.0001) and LVEDVi (β = 8.74 (95%CI, 0.66 to 16.83), p = 0.04) on multivariate analysis adjusted for age, gender, and PA level. Other parameters which correlated with stroke volumes included oxygen uptake efficiency slope (OUES) (RVSV: β = 6.88 (95%CI, 1.93 to 11.84), p = 0.008; LVSV: β = 17.86 (95% CI 10.31 to 25.42), p < 0.0001) and peak O2 pulse (RVSV: β = 0.03 (95%CI, 0.01 to 0.05), p = 0.007; LVSV: β = 0.08 (95% CI 0.05 to 0.11), p < 0.0001). On multivariate analysis adjusted for age and gender, PA level correlated significantly with peak VO2/kg (β = 0.02, 95% CI 0.003 to 0.04; p = 0.019). We observed a reduction in objective exercise tolerance in rToF patients. Biventricular stroke volumes and LVEDVi were associated with peak VO2 irrespective of RV size. OUES and peak O2 pulse were also associated with biventricular stroke volumes. While PA level was associated with peak VO2, the incremental value of this parameter should be the focus of future studies.

scholarly journals 789 Cardiopulmonary exercise testing in repaired tetralogy of Fallot patients: correlation with the level of physical activity and cardiac magnetic resonance imaging

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Marco Alfonso Perrone ◽  
Federica Gentili ◽  
Davide Curione ◽  
Paolo Ciancarella ◽  
Aurelio Secinaro ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Physical Activity ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Positive Association ◽  
Resonance Imaging ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2

Abstract Aims Patients with repaired Tetralogy of Fallot (rToF) tend to have a decent life free of limitations. In asymptomatic individuals, cardiac magnetic resonance imaging (MRI) is used to determine if pulmonary valve replacement (PVR) is necessary. Cardiopulmonary exercise testing (CPET) could aid in determining the extent of functional impairment. Methods and results rToF patients who had an MRI and CPET between 2019 and 2021 in a brief interval (&lt;1 year) were included in the study. Data were gathered on demographics, CPET parameters, MRI, type of surgery, clinical functional class, QRS duration, arrhythmic events, and level of physical activity. A total of 83 participants were enrolled in this study. There was a slight decrease in exercise capacity (median peak VO2/kg 30; range 25–33 mlO2/kg/min). Peak VO2 (r = 0.28), peak VO2/kg (r = 0.40), VO2 at AT (r = 0.31), peak oxygen pulse (r = 0.26), and oxygen uptake efficiency slope (OUES) (r = 0.35) values were found to have a positive association with right ventricular (RV) size. No significant correlation was observed between CPET parameters and PR, LVEF, and RVEF. A significant positive association was detected between right ventricular end-diastolic volume index (RVEDVi) and exercise capacity, especially up to 160 ml/m2. The analysis of the International Physical Activity Questionnaire (IPAQ) replies revealed a statistically significant relationship between the level of physical activity and both peak HR and the indexes of ventilatory efficiency. Conclusion In rToF patients with moderate–severe PR, NYHA class I, preserved RVEF, a slight reduction in exercise tolerance was detected. OUES could also be valuable to this population. A positive association was found between RV dilation and exercise performance up to 160 ml/m2 of RVEDVi, suggesting that perhaps at this cut-off value of RVEDVi, PVR could start being considered.

scholarly journals Longitudinal trajectory of cardiac magnetic resonance and cardiopulmonary exercise testing findings in moderate to severe COVID-19 and association with symptoms

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M P Cassar ◽  
A J Lewandowski ◽  
M Mahmod ◽  
C Xie ◽  
E M Tunnicliffe ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Mean Difference ◽  
Research Centre ◽  
Gas Transfer ◽  
Cardiopulmonary Exercise ◽  
Cardiac Symptoms ◽  
Health And Social Care

Abstract Background Cardiac magnetic resonance (CMR) and cardiopulmonary exercise testing (CPET) have provided important insights into the prevalence of early cardiopulmonary abnormalities in COVID-19 patients. It is currently unknown whether such abnormalities persist over time and relate to ongoing symptoms. Purpose To describe the longitudinal trajectory of cardiopulmonary abnormalities on CMR and CPET in moderate to severe COVID-19 patients and assess their relationship with ongoing symptoms. Methods Fifty-eight previously hospitalised COVID-19 patients and 30 age, sex, body mass index, comorbidity-matched controls underwent CMR, CPET and a symptom-based questionnaire at 2–3 months (2–3m). Repeat assessments (including gas transfer) were performed in 46 patients at 6 months (6m). Results During admission, 1/3rd of patients needed ventilation or intensive care (Table 1) and three (5%) had a raised troponin. On CMR, patients had preserved left (LV) and right ventricular (RV) volumes and function at 2–3m from infection. By 6m, LV function did not change but RV end diastolic volume decreased (mean difference −4.3 mls/m2, p=0.005) and RV function increased (mean difference +3.2%, p&lt;0.001, Fig. 1A). Patients had higher native T1 (a marker of fibroinflammation) at 2–3m compared to controls (Table 1, Fig. 1B), which normalised by 6m. Extracellular volume was normal and improved by 6m. Native T2, a marker of myocardial oedema, did not differ between patients and controls on serial CMR. At 2–3m, late gadolinium enhancement (LGE) was higher in patients (p=0.023) but became comparable to controls by 6m (p=0.62). Six (12%) patients had LGE in a myocarditis pattern and one (2%) had myocardial infarction. None had active myocarditis using the Modified Lake Louise Criteria. Lung imaging (T2-weighted) revealed parenchymal abnormalities in 2/3rds of patients at 2–3 and 6 months. The extent of abnormalities improved on serial imaging (Table 1). Gas transfer (DLco) was worse in those with lung abnormalities (77% vs 91% of predicted, p=0.009). CPET revealed reduced peak oxygen consumption (pVO2) in patients at 2–3m, which normalised by 6m (80.5% to 93.3% of predicted, p=0.001) (Table 1, Fig. 1C). At 2–3m, 49% of patients had submaximal tests (respiratory exchange ratio &lt;1.1), reducing to 25% by 6m (p=0.057). VE/VCO2 slope, a marker of lung efficiency, was abnormal in patients but improved on serial CPET (Table 1, Fig. 1D). Cardiac symptoms (chest pain, dyspnoea, palpitations, dizziness or syncope) were present in 83% of patients at 2–3m, reducing to 52% by 6m (p&lt;0.001). There was no significant association between CMR or CPET parameters and persistent cardiac symptoms at 6m (Fig. 1E). Conclusions Cardiopulmonary parameters (on CMR and CPET) improved in moderate-severe COVID-19 patients from 2–3 to 6 months post infection. Despite this, patients continued to experience cardiac symptoms which had no relationship with measured parameters. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): 1. NIHR Oxford and Oxford Health Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust2. Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107 Table 1 Figure 1

Abstract 16788: Cardiopulmonary Exercise Testing in Pulmonary Atresia With Intact Ventricular Septum

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Krishan Patel ◽  
Andrew L Cheng ◽  
Andrew Souza ◽  
Arash Sabati ◽  
Jon A Detterich
Keyword(s):  
Stroke Volume ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Pulmonary Atresia ◽  
Wilcoxon Test ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2 ◽  
O2 Pulse

Introduction: Pulmonary atresia with intact ventricular septum (PAIVS) is surgically managed with biventricular repair (2V), 1.5 ventricle palliation (1.5V), or single ventricle palliation (1V). Cardiopulmonary exercise testing (CPET) has been increasingly utilized in these patients. However, prognostic ability of CPET is limited by achievement of maximal exercise effort [respiratory exchange ratio (RER) > 1.1]. Even during submaximal exercise, the VE/VCO2 can impact peak VO2. This study aims to identify CPET differences in 1V, 1.5V, and 2V PAIVS patients. Methods: A retrospective, cross-sectional study was performed, identifying PAIVS patients undergoing CPET. Contemporaneous echocardiography and CMR data was collected. CPET measures were compared by treatment group using ANOVA, Kruskal-Wallis, and chi-squared test, as appropriate. Comparisons of VE/VCO2 between individual groups were performed using Wilcoxon test. Univariate associations with VE/VCO2 were determined using Pearson correlation. Results: Nineteen PAIVS patients were identified (age 12.4 ± 0.68; seven 1V, five 1.5V, seven 2V). Only 7/19 (36.8%) patients achieved RER > 1.1. Sex, age, RER, peak VO2, ventilatory anaerobic threshold, O2 pulse, BSA-adjusted O2 pulse, peak HR, and HR reserve did not differ between treatment groups. The VE/VCO2 ratio was different (p=0.037), with lower VE/VCO2 in 1.5V vs. 1V (p=0.021). Across all PAIVS patients, univariate associations with lower VE/VCO2 were male sex, higher BSA, hematocrit, and O2 pulse, and lower mitral inflow A wave velocity. In the 1.5V and 2V patients, higher RVEF and RV stroke volume by CMR were associated with lower VE/VCO2. Conclusions: The 1.5V palliation of PAIVS may be associated with better gas exchange efficiency compared to 1V palliation, while 2V patients were not different from either 1V or 1.5V. BSA-adjusted O2 pulse did not vary between treatment pathways, suggesting similar stroke volume response across all 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.

scholarly journals Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Laura Jones ◽  
Laura Tan ◽  
Suzanne Carey-Jones ◽  
Nathan Riddell ◽  
Richard Davies ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Low Cost ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Wearable Device ◽  
Cardiopulmonary Exercise

Abstract Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery. Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices. Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 males) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R = 0.57 (CI 0.29–0.76), R = 0.59 (CI 0.31–0.77) and R = 0.62 (CI 0.35–0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01–0.64), R = 0.39 (CI 0.04–0.66) and R = 0.42 (CI 0.07–0.68) respectively) and peak work (R = 0.56 (CI 0.27–0.75), R = 0.48 (CI 0.17–0.70) and R = 0.50 (CI 0.2–0.72) respectively). Receiver operator curve (ROC) analysis for direct and self-reported measures of 7-day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work. Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment. Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24 January 2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.

scholarly journals Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

2016 ◽  
Vol 25 (141) ◽  
pp. 333-347 ◽  
Author(s):  
Denis E. O'Donnell ◽  
Amany F. Elbehairy ◽  
Azmy Faisal ◽  
Katherine A. Webb ◽  
J. Alberto Neder ◽  
...  
Keyword(s):  
Physical Activity ◽  
Exercise Testing ◽  
Physiological Responses ◽  
Cardiopulmonary Exercise Testing ◽  
Chronic Obstructive ◽  
Exertional Dyspnoea ◽  
Obstructive Pulmonary Disease ◽  
Respiratory Impairment ◽  
Laboratory Exercise ◽  
Cardiopulmonary Exercise

Activity-related dyspnoea is often the most distressing symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and can persist despite comprehensive medical management. It is now clear that dyspnoea during physical activity occurs across the spectrum of disease severity, even in those with mild airway obstruction. Our understanding of the nature and source of dyspnoea is incomplete, but current aetiological concepts emphasise the importance of increased central neural drive to breathe in the setting of a reduced ability of the respiratory system to appropriately respond. Since dyspnoea is provoked or aggravated by physical activity, its concurrent measurement during standardised laboratory exercise testing is clearly important. Combining measurement of perceptual and physiological responses during exercise can provide valuable insights into symptom severity and its pathophysiological underpinnings. This review summarises the abnormal physiological responses to exercise in COPD, as these form the basis for modern constructs of the neurobiology of exertional dyspnoea. The main objectives are: 1) to examine the role of cardiopulmonary exercise testing (CPET) in uncovering the physiological mechanisms of exertional dyspnoea in patients with mild-to-moderate COPD; 2) to examine the escalating negative sensory consequences of progressive respiratory impairment with disease advancement; and 3) to build a physiological rationale for individualised treatment optimisation based on CPET.

scholarly journals Magnetic Resonance–Augmented Cardiopulmonary Exercise Testing

2016 ◽  
Vol 9 (12) ◽  
Author(s):  
Nathaniel J. Barber ◽  
Emmanuel O. Ako ◽  
Gregorz T. Kowalik ◽  
Mun H. Cheang ◽  
Bejal Pandya ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise
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