Outcomes of Patients With Reduced Exercise Capacity at Time of Exercise Echocardiography

2004 ◽  
Vol 79 (6) ◽  
pp. 750-757 ◽  
Author(s):  
Robert B. McCully ◽  
Veronique L. Roger ◽  
Steve R. Ommen ◽  
Douglas W. Mahoney ◽  
Kelli N. Burger ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Exercise Echocardiography

scholarly journals Decreased pulmonary vascular distensibility in adolescents conceived by in vitro fertilization

2019 ◽  
Vol 34 (9) ◽  
pp. 1799-1808
Author(s):  
K Forton ◽  
Y Motoji ◽  
B Pezzuto ◽  
S Caravita ◽  
A Delbaere ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Aerobic Exercise ◽  
Ventricular Function ◽  
Exercise Capacity ◽  
Right Ventricular Function ◽  
Exercise Echocardiography ◽  
Lung Diffusion ◽  
Diffusion Capacity ◽  
Aerobic Exercise Capacity

Abstract STUDY QUESTION What is the functional relevance of decreased pulmonary vascular distensibility in adolescents conceived by IVF? SUMMARY ANSWER Children born by IVF have a slight decrease in pulmonary vascular distensibility observed during normoxic exercise that is not associated with altered right ventricular function and aerobic exercise capacity. WHAT IS KNOWN ALREADY General vascular dysfunction and increased hypoxic pulmonary hypertension have been reported in ART children as compared to controls. Pulmonary hypertension or decreased pulmonary vascular distensibility may affect right ventricular function and thereby possibly limit maximal cardiac output and aerobic exercise capacity. STUDY DESIGN, SIZE, DURATION This prospective case-control study enrolled 15 apparently healthy adolescents conceived by IVF/ICSI after fresh embryo transfer paired in a 2 to 1 ratio to 30 naturally conceived adolescents between March 2015 and May 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Fifteen IVF/ICSI adolescents and 30 controls from singleton gestations matched by age, gender, weight, height and physical activity underwent exercise echocardiography, lung diffusion capacity measurements and a cycloergometer cardiopulmonary exercise test. A pulmonary vascular distensibility coefficient α was determined from the pulmonary arterial pressure (PAP) versus cardiac output (Q) relationships. Pulmonary capillary volume (Vc) was calculated from single breath nitric oxide and carbon monoxide lung diffusion capacity measurements (DLCO and DLNO) at rest and during exercise (100 W). Eight of the IVF subjects and eight controls underwent a 30 min hypoxic challenge at rest with a fraction of inspired oxygen of 0.12 to assess hypoxic pulmonary vasoconstriction. MAIN RESULTS AND THE ROLE OF CHANCE In normoxia, oxygen uptake (VO2), blood pressure, DLCO, DLNO, echocardiographic indices of right ventricular function, Q and PAP at rest and during exercise were similar in both groups. However, IVF children had a lower pulmonary vascular distensibility coefficient α (1.2 ± 0.3 versus 1.5 ± 0.3%/mmHg, P = 0.02) and a blunted exercise-induced increase in Vc (24 versus 32%, P < 0.05). Hypoxic-induced increase in pulmonary vascular resistance in eight IVF subjects versus eight controls was similar. LIMITATIONS, REASONS FOR CAUTION The IVF cohort was small, and thus type I or II errors could have occurred in spite of careful matching of each case with two controls. ART evolved over the years, so that it is not certain that the presently reported subtle changes will be reproducible in the future. As the study was limited to singletons born after fresh embryo transfers, our observations cannot be extrapolated to singletons born after frozen embryo transfer. WIDER IMPLICATIONS OF THE FINDINGS The present study suggests that adolescents conceived by IVF have preserved right ventricular function and aerobic exercise capacity despite a slight alteration in pulmonary vascular distensibility as assessed by two entirely different methods, i.e. exercise echocardiography and lung diffusing capacity measurements. However, the long-term prognostic relevance of this slight decrease in pulmonary vascular distensibility needs to be evaluated in prospective large scale and long-term outcome studies. STUDY FUNDING/COMPETING INTEREST(S) Dr Caravita was supported by an ERS PAH short term research training fellowship (STRTF2014-5264). Dr Pezzuto was funded by an Italian Society of cardiology grant. Dr Motoji was supported by a grant from the Cardiac Surgery Funds, Belgium. All authors have no conflicts of interests to declare.

Cardiac Reserve and Exercise Capacity: Insights from Combined Cardiopulmonary and Exercise Echocardiography Stress Testing

2021 ◽  
Vol 34 (1) ◽  
pp. 38-50
Author(s):  
Nicola Riccardo Pugliese ◽  
Nicolò De Biase ◽  
Lorenzo Conte ◽  
Luna Gargani ◽  
Matteo Mazzola ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Stress Testing ◽  
Exercise Echocardiography ◽  
Cardiac Reserve

scholarly journals Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy

2019 ◽  
Vol 27 (17) ◽  
pp. 1821-1831 ◽  
Author(s):  
Luca Ghiselli ◽  
Alberto Marchi ◽  
Carlo Fumagalli ◽  
Niccolò Maurizi ◽  
Andrea Oddo ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Capacity ◽  
Exercise Performance ◽  
Cardiac Death ◽  
Predictive Accuracy ◽  
Multivariable Analysis ◽  
Peak Exercise ◽  
Exercise Echocardiography ◽  
Metabolic Equivalents ◽  
Age Related

Aims Exercise performance is known to predict outcome in hypertrophic cardiomyopathy (HCM), but whether sex-related differences exist is unresolved. We explored whether functional impairment, assessed by exercise echocardiography, has comparable predictive accuracy in females and males with HCM. Methods We retrospectively evaluated 292 HCM patients (46 ± 16 years, 72% males), consecutively referred for exercise echocardiography; 242 were followed for 5.9 ± 4.2 years. Results Peak exercise capacity was 6.5 ± 1.6 metabolic equivalents (METs). Sixty patients (21%) showed impaired exercise capacity (≤5 METs). Exercise performance was reduced in females, compared with males (5.6 ± 1.6 vs 6.9 ± 1.5 METs, p < 0.001; peak METs ≤ 5 in 40% vs 13%, p < 0.001), largely driven by a worse performance in women >50 years of age. At multivariable analysis, female sex was independently associated with impaired exercise capacity (odds ratio: 4.67; 95% confidence interval (CI): 1.83–11.90; p = 0.001). During follow-up, 24 patients (10%) met the primary endpoint (a combination of cardiac death, heart failure requiring hospitalization, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator discharge, resuscitated sudden cardiac death and cardioembolic stroke). Event-free survival was reduced in females ( p = 0.035 vs males). Peak METs were inversely related to outcome in males (hazard ratio (HR) per unit increase: 0.57; 95% CI: 0.39–0.84; p = 0.004) but not in females (HR: 1.22; 95% CI: 0.66–2.24; p = 0.53). Conclusions Female patients with HCM showed significant age-related impairment in functional capacity compared with males, particularly evident in post-menopausal age groups. While women were at greater risk of HCM-related complications and death, impaired exercise capacity predicted adverse outcome only in men. These findings suggest the need for sex-specific management strategies in HCM.

scholarly journals Prognostic importance of tissue velocity imaging during exercise echocardiography in patients with systolic heart failure

2015 ◽  
Vol 2 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Jet van Zalen ◽  
Nikhil R Patel ◽  
Steven J Podd ◽  
Prashanth Raju ◽  
Rob McIntosh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Capacity ◽  
Stress Echocardiography ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Left Ventricular Ejection ◽  
Exercise Echocardiography ◽  
Powerful Predictor ◽  
Tissue Velocity ◽  
Velocity Imaging

Resting echocardiography measurements are poor predictors of exercise capacity and symptoms in patients with heart failure (HF). Stress echocardiography may provide additional information and can be expressed using left ventricular ejection fraction (LVEF), or diastolic parameters (E/E′), but LVEF has some major limitations. Systolic annular velocity (S′) provides a measure of longitudinal systolic function, which is relatively easy to obtain and shows a good relationship with exercise capacity. The objective of this study was to investigate the relationship among S′, E/E′ and LVEF obtained during stress echocardiography and both mortality and hospitalisation. A secondary objective was to compare S′ measured using a simplified two-wall model. A total of 80 patients with stable HF underwent exercise stress echocardiography and simultaneous cardiopulmonary exercise testing. Volumetric and tissue velocity imaging (TVI) measurements were obtained, as was peak oxygen uptake (VO2 peak). Of the total number of patients, 11 died and 22 required cardiac hospitalisation. S′ at peak exertion was a powerful predictor for death and hospitalisation. Cut-off points of 5.3 cm/s for death and 5.7 cm/s for hospitalisation provided optimum sensitivity and specificity. This study suggests that, in patients with systolic HF, S′ at peak exertion calculated from the averaged spectral TVI systolic velocity of six myocardial segments, or using a simplified measure of two myocardial segments, is a powerful predictor of future events and stronger than LVEF, diastolic velocities at rest or exercise and VO2 peak. Results indicate that measuring S′ during exercise echocardiography might play an important role in understanding the likelihood of adverse clinical outcomes in patients with HF.

scholarly journals Sildenafil enhances central hemodynamic responses to exercise, but not V̇o2peak, in people with diabetes mellitus

2019 ◽  
Vol 127 (1) ◽  
pp. 1-10
Author(s):  
Timothy J. Roberts ◽  
Andrew T. Burns ◽  
Richard J. MacIsaac ◽  
Andrew I. MacIsaac ◽  
David L. Prior ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Rate ◽  
Cardiac Output ◽  
Pulmonary Vascular Resistance ◽  
Exercise Capacity ◽  
Vascular Resistance ◽  
Exercise Performance ◽  
Exercise Echocardiography ◽  
Cardiopulmonary Exercise ◽  
Central Hemodynamic

Exercise capacity is frequently reduced in people with diabetes mellitus (DM), and the contribution of pulmonary microvascular dysfunction remains undefined. We hypothesized that pulmonary microvascular disease, measured by a novel exercise echocardiography technique termed pulmonary transit of agitated contrast (PTAC), would be greater in subjects with DM and that the use of pulmonary vasodilator agent sildenafil would improve exercise performance by reducing right ventricular afterload. Forty subjects with DM and 20 matched controls performed cardiopulmonary exercise testing and semisupine exercise echocardiography 1 h after placebo or sildenafil ingestion in a double-blind randomized crossover design. The primary efficacy end point was exercise capacity (V̇o2peak) while secondary measures included pulmonary vascular resistance, cardiac output, and change in PTAC. DM subjects were aged 44 ± 13 yr, 73% male, with 16 ± 10 yr DM history. Sildenafil caused marginal improvements in echocardiographic measures of biventricular systolic function in DM subjects. Exercise-induced increases in pulmonary artery systolic pressure and pulmonary vascular resistance were attenuated with sildenafil, while heart rate (+2.4 ±1.2 beats/min, P = 0.04) and cardiac output (+322 ± 21 ml, P = 0.03) improved. However, the degree of PTAC did not change ( P = 0.93) and V̇o2peak did not increase following sildenafil as compared with placebo (V̇o2peak: 31.8 ± 9.7 vs. 32.1 ± 9.5 ml·min−1·kg−1, P = 0.42). We conclude that sildenafil administration causes modest acute improvements in central hemodynamics but does not improve exercise capacity. This may be due to the mismatch in action of sildenafil on the pulmonary arteries rather than the distal pulmonary microvasculature and potential adverse effects on peripheral oxygen extraction. NEW & NOTEWORTHY This is one of the largest and most comprehensive studies of cardiopulmonary exercise performance in people with diabetes mellitus and to our knowledge the first to assess the effect of sildenafil using detailed echocardiographic measures during incremental exercise. Sildenafil attenuated the rise in pulmonary vascular resistance while augmenting cardiac output and intriguingly heart rate, without conferring any improvement in exercise capacity. The enhanced central hemodynamic indexes may have been offset by reduced peripheral O2 extraction.

Prognosis of Patients with Good Exercise Capacity and Mildly Abnormal Exercise Echocardiography Results: Identification of an At-risk Subgroup

2005 ◽  
Vol 18 (6) ◽  
pp. 644-648 ◽  
Author(s):  
Robert B. McCully ◽  
Steve R. Ommen ◽  
Kyle W. Klarich ◽  
Kelli N. Burger ◽  
Douglas W. Mahoney ◽  
...  
Keyword(s):  
At Risk ◽  
Exercise Capacity ◽  
Exercise Echocardiography

scholarly journals P1551 Exercise echocardiographic determinants of exercise tolerance in aortic stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Fazendas ◽  
A G Francisco ◽  
A G Manuel ◽  
H Pereira ◽  
A G Almeida
Keyword(s):  
Aortic Stenosis ◽  
Exercise Capacity ◽  
Exercise Tolerance ◽  
Univariate Analysis ◽  
Global Longitudinal Strain ◽  
Aortic Valve Area ◽  
Exercise Echocardiography ◽  
Echocardiographic Parameters ◽  
Gradient Variation ◽  
Age And Sex

Abstract Introduction A variation of 20 mmHg in the mean aortic gradient in asymptomatic aortic stenosis (AS) was proposed as an indicator of severity during exercise echocardiography. Objective to identify echocardiographic predictors of exercise tolerance in AS and analyze the association of the variation in mean aortic gradient (MAG) with exercise tolerance. Methods prospective study of patients (pts) referred for testing with asymptomatic AS. We performed exercise echocardiography using the modified Bruce Protocol. Baseline, peak and recovery imaging was performed. Exercise tolerance was expressed as METS and % of predicted METS for age and sex. Population 24 pts, 14 males, age 72+-9 years, body mass index (BMI): 28+-4 Kg/m2, etiology: bicuspid 6 pts, degenerative tricuspid 18 pts, 4 pts were in sinus rhythm, the remaining were in atrial fibrillation. Results baseline parameters: indexed aortic valve area (AVAi): 0,51+-0,13 cm2/m2, MAG 37+-12 mmHg, left ventricle: ejection fraction (LVEF): 63+-9%, cardiac index L/min/m2(CI) 3,2+-0,6, global longitudinal strain (LVGLS) -16+-3%, VTI ratio: 0,26+-0,05, valvulo-arterial impedance mmHg.ml-1.m2(Zva): 3,9+-0,9 . Peak parameters: AVAi: 0,54+-0,14 cm2/m2, MAG 53+-17 mmHg, LVEF: 69 (IQR 10)%, CI 3,2+-0,6, LVGLS -19+-5% , VTI ratio: 0,28+-0,06, Zva: 4,3+-1,4. Exercise tolerance: METS 6+-2, representing 86+-26% of the predicted exercise tolerance for age and sex. Statistics we performed an univariate analysis to identify the echocardiographic parameters associated with exercise tolerance, which were then used in a multiple regression analysis. A higher peak CI correlated with a higher exercise capacity (r = 0,5, p 0,01) and higher mean aortic gradient variation (r = 0,6 p &lt; 0,01). The strongest predictor was the peak CI (B coefficient 0,5, R = 0,75, R² 0,57): when corrected for age, sex and BMI, for each increase of 0,5 mL/min/m2 in the peak CI we would expect an increase of 1 MET. This model explains 57 % of the variation in exercise capacity in these patients. Conclusions higher mean aortic gradient variation is associated with higher exercise tolerance and the strongest determinant of exercise tolerance in AS is the peak CI.

scholarly journals Outcome after abnormal exercise echocardiography for patients with good exercise capacity

2002 ◽  
Vol 39 (8) ◽  
pp. 1345-1352 ◽  
Author(s):  
Robert B McCully ◽  
Veronique L Roger ◽  
Douglas W Mahoney ◽  
Kelli N Burger ◽  
Roger L Click ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Exercise Echocardiography
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