scholarly journals Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice

2021 ◽  
pp. 1-15
Author(s):  
Eva Pella ◽  
Afroditi Boutou ◽  
Marieta P. Theodorakopoulou ◽  
Pantelis Sarafidis
Keyword(s):  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Cardiopulmonary Exercise Testing ◽  
Adverse Outcomes ◽  
Exercise Intolerance ◽  
Exercise Limitation ◽  
Integrative Evaluation ◽  
Prognostic Utility ◽  
Risk Potential

<b><i>Background:</i></b> Chronic kidney disease (CKD) is often characterized by increased prevalence of cardiovascular risk factors and increased incidence of cardiovascular events and death. Reduced cardiovascular reserve and exercise intolerance are common in patients with CKD and are associated with adverse outcomes. <b><i>Summary:</i></b> The gold standard for identifying exercise limitation is cardiopulmonary exercise testing (CPET). CPET provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic function during maximal or submaximal exercise. It is useful in clinical setting for differentiation of the causes of exercise intolerance, risk stratification, and assessment of response to relevant treatments. A number of recent studies have used CPET in patients with pre-dialysis CKD, aiming to assess the cardiovascular reserve of these individuals, as well as the effect of interventions such as exercise training programs on their functional capacity. This review provides an in-depth description of CPET methodology and an overview of studies that utilized CPET technology to assess cardiovascular reserve in patients with pre-dialysis CKD. <b><i>Key Messages:</i></b> CPET can delineate multisystem changes and offer comprehensive phenotyping of factors determining overall cardiovascular risk. Potential clinical applications of CPET in CKD patients range from objective diagnosis of exercise intolerance to preoperative and long-term risk stratification and providing intermediate endpoints for clinical trials. Future studies should delineate the association of CPET indexes, with cardiovascular and respiratory alterations and hard outcomes in CKD patients, to enhance its diagnostic and prognostic utility in this population.

scholarly journals Cardiopulmonary exercise testing (CPET) in patients with end-stage kidney disease (ESKD): principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation

2021 ◽  
Author(s):  
Eva Pella ◽  
Afroditi Boutou ◽  
Aristi Boulmpou ◽  
Christodoulos E Papadopoulos ◽  
Aikaterini Papagianni ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Intolerance ◽  
End Stage Kidney Disease ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise ◽  
Functional Reserves ◽  
Increased Risk ◽  
End Stage

Abstract Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

Assessment of the CHA2DS2-VASc Score in Predicting Mortality and Adverse Cardiovascular Outcomes of Patients on Hemodialysis

2020 ◽  
Vol 51 (8) ◽  
pp. 635-640
Author(s):  
Miri Schamroth Pravda ◽  
Keren Cohen Hagai ◽  
Guy Topaz ◽  
Nili Schamroth Pravda ◽  
Nadeen Makhoul ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Risk Stratification ◽  
High Mortality ◽  
Medical Center ◽  
Composite Endpoint ◽  
Chronic Hemodialysis ◽  
Adverse Outcomes ◽  
First Year ◽  
Increased Risk

Background: Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis are at high mortality and cardiovascular risk. This study was aimed to assess whether the CHA2DS2-VASc score may be used for risk stratification of this population. Methods: Included were patients undergoing chronic hemodialysis at Meir Medical Center. The CHA2DS2-VASc score was calculated for each patient at the initiation of hemodialysis. Patients were classified into 3 groups according to the CHA2DS2-VASc score: 0–3 (low), 4–5 (intermediate), and ≥6 (high). The primary endpoint was the composite of all-cause mortality, myocardial infarction, and stroke during the first year of hemodialysis. Results: Of the 457 patients with ESRD, 181 (40%) had low, 193 (42%) intermediate, and 83 (18%) high CHA2DS2-VASc scores. During the first year of hemodialysis, 109 (23.8%) patients died, 17 (3.7%) had a stroke, and 28 (6.1%) had a myocardial infarction. Compared to patients in the low CHA2DS2-VASc score group, those in the intermediate and high score groups had higher risk for the composite endpoint (OR: 2.6, 95% CI: 1.6–4.2, p < 0.01 and OR: 4.2, 95% CI: 2.3–7.5, p < 0.01, respectively). Each 1-point increase in CHA2DS2-VASc score was associated with a 38% increased risk for the composite endpoint, a 19% increased risk for 1-year myocardial infarction, and a 29% increased risk for 1-year stroke. Conclusions: Patients with ESRD are at an extremely high mortality and cardiovascular risk within the first year of hemodialysis. The CHA2DS2-VASc score was strongly associated with adverse outcomes and may be used for risk stratification of these patients.

scholarly journals Strategy of Medical Care for Pregnant Women with Congenital Heart Disease

2021 ◽  
pp. 64-69
Author(s):  
S. O. Siromakha ◽  
Yu. V. Davydova ◽  
A. O. Tarnavska ◽  
N. I. Volkova ◽  
N. B. Nakonechna
Keyword(s):  
Cardiac Surgery ◽  
Cardiovascular Risk ◽  
Medical Care ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Congenital Heart ◽  
Adverse Outcomes ◽  
Long Term Results ◽  
Increased Risk

Grown-up congenital heart (GUCH) is a global challenge nowadays. The strategy of medical care for GUCH women dur-ing pregnancy, childbirth and the postpartum period is a topic of active discussion in the expert community. These patients have significantly increased risk of maternal and perinatal loss. A national obstetric cardiology and cardiac surgery multi-disciplinary team (OCCS) established in academic institutions in 2013 has provided medical support to 896 GUCH pregnant women over the last 7 years. In total, GUCH patients accounted for 36% of the cohort of all the examined pregnant women. Of these, 474 (53%) were primigravid. The mean age of the patients at the time of the first visit was 27.3 ± 5.7 years. Patients with uncorrected CHD accounted for 66.2% (n = 593), and 33.8% (n = 303) of pregnant women had undergone correction, including hemodynamic correction of complex CHD in 5 patients. Risk stratification was performed using several scores (mWHO, ZAHARA, CARPREG) for the comprehensive assessment of cardiovascular risk and prediction of pregnancy, deliv-ery, and postpartum period course. 82 patients were classified as having high cardiovascular risk (CVR) after the stratifica-tion. They needed admission to the cardiac surgery facility to receive different types of medical care. There were 2 (2.4%) cases of maternal loss and 3 (3.8%) cases of adverse perinatal outcomes in this group of patients. The article presents the algorithms for multidisciplinary care strategy choice in GUCH pregnant women with high CVR and their routing principles developed by the OCCS. These algorithms significantly reduced adverse outcomes of pregnancy and childbirth in this group of patients. Long-term results were evaluated in 69 patients (86.3%). The follow-up period ranged from 1 to 91 months, on average 34.4 ± 23.6 months. There were no long-term maternal losses or repeated cardiac surgeries. There was one case of unexplained death of a child 8 months after birth. The strategy of multidisciplinary medical care of a high-class GUCH pregnant woman should be personalized depending on the clinical data and in accordance with the ESC 2018 guidelines.

scholarly journals Esophageal Manometry Testing and Anti-Reflux Surgery: The Preoperative Necessity and Prognostic Utility

2021 ◽  
Vol 1 (3) ◽  
pp. 216-226
Author(s):  
Shahin Ayazi
Keyword(s):  
Risk Stratification ◽  
Antireflux Surgery ◽  
Esophageal Manometry ◽  
Critical Role ◽  
Gastroesophageal Junction ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Postoperative Dysphagia ◽  
Prognostic Utility

Manometric assessment of the gastroesophageal junction (GEJ) and esophageal body is the key to a better understanding of the mechanics of antireflux surgery (ARS) and maximizing its benefits while minimizing adverse outcomes. However, there is an attitude of uncertainty regarding the necessity of esophageal motility prior to ARS among some surgeons. This evidence-based review highlights the critical role of manometry in the preoperative workup for patients undergoing ARS. It also discusses how manometry can detect findings associated with favorable outcomes or the risk of postoperative dysphagia. Manometric data can be used for risk stratification and the prediction of outcomes, aiding the surgeon in matching an operation to the specific physiology of each individual patient.

scholarly journals Risk stratification and survival in patients with HFmrEF: the role of cardiopulmonary exercise testing

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J.G Westphal ◽  
P.C Schulze
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Risk Stratification ◽  
Exercise Testing ◽  
Primary Endpoint ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise ◽  
All Cause Mortality

Abstract Background The prognostic value of cardiopulmonary exercise testing (CPET) is established for risk stratification in patients with heart failure (HF) and reduced ejection fraction (HFrEF). Since the introduction of HF with mid-range ejection fraction (HFmrEF) as an additional category in 2016, optimal management strategy and risk stratification for these patients is a field of ongoing research. Purpose Left ventricular ejection fraction (LVEF) is only one part of the picture when planning treatment and estimating long time risk for patients with HF. We planned to investigate the predictive long-term value of exercise intolerance as measured by CPET in patients with HFmrEF in comparison to HFrEF. Methods We performed a single-center retrospective cohort study of ambulatory consecutive patients that showed signs of heart failure (NYHA functional class II or III) and had a LVEF of 49% or below as measured by echocardiography at the time of CPET. All patients underwent CPET evaluation with an upright bicycle between 2015–2017. The primary endpoint of all-cause mortality as well as the secondary composite endpoint of all-cause mortality or heart transplant/ventricular assist device implantation (transplant/VAD free survival) were assessed. Results For the primary analysis, 253 patients (mean age 61.2±13.0 years, 82.6% male) were included. 68 patients showed an LVEF between 40 and 49% (HFmrEF) whereas 185 patients had an LVEF of below 40% (HFrEF). HF etiology was in 31.3% ischemic. Mean BNP values were 788±1061 pg/ml while HFmrEF patients had on average lower values than HFrEF (322±676 vs. 945±1121, p&lt;0.001). Patients were followed up for a median of 4.2 years (IQR: 3.5–5.0 years). Over this period, the primary and secondary end-point occurred in 22.5%/30.8% of patients. Patients in the HFmrEF group showed a higher mean peak oxygen uptake compared to HFrEF (pVO2; 17.3±4.6 vs 14.2±3.7 ml/min/kg, p&lt;0.001), peak exercise power (Pmax; 111±49 vs 91±38 Watt, p=0.02) and peak oxygen pulse (pO2/HR; 12.6±4.2 vs 10.4±4.1 ml/min/kg, p&lt;0.001). The Kaplan-Meier-Estimate showed a significant difference in survival for both HFmrEF and HFrEF who had pVO2 below 14 ml/min/kg (Log Rank: Chi2: 4.45, p=0.035 and Chi2: 10.05, p=0.02). In univariate Cox regression, pVO2 was predictive of the primary endpoint (HR per +1 mL/kg/min: 0.81; CI: 0.71–0.93; p=0.002 and HR per +1 mL/kg/min: 0.84; CI: 0.77–0.92; p&lt;0.001) in both groups as was Pmax and pO2/HR (p&lt;0.05 for both variables in both groups). Conclusion As in HFrEF, CPET is a useful tool to stratify risk in HFmrEF as well. Our findings support the prognostic role of pVO2 as well as pO2/HR and Pmax in HF with mid-range LVEF. Using a cut off of pVO2 14 ml/min/kg selected patients at risk with similar long-term prognosis as in the HFrEF cohort. Further research to identify subgroups at risk within the heterogeneous group of HFmrEF is warranted for optimal risk stratification. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Cardiac computed tomography improves prediction of long-term cardiovascular events: a retrospective cohort study of type 2 diabetic with higher cardiovascular risk

2020 ◽  
Author(s):  
Zhijie Jian ◽  
Zhe Liu ◽  
Li Zhou ◽  
Ningning Ding ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Cardiovascular Events ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Ct Data ◽  
Type 2 Diabetic

Abstract Background: The value of cardiac computed tomography (CT) for screening and risk stratification in patients with type 2 diabetes mellitus (DM) who are at a higher cardiovascular risk is unclear. Thus, this study aim s to investigate the efficacy of cardiac CT in predicting long-term cardiovascular events (CVEVs) in this subset of patients. Methods: Type 2 diabetic with a higher cardiovascular risk who underwent cardiac CT between 2012 and 2014 were included in this study. Cardiac CT was performed, and coronary artery calcium score, location and extent of lesion, stenosis severity, plaque composition, and epicardial adipose tissue (EAT) volume were assessed. The endpoints were a composite of CVEVs (cardiac death, non-fatal myocardial infarction, or coronary revascularization,non-fatal stroke, hospitalization for unstable angina, and hospitalization for congestive heart failure). Potential predictors of CVEVs were identified. Predictive models were created and compared. Results: CVEVs occurred in 26.8% of the patients. Independent predictors of CVEVs included diabetes duration (odds ratio [OR]=10.003), mean creatinine level (OR=3.845), hypertension (OR=3.844), atheroma burden obstructive score (OR=14.060), segment stenosis score (OR=7.912), and EAT volume (OR=7.947). The model including cardiac CT data and clinical parameters improved the prediction of CVEVs, with an area under the receiver operating characteristic curve of 0.912 (95% confidence interval 0.829–0.963; p<0.05) for the prediction of the study endpoints. Conclusion: Cardiac CT showed a great value in risk stratification for patients with diabetes with higher cardiovascular risk. Cardiac CT data may help predict CVEVs and potentially improve outcomes.

scholarly journals Development and Validation of a Clinical Score for Cardiovascular Risk Stratification of Long‐Term Childhood Cancer Survivors

2018 ◽  
Vol 23 (8) ◽  
pp. 965-973 ◽  
Author(s):  
Evangelos K. Oikonomou ◽  
Sofia G. Athanasopoulou ◽  
Polydoros N. Kampaktsis ◽  
Damianos G. Kokkinidis ◽  
Christos A. Papanastasiou ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Clinical Score ◽  
Childhood Cancer Survivors ◽  
Cardiovascular Risk Stratification ◽  
Development And Validation
Sign in / Sign up

Export Citation Format

Share Document