scholarly journals Risk Stratification in Patients with Ischemic Stroke and Residual Cardiovascular Risk with Current Secondary Prevention

2021 ◽  
Vol Volume 13 ◽  
pp. 813-823
Author(s):  
Mari Nordbø Gynnild ◽  
Steven HJ Hageman ◽  
Jannick AN Dorresteijn ◽  
Olav Spigset ◽  
Stian Lydersen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Secondary Prevention ◽  
Residual Cardiovascular Risk

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.

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