scholarly journals Predictors of Exercise Capacity in Dilated Cardiomyopathy with Focus on Pulmonary Venous Flow Recorded with Transesophageal Eco-Doppler

2021 ◽  
Vol 10 (24) ◽  
pp. 5954
Author(s):  
Carlo Caiati ◽  
Adriana Argentiero ◽  
Cinzia Forleo ◽  
Stefano Favale ◽  
Mario Erminio Lepera
Keyword(s):  
Dilated Cardiomyopathy ◽  
Exercise Capacity ◽  
Univariate Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Female Gender ◽  
Venous Flow ◽  
Relative Contribution ◽  
Peak Vo2 ◽  
Modifiable Factors ◽  
Pulsed Wave Doppler

The aim of this study was to clarify the relative contribution of elevated left ventricle (LV) filling pressure (FP) estimated by pulmonary venous (PV) and mitral flow, transesophageal Doppler recording (TEE), and other extracardiac factors like obesity and renal insufficiency (KI) to exercise capacity (ExC) evaluated by cardiopulmonary exercise testing (CPX) in patients with dilated cardiomyopathy (DCM). During the CPX test, 119 patients (pts) with DCM underwent both peak VO2 consumption and then TEE with color-guided pulsed-wave Doppler recording of PVF and transmitral flow. In 78 patients (65%), peak VO2 was normal or mildly reduced (>14 mL/kg/min) (group 1) while it was markedly reduced (≤14 mL/kg/min) in 41 (group 2). In univariate analysis, systolic fraction (S Fract), a predictor of elevated pre-a LV diastolic FP, appeared to be the best diastolic parameter predicting a significantly reduced peak VO2. Logistic regression analysis identified five parameters yielding a unique, statistically significant contribution in predicting reduced ExC: creatinine clearance < 52 mL/min (odds ratio (OR) = 7.4, p = 0.007); female gender (OR = 7.1, p = 0.004); BMI > 28 (OR = 5.8, p = 0.029), age > 62 years (OR = 5.5, p = 0.03), S Fract < 59% (OR = 4.9, p = 0.02). Conclusion: KI was the strongest predictor of reduced ExC. The other modifiable factors were obesity and severe LV diastolic dysfunction expressed by blunted systolic venous flow. Contrarily, LV ejection fraction was not predictive, confirming other previous studies. This has important clinical implications.

scholarly journals Right ventricular systolic dysfunction but not dilatation correlates with prognostically significant reductions in exercise capacity in repaired Tetralogy of Fallot

2019 ◽  
Vol 21 (8) ◽  
pp. 906-913 ◽  
Author(s):  
Imran Rashid ◽  
Adil Mahmood ◽  
Tevfik F Ismail ◽  
Shamus O’Meagher ◽  
Shelby Kutty ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Exercise Capacity ◽  
Multivariable Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Pulmonary Regurgitation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Peak Vo2 ◽  
Repaired Tetralogy Of Fallot

Abstract Aims The optimal timing for pulmonary valve replacement in asymptomatic patients with repaired Tetralogy of Fallot (rTOF) and pulmonary regurgitation remains uncertain but is often guided by increases in right ventricular (RV) end-diastolic volume. As cardiopulmonary exercise testing (CPET) performance is a strong prognostic indicator, we assessed which cardiovascular magnetic resonance (CMR) parameters correlate with reductions in exercise capacity to potentially improve identification of high-risk patients. Methods and results In all, 163 patients with rTOF (mean age 24.5 ± 10.2 years) who had previously undergone CMR and standardized CPET protocols were included. The indexed right and left ventricular end-diastolic volumes (RVEDVi, LVEDVi), right and left ventricular ejection fractions (RVEF, LVEF), indexed RV stroke volume (RVSVi), and pulmonary regurgitant fraction (PRF) were quantified by CMR and correlated with CPET-determined peak oxygen consumption (VO2) or peak work. On univariable analysis, there was no significant correlation between RVEDVi and PRF with peak VO2 or peak work (% Jones-predicted). In contrast, RVEF and RVSVi had significant correlations with both peak VO2 and peak work that remained significant on multivariable analysis. For a previously established prognostic peak VO2 threshold of &lt;27 mL/kg/min, receiver-operating characteristic curve analysis demonstrated a Harrell’s c of 0.70 for RVEF (95% confidence interval 0.61–0.79) with a sensitivity of 88% for RVEF &lt;40%. Conclusion In rTOF, CMR indices of RV systolic function are better predictors of CPET performance than RV size. An RVEF &lt;40% may be useful to identify prognostically significant reductions in exercise capacity in patients with varying degrees of RV dilatation.

scholarly journals Mechanisms of Exercise Capacity Improvement after Cardiac Rehabilitation Following Myocardial Infarction Assessed with Combined Stress Echocardiography and Cardiopulmonary Exercise Testing

2021 ◽  
Vol 10 (18) ◽  
pp. 4083
Author(s):  
Krzysztof Smarz ◽  
Tomasz Jaxa-Chamiec ◽  
Beata Zaborska ◽  
Maciej Tysarowski ◽  
Andrzej Budaj
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Oxygen Extraction ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2

Cardiac rehabilitation (CR) is indicated in all patients after acute myocardial infarction (AMI) to improve prognosis and exercise capacity (EC). Previous studies reported that up to a third of patients did not improve their EC after CR (non-responders). Our aim was to assess the cardiac and peripheral mechanisms of EC improvement after CR using combined exercise echocardiography and cardiopulmonary exercise testing (CPET-SE). The responders included patients with an improved EC assessed as a rise in peak oxygen uptake (VO2) ≥ 1 mL/kg/min. Peripheral oxygen extraction was calculated as arteriovenous oxygen difference (A-VO2Diff). Out of 41 patients (67% male, mean age 57.5 ± 10 years) after AMI with left ventricular ejection fraction (LVEF) ≥ 40%, 73% improved their EC. In responders, peak VO2 improved by 27% from 17.9 ± 5.2 mL/kg/min to 22.7 ± 5.1 mL/kg/min, p < 0.001, while non-responders had a non-significant 5% decrease in peak VO2. In the responder group, the peak exercise heart rate, early diastolic myocardial velocity at peak exercise, LVEF at rest and at peak exercise, and A-VO2Diff at peak exercise increased, the minute ventilation to carbon dioxide production slope decreased, but the stroke volume and cardiac index were unchanged after CR. Non-responders had no changes in assessed parameters. EC improvement after CR of patients with preserved LVEF after AMI is associated with an increased heart rate response and better peripheral oxygen extraction during exercise.

Abstract 16896: Exercise Pulmonary Capillary Wedge Pressure Patterns in Patients With Normal Resting Left-sided Filling Pressures Predict Heart Failure Outcomes

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Aaron S Eisman ◽  
Ravi V Shah ◽  
Bishnu P Dhakal ◽  
Stephanie M Meller ◽  
Paul P Pappagianopoulos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Capillary Wedge Pressure ◽  
Exercise Capacity ◽  
Exercise Testing ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Vo2 ◽  
Pulmonary Capillary ◽  
Wedge Pressure

Introduction: Serial measurements of pulmonary capillary wedge pressure (PCWP) during exercise testing may help to improve hemodynamic (HD) classification of heart failure with preserved ejection fraction (HFpEF). However, the physiologic and prognostic significance of exercise PCWP patterns is largely unknown. Hypothesis: An elevated PCWP increment relative to cardiac output (CO) augmentation during exercise will independently predict exercise capacity and outcomes in patients with dyspnea on exertion and normal resting PCWP (DOE-nlrW). Methods: In a single center cohort of 175 patients referred for cardiopulmonary exercise testing (CPET) with invasive HD monitoring (n = 33 normal controls, n = 32 HFpEF with resting PCWP ≥ 15, and n = 110 consecutive patients with DOE-nlrW and LVEF > 0.45) 1,929 PCWP-CO points during exercise were measured. Median follow-up was 3.2 years and events consisted of HF hospitalization, CV death, or future RHC with resting PCWP ≥ 15 mmHg. Results: PCWP-CO slope of 1.2±0.4 mmHg/L/min in controls was used to establish the upper limit (mean + 2SDev) of normal of 2mmHg/L/min. HFpEF patients had a PCWP-CO slope of 3.6±1.8 mmHg/L/min. In the DOE-nlrW cohort, patients achieved a mean peak VO2 of 17±6 ml/kg/min (74±19 % predicted), mean PCWP-CO was 2.1±1.3 mmHg/L/min (Figure) with 45 of 110 patients having elevated PCWP-CO. PCWP-CO but not resting PCWP was related to peak VO2 in univariable (rho = -0.51, p < 0.01) and multi-variable linear regression adjusted for age, sex, hypertension, beta blocker use, diabetes, and resting PCWP (ß = -0.17, p = 0.03). Increased PCWP-CO also predicted worse event-free survival in univariable Cox regression (HR 1.67, p < 0.01) and after adjustment for age, sex, BMI, and resting PCWP (HR 1.56, p = 0.03). Conclusions: Elevated PCWP-CO during exercise ( > 2mmHg/L/min) is common in DOE-nlrW and predicts exercise capacity as well as outcomes, suggesting that assessment of exercise HD may help to refine early HFpEF diagnosis.

P4601Reduced exercise capacity and clinical outcomes following acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Tashiro ◽  
A Tanaka ◽  
H Ishii ◽  
N Motomura ◽  
K Arai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Exercise Capacity ◽  
Cardiopulmonary Exercise Testing ◽  
Coronary Intervention ◽  
Peak Oxygen Consumption ◽  
Primary Pci ◽  
Peak Vo2

Abstract Background Reduced exercise capacity is known to be an important predictor of poor prognosis and disability in patients with cardiovascular diseases and chronic heart failure, and even members of the general population. However, data about exercise capacity assessed by cardiopulmonary exercise testing (CPX) in acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) is scarce. The purpose of this study is to assess the associated factors and clinical influence of exercise capacity measured by CPX in AMI patients. Methods Among 594 consecutive AMI patients who underwent primary PCI, we examined 136 patients (85.3% men, 64.9±11.9 years) who underwent CPX during hospitalization for AMI. CPX was usually performed five days after the onset of AMI. Reduced exercise capacity was defined as peak oxygen consumption (peak VO2) ≤12. Clinical outcomes including all-cause death, myocardial infarction, and hospitalization due to heart failure were followed. Results Among 136 patients, reduced exercise capacity (peak VO2 ≤12) was seen in 38 patients (28%). Patients with reduced exercise capacity were older, more likely to have hypertension, and had lower renal function. In echocardiography, patients with reduced exercise capacity had higher E/e' and larger left atria. Median follow-up term was 12 months (interquartile range: 9–22). The occurrence of composite endpoints of all-cause death, myocardial infarction, and hospitalization due to heart failure was significantly higher in patients with peak VO2≤12 than those with peak VO2>12 (p<0.001). Multivariate logistic analysis showed that E/e' (Odds ratio, 1.19, 95%, confidence interval 1.09 to 1.31, p<0.001) was an independent predictor of reduced exercise capacity (peak VO2≤12). Cumulative incidence of clinical events Conclusion Diastolic dysfunction is associated with reduced exercise capacity following successful primary PCI in AMI patients and may lead to poorer clinical outcomes.

scholarly journals Insights from cardiopulmonary exercise testing in pediatric patients with hypertrophic cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Gallo ◽  
V Mastromarino ◽  
G Limongelli ◽  
G Calcagni ◽  
L Ragno ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Adverse Events ◽  
Exercise Capacity ◽  
Univariate Analysis ◽  
Control Group ◽  
Cardiopulmonary Exercise ◽  
End Point ◽  
Peak Vo2

Abstract Background Hypertrophic cardiomyopathy (HCM) is characterized by extremely varied phenotypic expression ranging from asymptomatic to heart failure (HF) to sudden cardiac death (SCD). Although children with HCM are considered in the highest risk spectrum, the most common recommendations on pharmacological and non-pharmacological treatment (i.e. drugs, ICD, septal reduction procedures, inclusion in cardiac transplantation list) are often disregarded or too much postponed in this setting and strong evidence-based risk prediction models are missing. A systematic cardiopulmonary exercise test (CPET) assessment might be helpful to disclose an unsuspected functional limitation. Purpose The aim of our multicenter retrospective study was to investigate possible clinical insights, in terms of functional and prognostic assessment, coming from a full CPET assessment in a cohort of pediatric HCM outpatients aged less than 18 years old. Methods Sixty consecutive pediatric HCM outpatients aged &lt;18 years-old were enrolled, each of them undergoing a full clinical assessment including a CPET; a group of 60 healthy subjects served as controls. An unique composite end-point of HF-related and SCD or SCD-equivalent events was also explored. During a median follow-up of 53 months, a total of 13 HF- and 7 SCD-related first events were collected. Results An impaired exercise capacity, consisting on peak VO2 values &lt;80% of the predicted, has been found in the 78% of the study sample (n. 47 patients). Despite most of the HCM patients were classified in NYHA I functional class, most of them (n. 33, 73%) showed a reduced exercise capacity, the percentage of impaired exercise capacity raising in the NYHA II group (n. 14 patients, 93%). Respect to the control Group, the HCM patients showed a significantly poorer functional status in terms of maximum workload achieved, peak VO2 (regardless the adopted correction), circulatory power and VE/VCO2 slope values (Figure 1, panel A). HCM patients who experience adverse events during the follow-up (Event Group) showed the worst CPET profile (Figure 1, panel B). The composite end-point occurred more frequently in patients with the worst CPETs' profiles. At the univariate analysis, peak VO2% was the variable with the strongest association with adverse events at follow-up (C-index=0.72, p=0.025) and a cut-off value equal to 60% was the most accurate in identifying those patients at the highest risk (Figure 2). Conclusions Our findings support the role of CPET analysis as an insightful approach in the young HCM clinical management. In a group of young asymptomatic or slightly symptomatic HCM patients, the CPET allowed us to estimate accurately their functional capacity and to disclose a portion of un-recognized exercise impairment. Our data argue in favor of a possible role of some CPET-derived variables in the early identification of those young HCM patients at highest risk of HCM related events. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals 1159 Right ventricular electromechanical dyssynchrony in relation to right ventricular remodeling, dysfunction and exercise capacity in Ebstein anomaly

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Y Akazawa ◽  
T Fujioka ◽  
A Kuhn ◽  
W Hui ◽  
C Slorach ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Exercise Capacity ◽  
Ventricular Remodeling ◽  
Global Longitudinal Strain ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Intolerance ◽  
Ebstein Anomaly ◽  
Peak Vo2 ◽  
Qrs Duration ◽  
Septal Flash

Abstract Background Abnormal atrioventricular conduction and functional right ventricular (fRV) dysfunction are common in patients with Ebstein anomaly (EA). However, the relation of fRV dyssynchrony to fRV function in EA has not been studied. Purpose We hypothesized that fRV electromechanical dyssynchrony is associated with fRV remodeling, dysfunction and exercise intolerance in EA patients. Methods Non-operated EA patients and age-matched controls prospectively underwent echocardiography, cardiovascular magnetic resonance imaging (CMR) and cardiopulmonary exercise testing to quantify RV remodeling, dysfunction and exercise capacity, respectively. The relation of these to fRV dyssynchrony was investigated. RV mechanical dyssynchrony was defined by early septal activation (right-sided septal flash), RV lateral wall prestretch/late contraction, postsystolic shortening, and the maximal intra-RV delay (difference in time to peak of lateral basal RV and apical septal segments) using 2-dimensional strain echocardiography. Results Thirty-five EA patients (age 31.6 ± 17.3 years, 19 female) and 35 age-matched controls were studied. QRS duration and intra-fRV mechanical delay were significantly longer in EA compared with controls. 19/35(54%) of EA patients had early activation of septal segments with simultaneous stretching and consequent late activation and post-systolic shortening of RV lateral segments. QRS duration correlated with fRV end-diastolic (fRVEDVI, r = 0.46, P &lt;0.01) and end-systolic indexed volumes (fRVESVIr = 0.57, P &lt;0.001). Intra-fRV delay correlated with RV global longitudinal strain (GLS, r=-0.45,P &lt;0.05) and RV fractional area change (r=-0.56, P &lt;0.01). Intra-fRV delay was also associated with fRVEDVI (r = 0.43, P &lt;0.05), fRVESVI (r = 0.63, P &lt;0.001), fRVEF (r=-0.46,P &lt;0.05) and predicted peak VO2 (r=-0.39, P &lt; 0.05). EA patients with versus without a septal flash had lower fRVEF (45 ± 11 vs. 54 ± 8%, p &lt; 0.05) and predicted peak VO2 (0.71 ± 0.19 vs. 0.92 ± 0.33, p &lt; 0.05). Conclusions In EA, fRV electromechanical dyssynchrony is associated with fRV remodeling, dysfunction and impaired exercise capacity and may constitute a therapeutic target. Abstract 1159 Figure.

scholarly journals 1167 Atrial strain predicts exercise capacity in patients with the fontan circulation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J P Cordeiro Rato Mesquita Da Silva ◽  
D Martins ◽  
S Cordeiro Mendes ◽  
R Anjos
Keyword(s):  
Strain Rate ◽  
Exercise Capacity ◽  
Univariate Analysis ◽  
Continuous Variable ◽  
Fontan Circulation ◽  
P Wave ◽  
P Value ◽  
Peak Vo2 ◽  
Atrial Strain ◽  
Fontan Patients

Abstract Funding Acknowledgements None Introduction Atrial function has recently emerged as a valuable parameter, particularly for evaluation of ventricular diastolic dysfunction and heart failure. There is a strong need for reliable echocardiographic predictors of exercise capacity in univentricular hearts, but their particular anatomy makes it challenging. In this work we aimed to characterize the relationship between atrial strain and exercise parameters in the Fontan population. Methods Fontan patients followed in our outpatient clinic were prospectively evaluated with cardiopulmonary exercise test and transthoracic echocardiogram. The dominant atrium, i.e. the atrium connected to the dominant atrioventricular valve, was assessed with speckle-tracking echocardiography for active (εact), conduit (εcon), and reservoir (εres) strain; and εact/εres ratio. A single cardiac loop from the 4 chamber view was selected for this analysis and the ‘zero’ strain reference for atrial deformation analysis was set at the onset of the electrocardiogram P wave. Exercise capacity defined as the percentage of peak oxygen uptake (VO2), comparing with predicted values, was chosen as the dependent variable. Independent variables were selected among clinical and echocardiographic data. Statistical analysis was performed using SPSS version 23. T-student test was used for binomial and continuous variable correlation; single and multivariable linear regression was used for continuous variable correlation. Statistical significance was defined as p-value &lt; 0.05. Results Fifty-two Fontan patients were assessed. Nineteen (37%) were excluded due to inadequate deformation tracking of the atrial wall. Mean age was 18.0 years (SD 6.9, min. 10.0 - max. 36.0), mean age at Fontan surgery was 7.0 years (SD 2.9, min. 3.0 – max. 18.0). Peak VO2 as a percentage of the predicted value was 66.5% (SD 18.8, min. 36.4 – max. 118.6). εact was -11.1% (SD 3.7, min. -21.1 – max. -4.8), εcon was 10.6% (SD 6.5, min. -0.5 – max. 6.5), εres was 21.7% (SD 5.2, min. 13.2 – max. 34.4) and εact/εres ratio was 0.54 (SD 0.23, min. 0.22 – max. 1.04). On univariate analysis, all atrial strain variables correlated with peak VO2. After adjusting for collinearity, multivariable regression defined age (estimate -1.6, 95% CI: -2.5 to -0.9, p-value &lt; 0.001) and εact strain (estimate 1.8, 95% CI: 0.5 to 3.2, p-value = 0.011) as the strongest predictors of peak VO2 (r2= 0.479). Conclusion Peak VO2 defines exercise capacity and is a strong marker of prognosis in Fontan patients. There are very few echocardiographic variables capable of predicting it, in part due to a variable cardiac anatomy. We showed that atrial strain rate is a novel echocardiographic parameter that predicts peak VO2. In the Fontan circulation, a higher reliance on active atrial contraction for ventricular filling predicts lower exercise capacity. Therefore, atrial strain rate, whenever measurable, may provide a new method of risk stratification in this population. Abstract 1167 Figure. Example of atrial strain curve.

scholarly journals Predictors of Exercise Capacity in Patients with Hypertrophic Obstructive Cardiomyopathy

2018 ◽  
Vol 7 (11) ◽  
pp. 447 ◽  
Author(s):  
Joshua Smith ◽  
Jose Medina-Inojosa ◽  
Veronica Layrisse ◽  
Steve Ommen ◽  
Thomas Olson
Keyword(s):  
Exercise Capacity ◽  
Left Atrial ◽  
Cardiopulmonary Exercise Testing ◽  
Left Atrial Volume ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Peak Vo2 ◽  
History Of

Hypertrophic obstructive cardiomyopathy (HOCM) patients exhibit compromised peak exercise capacity (VO2peak). Importantly, severely reduced VO2peak is directly related to increased morbidity and mortality in these patients. Therefore, we sought to determine clinical predictors of VO2peak in HOCM patients. HOCM patients who performed symptom-limited cardiopulmonary exercise testing between 1995 and 2016 were included for analysis. Peak VO2 was reported as absolute peak VO2, indexed to body weight and analyzed as quartiles, with quartile 1 representing the lowest VO2peak. Step-wise regression models using demographic features and clinical and physiologic characteristics were created to determine predictors of HOCM patients with the lowest VO2peak. We included 1177 HOCM patients (age: 53 ± 14 years; BMI: 24 ± 12 kg/m2) with a VO2peak of 18.0 ± 5.6 mL/kg/min. Significant univariate predictors of the lowest VO2peak included age, female sex, New York Health Association (NYHA) class, BMI, left atrial volume index, E/e’, E/A, hemoglobin, N-terminal pro b-type natriuretic peptide (NT-proBNP), and a history of diabetes, hypertension, stroke, atrial fibrillation, or coronary artery disease. Independent predictors of the lowest VO2peak included age (OR, CI: 1.03, 1.02–1.06; p < 0.0001), women (4.66, 2.94–7.47; p = 0.001), a history of diabetes (2.05, 1.17–3.60; p = 0.01), BMI (0.94, 0.92–0.96; p < 0.0001), left atrial volume index (1.07, 1.05–1.21; p = 0.04), E/e’ (1.05, 1.01–1.08; p = 0.004), hemoglobin (0.76, 0.65–0.88; p = 0.0004), and NT-proBNP (1.72, 1.42–2.11; p < 0.0001). These findings demonstrate that demographic factors (i.e., age and sex), comorbidities (e.g., diabetes and obesity), echocardiography indices, and biomarkers (e.g., hemoglobin and NT-proBNP) are predictive of severely compromised VO2peak in HOCM patients.

scholarly journals Chronotropic Incompetence Limits Aerobic Exercise Capacity in Patients Taking Beta-Blockers

2020 ◽  
Author(s):  
Maciej Tysarowski ◽  
Krzysztof Smarz ◽  
Beata Zaborska ◽  
Ewa Pilichowska-Paszkiet ◽  
Malgorzata Sikora-Frac ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Beta Blocker ◽  
Partial Correlation ◽  
Beta Blockers ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Chronotropic Incompetence ◽  
Peak Vo2 ◽  
Aerobic Exercise Capacity ◽  
Variance Explained

Background: Chronotropic incompetence in patients taking beta-blockers is associated with poor prognosis; however, its impact on exercise capacity (EC) remains unclear. Methods: We retrospectively analyzed data from consecutive patients taking beta-blockers referred for cardiopulmonary exercise testing. EC was expressed as peak oxygen uptake (peak VO2; mL/kg/min). Chronotropic incompetence was defined as chronotropic index (CI) ≤ 62%. CI was calculated as [(HR at peak-HR at rest) / (maximum predicted HR-HR at rest)] x 100%. Results: Among 140 patients all taking beta-blockers (age 61 ± 9.7 years; 73% males), there were 113 (80.7%) patients with chronotropic incompetence. EC was lower in the group with chronotropic incompetence than the group without it, peak VO2 18.3 ± 5.7 vs. 24.0 ± 5.3 mL/kg/min, p < 0.001. In multivariate analysis EC correlated positively with CI (β = 0.14, p < 0.001) and male gender (β = 5.12, p < 0.001), and negatively with age (β = −0.17, p < 0.001) and presence of heart failure (β = −3.35, p < 0.001). Beta-blocker dose was not associated with EC. Partial correlation attributable to CI accounted for more than one-third of the variance in EC explained by the model. Conclusions: In patients taking beta-blockers, presence of chronotropic incompetence was associated with lower EC, regardless of the beta-blocker dose. CI accounted for more than one-third of EC variance explained by our model.

scholarly journals Left ventricle ejection fraction and strain derived by three-dimensional echocardiography are associated with exercise capacity in the patients with heart failure

2019 ◽  
Vol 76 (8) ◽  
pp. 779-786 ◽  
Author(s):  
Milena Pavlovic-Kleut ◽  
Aleksandra Sljivic ◽  
Vera Celic
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Capacity ◽  
Cardiopulmonary Exercise Testing ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Lv Function ◽  
Peak Vo2 ◽  
Patients With Heart Failure

Background/Aim. Echocardiography represents the most commonly performed noninvasive cardiac imaging tests for the patients with heart failure (HF). The aim of this study was to assess the relationship between the exercise capacity parameters [peak oxygen consumption (VO2) and the minute ventilation-carbon dioxide production relationship (VE/VCO2)] and the three-dimensional speckle-tracking echocardiography (3D-STE) imaging of left ventricular (LV) function in the HF patients with the reduced LV ejection fraction (LVEF). Methods. This cross-sectional study included 80 patients with diagnosed ischemic LV systolic dysfunction (LVEF < 45%) divided into subgroups based on the proposed values of analyzed cardiopulmonary exercise testing (CPET) variables: VO2 peak ? 15 mL/kg/min, VO2 peak > 15 mL/kg/min, VE/VCO2 slope < 36 and VE/VCO2 slope ? 36. All patients underwent a physical examination, laboratory testing, two-dimensional (2D) and 3DE, and CPET. Results. LVEF, global longitudinal, circumferential, radial and area strains were significantly lower in the subgroups of subjects with a peak VO2 less, or equal to 15 mL O2/kg per min and with a VE/VCO2 slope greater, or equal to 36 compared to the subgroups of subjects with a peak VO2 greater than 15 mL O2/kg per min and with a VE/VCO2 slope less than 36. There was a significantly positive correlation between the peak VO2 values and parameters of 3DE, and a significantly negative correlation between the VE/VCO2 slope values and parameters of 3DE. Conclusion. The results of this study provide further evidence that the LV function can be noninvasively and objectively measured by 3D-STE. A significant correlation between examined parameters suggests that LVEF and strain derived by 3DE are associated with exercise capacity in the patients with HF.

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