Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

Assumpção, Camila Regina Alves de; Prado, Danilo Marcelo Leite do; Jordão, Camila Paixão; Dourado, Luciana Oliveira Cascaes; Vieira, Marcelo Luiz Campos; Montenegro, Carla Giuliano de Sá Pinto; Negräo, Carlos Eduardo; Gowdak, Luís Henrique Wolff; Matos, Luciana Diniz Nagem Janot de

doi:10.1016/j.clinsp.2021.100003

Cited by 5 publications

(8 citation statements)

References 30 publications

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“…According to the different detection methods, the indexes were mainly divided into Blood pressure and ultrasound indicators (19), Blood biochemical indicators (89), Metabolic compound (166), among which Blood biochemical indicators were divided into Routine blood indicators (26), Biochemical indicators of blood lipid (9), Biochemical indicators of organs (24) and Biochemical indicators of function (30) according to different detection purposes. The 274 indicators were used to construct three sets of logistic regression models (Supplemental Table S2), aiming to screen the relevant in uencing factors of hypertension in resting state (Model-1), the in uencing factors related to normal group in resting and different exercise states (Model-2), and the in uencing factors related to hypertension group in resting and different exercise states (Model-3).…”

Section: Results and Analysismentioning

confidence: 99%

“…The inclusion criteria of the research: 1) age ≥ 18 years old; 2) ability to tolerate the acute exercise required for running on a treadmill at a speed of 7km/h for 2 minutes. Exclusion criteria [19]:1) daily habits including eating disorders, excessive drinking, pregnancy and breastfeeding; 2) diseases including previous obesity surgery, acute or severe systemic infection, severe cardiovascular diseases, malignant tumors and mental disorders.…”

Section: Normal and Hypertension Groupsmentioning

confidence: 99%

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Divergent indicator changes in different exercise states in non-hypertensive individuals and patients with hypertension

Zhang¹,

Xu²,

Gao³

et al. 2023

Preprint

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Background Hypertension is a kind of clinical syndrome, characterized by the increase of systemic arterial pressure. There is a lack of identifiable triggers and predictors of hypertensive disease in response to treatment at rest and during exercise. In this study, a mathematical model was used to screen and compare the indicators and related changes at rest and during exercise between normotensive and hypertensive individuals. Methods Blood pressure and ultrasound-related indicators, blood biochemical indicators and metabolic compounds were collected and logistic regression model and Principal component analysis (PCA) were used to explore the differences of indexes at rest and in different exercise states in healthy and hypertensive patients. An indicator change map for hypertension is established. Results The results reveal that hypertension is not only related to oxidative stress, inflammatory reaction and fatty acid oxidation, but also involves various amino acid metabolism. The defined mathematical models and indicators changes during exercise might be helpful for early screening of hypertension and future studies are needed to explore their value on prevention and control of hypertension. Conclusion The research shows that the main regulation indicators at different exercise states differ significantly in the normal group and the hypertensive group. The key indicators of the normal group are blood pressure and ultrasound related indicators, while those of the hypertensive group are metabolites related to lactic acid metabolism, glycolysis, aerobic oxidation and lipid metabolism.

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Section: Results and Analysismentioning

confidence: 99%

Section: Normal and Hypertension Groupsmentioning

confidence: 99%

Divergent indicator changes in different exercise states in non-hypertensive individuals and patients with hypertension

Zhang¹,

Xu²,

Gao³

et al. 2023

Preprint

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“…Cardiopulmonary exercise testing (CPET) allows for the non-invasive, objective quantification of cardiopulmonary fitness, and is thus held as the 'gold standard' methodology for evaluating functional capacity [1,2]. In contrast to more traditional assessments, such as ECG stress testing and the 6-minute walk test, CPET makes it possible to determine the potential pathophysiological mechanisms underlying exercise intolerance [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…The utility of CPET as a diagnostic and prognostic tool in the evaluation of patients with coronary artery disease (CAD) and heart failure has received some attention [1][2][3][4][5]. In particular, an early plateau or inflection in the normal linear progression of oxygen pulse (O 2 Pulse) and oxygen consumption (VO 2 ) despite an increasing work-rate (WR) are suggested to be indicative of inducible and reversable ischaemia [2,4,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…In particular, an early plateau or inflection in the normal linear progression of oxygen pulse (O 2 Pulse) and oxygen consumption (VO 2 ) despite an increasing work-rate (WR) are suggested to be indicative of inducible and reversable ischaemia [2,4,[6][7][8][9]. In principle, O 2 Pulse reflects left ventricular stroke volume (SV) (and arteriovenous oxygen difference) [1,4]. Consequently, a plateau or inflection in O 2 Pulse, despite increasing WR suggests a pathological impairment of stroke volume, possibly caused by myocardial ischaemia [1,2,4].…”

Section: Introductionmentioning

confidence: 99%

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Inter- and intra-observer reliability and agreement of O2Pulse inflection during cardiopulmonary exercise testing: A comparison of subjective and novel objective methodology

Nickolay,

McGregor,

Powell

et al. 2024

PLoS ONE

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Cardiopulmonary exercise testing (CPET) is the ‘gold standard’ method for evaluating functional capacity, with oxygen pulse (O2Pulse) inflections serving as a potential indicator of myocardial ischaemia. However, the reliability and agreement of identifying these inflections have not been thoroughly investigated. This study aimed to assess the inter- and intra-observer reliability and agreement of a subjective quantification method for identifying O2Pulse inflections during CPET, and to propose a more robust and objective novel algorithm as an alternative methodology. A retrospective analysis was conducted using baseline data from the HIIT or MISS UK trial. The O2Pulse curves were visually inspected by two independent examiners, and compared against an objective algorithm. Fleiss’ Kappa was used to determine the reliability of agreement between the three groups of observations. The results showed almost perfect agreement between the algorithm and both examiners, with a Fleiss’ Kappa statistic of 0.89. The algorithm also demonstrated excellent inter-rater reliability (ICC) when compared to both examiners (0.92–0.98). However, a significant level (P ≤0.05) of systematic bias was observed in Bland-Altman analysis for comparisons involving the novice examiner. In conclusion, this study provides evidence for the reliability of both subjective and novel objective methods for identifying inflections in O2Pulse during CPET. These findings suggest that further research into the clinical significance of O2Pulse inflections is warranted, and that the adoption of a novel objective means of quantification may be preferable to ensure equality of outcome for patients.

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The evolving role of cardiopulmonary exercise testing in ischemic heart disease – state of the art review

Chaudhry,

Kumar,

Arena

et al. 2023

Current Opinion in Cardiology

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Purpose of review Cardiopulmonary exercise testing (CPET) is the gold standard for directly assessing cardiorespiratory fitness (CRF) and has a relatively new and evolving role in evaluating atherosclerotic heart disease, particularly in detecting cardiac dysfunction caused by ischemic heart disease. The purpose of this review is to assess the current literature on the link between cardiovascular (CV) risk factors, cardiac dysfunction and CRF assessed by CPET. Recent findings We summarize the basics of exercise physiology and the key determinants of CRF. Prognostically, several studies have been published relating directly measured CRF by CPET and outcomes allowing for more precise risk assessment. Diagnostically, this review describes in detail what is considered healthy and abnormal cardiac function assessed by CPET. New studies demonstrate that cardiac dysfunction on CPET is a common finding in asymptomatic individuals and is associated with CV risk factors and lower CRF. This review covers how key CPET parameters change as individuals transition from the asymptomatic to the symptomatic stage with progressively decreasing CRF. Finally, a supplement with case studies with long-term longitudinal data demonstrating how CPET can be used in daily clinical decision making is presented. Summary In summary, CPET is a powerful tool to provide individualized CV risk assessment, monitor the effectiveness of therapeutic interventions, and provide meaningful feedback to help patients guide their path to improve CRF when routinely used in the outpatient setting.

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Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

Cited by 5 publications

References 30 publications

Divergent indicator changes in different exercise states in non-hypertensive individuals and patients with hypertension

Divergent indicator changes in different exercise states in non-hypertensive individuals and patients with hypertension

Inter- and intra-observer reliability and agreement of O2Pulse inflection during cardiopulmonary exercise testing: A comparison of subjective and novel objective methodology

The evolving role of cardiopulmonary exercise testing in ischemic heart disease – state of the art review

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