Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death

Gitt, Anselm K.; Wasserman, Karlman; Kilkowski, Caroline; Kleemann, Thomas; Kilkowski, Andreas; Bangert, Matthias; Schneider, Steffen; Schwarz, Anne-Catherine; Senges, Jochen

doi:10.1161/01.cir.0000041428.99427.06

Cited by 418 publications

(155 citation statements)

References 25 publications

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“…Impaired physical capacity in young patients with ADPKD could be explained by underlying endothelial dysfunction, which could depend on inadequate response of nitric oxide, asymmetric dimethylarginine, and BP to acute exercise [36, 61]. Several studies have identified V’E/V’CO 2 , anaerobic threshold, and V’O 2max as prognostic factors in cardiovascular diseases [62-63]. We found, also, a significant increase of cTnT in ADPKD patients, a sensitive and specific marker of ischemic myocardial damage, renally cleared, and widely used as a predictor of cardiovascular events [53].…”

Section: Discussionmentioning

confidence: 99%

Early Markers of Cardiovascular Risk in Autosomal Dominant Polycystic Kidney Disease

Lai

Mastroluca

Matino

et al. 2017

Kidney Blood Press Res

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Background/Aims: Cardiovascular disease is the most frequent cause of morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD) patients, often before the onset of renal failure, and the pathogenetic mechanism is not yet well elucidated. The aim of the study was to identify early and noninvasive markers of cardiovascular risk in young ADPKD patients, in the early stages of disease. Methods: A total of 26 patients with ADPKD and 24 control group, matched for age and sex, were enrolled, and we have assessed inflammatory indexes, mineral metabolism, metabolic state and markers of atherosclerosis and endothelial dysfunction (carotid intima media thickness (IMT), ankle brachial index (ABI), flow mediated dilation (FMD), renal resistive index (RRI), left ventricular mass index (LVMI)) and cardiopulmonary exercise testing (CPET), maximal O₂ uptake (V’O₂max), and O₂ uptake at lactic acid threshold (V’O₂@LT). Results: The ADPKD patients compared to control group, showed a significant higher mean value of LVMI, RRI, homocysteine (Hcy), Homeostasis Model Assessment-insulin resistance (HOMA-IR), serum uric acid (SUA), Cardiac-troponinT (cTnT) and intact parathyroid hormone (iPTH) (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.007, p=0.019; respectively), and a lower value of FMD and 25-hydroxyvitaminD (25-OH-VitD) (p<0.001, p<0.001) with reduced parameters of exercise tolerance, as V’O₂max, V’O₂max/Kg and V’O₂max (% predicted) (p<0.001, p<0.001, p=0.018; respectively), and metabolic response indexes (V’O₂@LT, V’O₂ @LT%, V’O₂@LT/Kg,) (p<0.001, p=0.14, p<0.001; respectively). Moreover, inflammatory indexes were significantly higher in ADPKD patients, and we found a positive correlation between HOMA-IR and C-reactive protein (CRP) (r=0.507, p=0.008), and a negative correlation between HOMA-IR and 25-OH-VitD (r=-0.585, p=0.002). Conclusion: In our study, ADPKD patients, in the early stages of disease, showed a greater insulin resistance, endothelial dysfunction, inflammation and mineral metabolism disorders, respect to control group. Moreover, these patients presented reduced tolerance to stress, and decreased anaerobic threshold to CPET. Our results indicate a major and early cardiovascular risk in ADPKD patients. Therefore early and noninvasive markers of cardiovascular risk and CPET should be carried out, in ADPKD patients, in the early stages of disease, despite the cost implication.

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Section: Discussionmentioning

confidence: 99%

Early Markers of Cardiovascular Risk in Autosomal Dominant Polycystic Kidney Disease

Lai

Mastroluca

Matino

et al. 2017

Kidney Blood Press Res

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“…Such exercise protocols elicit non-linear changes or 'thresholds' in gas-exchange and ventilatory parameters prior to exhaustion. The first and second gas-exchange thresholds (G EX 1 and G EX 2 ) obtained during incremental work are widely used in: (1) research to demarcate exercise-intensity domains (Carter et al 2002;Cross et al 2010;Jones and Poole 2005); (2) the design of athletic training programmes (Carter et al 2000;Yoshida et al 1982); and (3) to provide prognostic value for clinical populations (Chase et al 2010;Gitt et al 2002;Wasserman et al 2005). The G EX 1 and G EX 2 are characterised by disproportionate increases in expired minute ventilation _ V E with respect to _ V O 2 and CO 2 production ( _ V CO 2 ) during incremental exercise, respectively (Beaver et al 1986;Wasserman et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Evidence of break-points in breathing pattern at the gas-exchange thresholds during incremental cycling in young, healthy subjects

et al. 2011

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The present study investigated whether 'break-points' in breathing pattern correspond to the first ([Formula: see text]) and second gas-exchange thresholds ([Formula: see text]) during incremental cycling. We used polynomial spline smoothing to detect accelerations and decelerations in pulmonary gas-exchange data, which provided an objective means of 'break-point' detection without assumption of the number and shape of said 'break-points'. Twenty-eight recreational cyclists completed the study, with five individuals excluded from analyses due to low signal-to-noise ratios and/or high risk of 'pseudo-threshold' detection. In the remaining participants (n = 23), two separate and distinct accelerations in respiratory frequency (f (R)) during incremental work were observed, both of which demonstrated trivial biases and reasonably small ±95% limits of agreement (LOA) for the [Formula: see text] (0.2 ± 3.0 ml O(2) kg(-1) min(-1)) and [Formula: see text] (0.0 ± 2.4 ml O(2) kg(-1) min(-1)), respectively. A plateau in tidal volume (V (T)) data near the [Formula: see text] was identified in only 14 individuals, and yielded the most unsatisfactory mean bias ±LOA of all comparisons made (-0.4 ± 5.3 ml O(2) kg(-1) min(-1)). Conversely, 18 individuals displayed V (T)-plateau in close proximity to the [Formula: see text] evidenced by a mean bias ± LOA of 0.1 ± 3.1 ml O(2) kg(-1) min(-1). Our findings suggest that both accelerations in f (R) correspond to the gas-exchange thresholds, and a plateau (or decline) in V (T) at the [Formula: see text] is a common (but not universal) feature of the breathing pattern response to incremental cycling.

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“…Indexes reflecting the chemoreceptor stimulation also correlate with the VE/VCO 2 slope. Interestingly, this parameter has shown a high prognostic value in CHF patients [45,46].…”

Section: Abnormalities Of the Ventilatory Responsementioning

confidence: 98%

Physiology of the abnormal response of heart failure patients to exercise

Cohen‐Solal

Beauvais²,

Tabet³

2004

Curr Cardiol Rep

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Chronic heart failure is associated with reduced exercise capacity. Altered diastolic function and reduced chronotropic response play an important role. However, there is no clear correlation between any hemodynamic parameter and exercise capacity. Peripheral factors, long overlooked, seem to play a major role. Altered peripheral vasodilatation, involving endothelial abnormalities, alters the optimal distribution of blood flow. Muscular abnormalities are constant: aside from muscle atrophy, altered muscle metabolism results in an altered utilization of oxygen. A comprehensive understanding of all these determinants of exercise response is important to optimize the care of the patient. Sole improvement of cardiac function may be insufficient to correct their exercise intolerance; regular training may well have beneficial effects on exercise capacity, functional impairment, and quality of life.

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Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death

Cited by 418 publications

References 25 publications

Early Markers of Cardiovascular Risk in Autosomal Dominant Polycystic Kidney Disease

Early Markers of Cardiovascular Risk in Autosomal Dominant Polycystic Kidney Disease

Evidence of break-points in breathing pattern at the gas-exchange thresholds during incremental cycling in young, healthy subjects

Physiology of the abnormal response of heart failure patients to exercise

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