Ischemic etiology of heart failure identifies patients with more severely impaired exercise capacity

Feo, Stefania De; Franceschini, Lorenzo; Brighetti, Giovanna; Cicoira, Mariantonietta; Zanolla, Luisa; Rossi, Andrea; Golia, Giorgio; Zardini, Piero

doi:10.1016/j.ijcard.2004.10.037

Cited by 25 publications

(15 citation statements)

References 17 publications

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“…Therefore, a prospective study is necessary to confirm the current findings and to establish clinical recommendations. In this study, several patient and disease characteristics, as well as comorbities, were associated with early PA. A significant effect of age and NYHA functional class on 6-minute walking distances 30 and cardiorespiratory fitness, 31 as well as a detrimental effect of raised jugular venous pressure on PA, is described. 30 The decline of cardiorespiratory fitness with age 32 likely increases exercise-induced symptoms of fatigue and dyspnea in patients with HF.…”

Section: Discussionmentioning

confidence: 95%

“…38 Patients with ischemic cause, compared with those with nonischemic cause, demonstrate lower peak oxygen uptake and a steeper VE/VCO 2 slope. 31 Impaired PA may result from chronotropic incompetence, exercise-induced myocardial ischemia, and mitral regurgitation. 39 Treatment with an ACE inhibitor improves exercise duration 40 as well as peak aerobic capacity.…”

Section: Discussionmentioning

confidence: 99%

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Physical Activity Measured With Implanted Devices Predicts Patient Outcome in Chronic Heart Failure

Conraads

Spruit

Braunschweig

et al. 2014

Circ: Heart Failure

106

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Background— Physical activity (PA) predicts cardiovascular mortality in the population at large. Less is known about its prognostic value in patients with chronic heart failure (HF). Methods and Results— Data from 836 patients with implantable cardioverter defibrillator without or with cardiac resynchronization therapy enrolled in the Sensitivity of the InSync Sentry OptiVol feature for the prediction of Heart Failure (SENSE-HF) 1 study and the Diagnostic Outcome Trial in Heart Failure (DOT-HF) were pooled. The devices continuously measured and stored total daily active time (single-axis accelerometer). Early PA (average daily activity over the earliest 30-day study period) was studied as a predictor of time to death or HF-related hospital admission (primary end point). Data from 781 patients were analyzed (65±10 years; 85% men; left ventricular ejection fraction, 26±7%). Older age, shorter height, ischemic cause, peripheral artery disease, atrial fibrillation, diabetes mellitus, rales, peripheral edema, higher New York Heart Association class, lower diastolic blood pressure, and no angiotensin II receptor blocker/angiotensin-converting enzyme inhibitor use were associated with reduced early PA. The primary end point occurred in 135 patients (15±7 months of follow-up). In multivariable analysis including baseline variables, early PA predicted death or HF hospitalization, with a 4% reduction in risk for each 10 minutes per day additional activity (hazard ratio [HR], 0.96; confidence interval [CI], 0.94–0.98; P =0.0002 compared with a model with the same baseline variables but without PA). PA also predicted death (HR, 0.93; CI, 0.90–0.96; P <0.0001) and HF hospitalization (HR, 0.97; CI, 0.95–0.99; P =0.011). Conclusions— Early PA, averaged over a 30-day window early after defibrillator implantation or cardiac resynchronization therapy in patients with chronic HF, predicted death or HF hospitalization, as well as mortality and HF hospitalization separately, accounting for baseline HF severity. Clinical Trial Registration Information— URL: http://www.clinicaltrials.gov . Unique identifiers: NCT00400985, NCT00480077.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Physical Activity Measured With Implanted Devices Predicts Patient Outcome in Chronic Heart Failure

Conraads

Spruit

Braunschweig

et al. 2014

Circ: Heart Failure

106

View full text Add to dashboard Cite

show abstract

“…A comprehensive assessment of all potentially valuable CPET variables in the diagnosis of exerciseinduced myocardial ischemia is very important [5]. The ventilatory response evaluation by the linear regression slope of the minute ventilation (VE) and the carbon dioxide production (VCO 2 ) (VE/VCO 2 ) during a CPET is of great interest in heart failure [6,7].…”

mentioning

confidence: 99%

Myocardial perfusion defects detected by cardiopulmonary exercise testing: Role of VE/VCO2 slope in patients with chest pain suspected of coronary artery disease

Abreu-González

Gómez

García-Baute

et al. 2012

International Journal of Cardiology

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“…A 'normal' LVEF in the setting of chronic MR and dilated LV is associated with a progressive deterioration of VVC and impaired forward stroke work [8]. VV uncoupling may be worse among ischemic than non-ischemic heart failure patients [26].…”

Section: Discussionmentioning

confidence: 99%

Relation of ventricular-vascular coupling to exercise capacity in ischemic cardiomyopathy: a cardiac multi-modality imaging study

Wong

Dumont

Austin

et al. 2009

Int J Cardiovasc Imaging

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The purpose of this study was to examine the relationship between noninvasive measurements of ventricular-vascular coupling (VVC) with exercise tolerance, and compared the value of VVC versus other traditional determinants of exercise capacity in this population. 43 patients with ischemic CMP (age 59 +/- 9 years, mean EF 24 +/- 8%) underwent cardiopulmonary exercise testing, echocardiography and cardiac magnetic resonance (CMR). VVC was defined non-invasively by the ratio of ventricular systolic elastance (Ees) to the arterial elastance (Ea), where Ees = end-systolic pressure/end-systolic volume index and Ea = end-systolic pressure/stroke volume index. VVC significantly correlated with baseline heart rate (HR), peak exercise systolic blood pressure, maximum oxygen consumption (MVO(2)) and peak O(2) pulse (MVO(2)/HR). A higher VVC was associated with higher LVEF and RVEF but showed inverse relation to mitral E wave velocity. Univariate predictors of MVO(2) are baseline HR, chronotropic reserve, VVC and aortic distensibility; whilst mitral E wave velocity, LVEF, VVC, Ees significantly correlated with peak O(2) pulse. By stepwise multivariate analysis, VVC remained the only independent predictor of peak O(2) pulse. Ventricular-vascular coupling at rest may be a clinically important parameter in predicting exercise capacity in patients with advanced heart failure, and may become an additional target for therapeutic interventions.

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Ischemic etiology of heart failure identifies patients with more severely impaired exercise capacity

Cited by 25 publications

References 17 publications

Physical Activity Measured With Implanted Devices Predicts Patient Outcome in Chronic Heart Failure

Physical Activity Measured With Implanted Devices Predicts Patient Outcome in Chronic Heart Failure

Myocardial perfusion defects detected by cardiopulmonary exercise testing: Role of VE/VCO2 slope in patients with chest pain suspected of coronary artery disease

Relation of ventricular-vascular coupling to exercise capacity in ischemic cardiomyopathy: a cardiac multi-modality imaging study

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