Left Ventricular Ejection Fraction During Supine and Upright Exercise in Patients With Systemic Hypertension and Its Relation to Peak Filling Rale

Schulman, Douglas S.; Tugoen, John F.; Flores, Angel R.; Dianzumba, Sinda; Reichek, Nathaniel

doi:10.1016/s0002-9149(99)80802-9

Cited by 12 publications

(4 citation statements)

References 31 publications

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“…Previous studies have identified higher blood pressure and LV hypertrophy as determinants of impaired exercise capacity in hypertensive patients (4)(5)(6)(7)(8)24). From this, increased exercise capacity would be expected following LV hypertrophy regression induced by antihypertensive therapy (25).…”

Section: Discussionmentioning

confidence: 98%

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Exercise performance during losartan‐ or atenolol‐based treatment in hypertensive patients with electrocardiographic left ventricular hypertrophy (a LIFE substudy)

et al. 2006

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The objective of the study was to assess the influence of left ventricular (LV) hypertrophy regression on exercise capacity in hypertensive patients. Doppler echocardiography was performed at rest and during exercise in 51 patients with electrocardiographic LV hypertrophy before and after 1 year of randomized blinded losartan- or atenolol-based antihypertensive treatment. After 1 year, blood pressure was comparably reduced by 32/14 and 27/13 mmHg, respectively, in the losartan and atenolol groups, but the atenolol group had higher mean LV mass index (118 vs 103 g/m2) and lower LV ejection fraction (61% vs 67%) and midwall shortening (15.8% vs 16.8%) (all p<0.05). Resting diastolic Doppler indices remained unchanged and did not differ between the groups. Peak oxygen uptake during exercise was virtually unchanged after 1 year and did not differ between the groups in spite of a lower peak exercise heart rate in atenolol-treated patients. In multivariate analysis, higher peak oxygen uptake at 1 year was associated with lower body mass index, and higher systolic blood pressure and shorter isovolumic relaxation time at peak exercise (multiple R2 = 0.51, p<0.01), while age, gender, heart rate increase during exercise, reduction in LV mass and study treatment did not enter. In conclusion, reduction in blood pressure and LV mass induced by losartan or atenolol treatment was not accompanied by improved exercise capacity after 1 year. The results may be explained by persistent impairment of myocardial relaxation influencing exercise capacity.

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Section: Discussionmentioning

confidence: 98%

“…Blood pressure and LV mass and function independently influence exercise capacity in these patients (4)(5)(6)(7)(8). In particular, associations of diastolic relaxation and LV filling with exercise performance have been demonstrated in hypertensive patients with LV hypertrophy (9,10).…”

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confidence: 99%

Exercise performance during losartan‐ or atenolol‐based treatment in hypertensive patients with electrocardiographic left ventricular hypertrophy (a LIFE substudy)

et al. 2006

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“…In healthy individuals, although cardiac output increases in the supine exercise due to an increased preload and stroke volume (16-20), there is also reduced blood ow to the leg muscles (21), resulting in reduced muscle oxygen uptake, more profound muscle deoxygenation (22), and a lower anaerobic threshold (21) compared to the upright exercise. In patients with comorbidities, supine exercise has generally been found to worsen physiologic parameters compared to upright exercise, including a drop in forced vital capacity (23) and alveolar ventilation (with an increase in partial pressure of end tidal CO 2 ) (24) in patients with chronic obstructive pulmonary disease (COPD), a failure to increase left ventricular ejection fraction in patients with hypertension (25), and ST segment depression possibly indicating a lower ischemic threshold in patients with coronary artery disease (26). However, positional effects on exercise in patients with HPS, and the unique impact of orthodeoxia have not been reported.…”

Section: Study Rationale and Purposementioning

confidence: 99%

Supine Versus Upright Exercise in Patients With Hepatopulmonary Syndrome and Orthodeoxia: Study Protocol for a Randomized Controlled Crossover Trial

Parikh

Lui

Faughnan

et al. 2021

Preprint

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Background: The hepatopulmonary syndrome (HPS) is a pulmonary complication of liver disease found in 10 to 32% of patients with cirrhosis and characterized by intrapulmonary vascular dilatations and abnormal oxygenation. Liver transplantation is the only effective therapy for this disease. Patients with HPS have significant exercise limitation, impacting their quality of life and associated with poor liver transplant outcomes. Many patients with HPS exhibit orthodeoxia – an improvement in oxygenation in the supine compared to the upright position. We hypothesize that exercise capacity will be superior in the supine compared to the upright position in such patients.Methods: We propose a randomized controlled cross-over trial in patients with HPS and orthodeoxia, comparing the effect of supine versus upright position on exercise. Participants will be randomized to cycle ergometry in either the supine or upright position, followed by a crossover to the alternate position after a minimum of 1 day to a maximum of 4 weeks. Exercise will be performed at a constant work rate of 70-85% of the predicted peak work rate until the “stopping time” is reached, defined by exhaustion, profound desaturation, or safety concerns (drop in systolic blood pressure or life-threatening arrhythmia). The primary outcome will be the difference in stopping time between exercise positions.Discussion: HPS patients have hypoxemia leading to significant exercise limitation. If our study is positive, a supine exercise regimen could become a routine prescription for patients with HPS and orthodeoxia, enabling them to exercise more effectively. Future studies could explore the corresponding effects of a supine exercise training regimen on physiologic variables such as long-term exercise capacity, quality of life, dyspnea, and liver transplantation outcomes. Trial registration: The ClinicalTrials.gov Protocol Registration and Results System (PRS): NCT04004104. Registered on 1st July 2019. https://clinicaltrials.gov/ct2/show/NCT04004104

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“…In healthy individuals, although cardiac output increases in the supine exercise due to an increased preload and stroke volume [ 16 – 18 ], there is also reduced blood flow to the leg muscles [ 19 ], resulting in reduced muscle oxygen uptake, more profound muscle deoxygenation [ 20 ], and a lower anaerobic threshold [ 19 ] compared to the upright exercise. In patients with comorbidities, supine exercise has generally been found to worsen physiologic parameters compared to upright exercise, including a drop in alveolar ventilation (with an increase in partial pressure of end tidal CO 2 ) [ 21 ] in patients with chronic obstructive pulmonary disease (COPD), a failure to increase left ventricular ejection fraction in patients with hypertension [ 22 ], and ST segment depression possibly indicating a lower ischemic threshold in patients with coronary artery disease [ 23 ]. However, positional effects on exercise in patients with HPS, and the unique impact of orthodeoxia have not been reported.…”

Section: Introductionmentioning

confidence: 99%

Supine vs upright exercise in patients with hepatopulmonary syndrome and orthodeoxia: study protocol for a randomized controlled crossover trial

H.N.Parikh

Lui

Faughnan

et al. 2021

Trials

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Background The hepatopulmonary syndrome (HPS) is a pulmonary complication of liver disease found in 10 to 32% of patients with cirrhosis and is characterized by intrapulmonary vascular dilatations and abnormal oxygenation. Liver transplantation is the only effective therapy for this disease. Patients with HPS have significant exercise limitations, impacting their quality of life and associated with poor liver transplant outcomes. Many patients with HPS exhibit orthodeoxia—an improvement in oxygenation in the supine compared to the upright position. We hypothesize that exercise capacity will be superior in the supine compared to the upright position in such patients. Methods We propose a randomized controlled crossover trial in patients with moderate HPS (PaO2 < 80 mmHg) and orthodeoxia (supine to upright PaO2 decrease > 4 mmHg) comparing the effect of supine vs upright position on exercise. Patients with pulmonary hypertension, FEV1/FVC ratio < 0.65, significant coronary artery disease, disorders preventing or contraindicating use of a cycle ergometer, and/or moderate or severe ascites will be excluded. Participants will be randomized to cycle ergometry in either the supine or upright position. After a short washout period (a minimum of 1 day to a maximum of 4 weeks), participants will crossover and perform an exercise in the alternate position. Exercise will be performed at a constant work rate of 70–85% of the predicted peak work rate until the “stopping time” is reached, defined by exhaustion, profound desaturation, or safety concerns (drop in systolic blood pressure or life-threatening arrhythmia). The primary outcome will be the difference in the stopping time between exercise positions, compared with a repeated measures analysis of variance method with a mixed effects model approach. The model will be adjusted for period effects. P < 0.05 will be considered statistically significant. Discussion HPS patients have hypoxemia leading to significant exercise limitations. If our study is positive, a supine exercise regimen could become a routine prescription for patients with HPS and orthodeoxia, enabling them to exercise more effectively. Future studies could explore the corresponding effects of a supine exercise training regimen on physiologic variables such as long-term exercise capacity, quality of life, dyspnea, and liver transplantation outcomes. Trial registration ClinicalTrials.gov Protocol Registration and Results System (PRS) NCT04004104. Registered on 1 July 2019

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Left Ventricular Ejection Fraction During Supine and Upright Exercise in Patients With Systemic Hypertension and Its Relation to Peak Filling Rale

Cited by 12 publications

References 31 publications

Exercise performance during losartan‐ or atenolol‐based treatment in hypertensive patients with electrocardiographic left ventricular hypertrophy (a LIFE substudy)

Exercise performance during losartan‐ or atenolol‐based treatment in hypertensive patients with electrocardiographic left ventricular hypertrophy (a LIFE substudy)

Supine Versus Upright Exercise in Patients With Hepatopulmonary Syndrome and Orthodeoxia: Study Protocol for a Randomized Controlled Crossover Trial

Supine vs upright exercise in patients with hepatopulmonary syndrome and orthodeoxia: study protocol for a randomized controlled crossover trial

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