Oxygen Uptake During Activities of Daily Life in Patients Treated With a Left Ventricular Assist Device

Mirza, Kiran K; Bonne, Thomas Christian; Nordsborg, Nikolai Baastrup; Rossing, Kasper; Boesgaard, S.; Gustafsson, Finn

doi:10.1016/j.healun.2022.03.009

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Surprisingly, for patients with more advanced HF, some mundane activities such as making a bed could result in a supramaximal exercise from a metabolic point of view, as evidenced by a complete erosion of the so termed ‘VO 2 reserve’ (defined as the difference between peak VO 2 reached by the subject during a maximal CPET and the VO 2 he achieves during the activity). These experimental findings were also confirmed in a population of LVAD carriers 18 and similarly, in a recent report by Mapelli et al 19 we showed that VO 2 measured during 6MWT is frequently higher that peak VO 2 achieved by a ramp exercise protocol particularly in patients with peak VO 2 < 12 mL/min/kg ( Figure 4 ) showing that 6MWT can be a maximal and even supra maximal exercise test.…”

supporting

confidence: 85%

“…With this regards, different wearable ergo-spirometers have been developed during the last decades and used to allow an accurate metabolic data collection during different activities, able to reproduce HF patients’ everyday life. 17 , 18 In brief, with this method daily activities can be divided in three different groups: (1) activities where exercise time and work intensity are both variable and self-adjusted (i.e. climbing a stair at the patient’s own pace); (2) activities with fixed execution time but variable intensity (i.e.…”

mentioning

confidence: 99%

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Cardiopulmonary exercise testing and heart failure: a tale born from oxygen uptake

Mapelli

Salvioni

Mattavelli

et al. 2023

European Heart Journal Supplements

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Since 50 years, cardiopulmonary exercise testing (CPET) plays a central role in heart failure (HF) assessment. Oxygen uptake (VO2) is one of the main HF prognostic indicators, then paralleled by ventilation to carbon dioxide (VE/VCO2) relationship slope. Also anaerobic threshold retains a strong prognostic power in severe HF, especially if expressed as a percent of maximal VO2 predicted value. Moving beyond its absolute value, a modern approach is to consider the percentage of predicted value for peak VO2 and VE/VCO2 slope, thus allowing a better comparison between genders, ages, and races. Several VO2 equations have been adopted to predict peak VO2, built considering different populations. A step forward was made possible by the introduction of reliable non-invasive methods able to calculate cardiac output during exercise: the inert gas rebreathing method and the thoracic electrical bioimpedance. These techniques made possible to calculate the artero-venous oxygen content differences (ΔC(a-v)O2), a value related to haemoglobin concentration, pO2, muscle perfusion, and oxygen extraction. The role of haemoglobin, frequently neglected, is however essential being anaemia a frequent HF comorbidity. Finally, peak VO2 is traditionally obtained in a laboratory setting while performing a standardized physical effort. Recently, different wearable ergo-spirometers have been developed to allow an accurate metabolic data collection during different activities that better reproduce HF patients’ everyday life. The evaluation of exercise performance is now part of the holistic approach to the HF syndrome, with the inclusion of CPET data into multiparametric prognostic scores, such as the MECKI score.

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confidence: 85%

mentioning

confidence: 99%

Cardiopulmonary exercise testing and heart failure: a tale born from oxygen uptake

Mapelli

Salvioni

Mattavelli

et al. 2023

European Heart Journal Supplements

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“…On average 6MWT-V ˙O2 can elicit 75.3 ± 33.8% of the CPET V ˙O2 , but this ratio can be extremely variable depending on the population considered. In fact, as previously described in three recent trials, [6][7][8] the more severe the patient with HF, the more they consume their 'V ˙O2 reserve', going so far as to erode it in 42% of cases in patients with CPET V ˙O2 below 12 mL/kg/min. Interestingly, LVAD carriers showed metabolic behaviour similar to the one of their non-LVAD HF patients counterpart since, with an exercise capacity similar to the one of severe HF patients (peakV ˙O2 14.9 mL/kg/min, 53.8% of the predicted, and V ˙E/V ˙CO 2 slope 38.6) their 6MWT-V ˙O2 corresponds to 95.9% of CPET V ˙O2 , a value similar to the one of 'moderate' HF subjects (see Table 1, Group 2).…”

Section: Discussionmentioning

confidence: 76%

“…However, this is not the case being 6MWT affected not only by CPET determinants such as respiratory, circulatory, and metabolic functions, but also by lower limb muscle strength and balance ability. 4 , 5 In any case, the 6MWT is generally considered a submaximal (and therefore safer) test, recent trials 6 , 7 , 8 demonstrated how daily‐life activities, including a brisk walk, represent maximal exercises from a metabolic point of view for many HF patients. 9 This is particularly evident for the most severe patients, in which the V̇O 2 measured during 6MWT exceed the peakV̇O 2 in almost half of the cases.…”

Section: Introductionmentioning

confidence: 99%

Taking a walk on the heart failure side: comparison of metabolic variables during walking and maximal exertion

Mapelli,

Salvioni,

Bonomi

et al. 2024

ESC Heart Failure

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AimsAlthough cardiopulmonary exercise testing (CPET) is the gold standard to assess exercise capacity, simpler tests (i.e., 6‐min walk test, 6MWT) are also commonly used. The aim of this study was to evaluate the relationship between cardiorespiratory parameters during CPET and 6MWT in a large, multicentre, heterogeneous population.MethodsWe included athletes, healthy subjects, and heart failure (HF) patients of different severity, including left ventricular assist device (LVAD) carriers, who underwent both CPET and 6MWT with oxygen consumption measurement.ResultsWe enrolled 186 subjects (16 athletes, 40 healthy, 115 non‐LVAD HF patients, and 15 LVAD carriers). CPET‐peakV̇O2 was 41.0 [35.0–45.8], 26.2 [23.1–31.0], 12.8 [11.1–15.3], and 15.2 [13.6–15.6] ml/Kg/min in athletes, healthy, HF patients, and LVAD carriers, respectively (P < 0.001). During 6MWT they used 63.5 [56.3–76.8], 72.0 [57.8–81.0], 95.5 [80.3–109], and 95.0 [92.0–99.0] % of their peakV̇O2, respectively. None of the athletes, 1 healthy (2.5%), 30 HF patients (26.1%), and 1 LVAD carrier (6.7%), reached a 6MWT‐V̇O2 higher than their CPET‐peakV̇O2. Both 6MWT‐V̇O2 and walked distance were significantly associated with CPET‐peakV̇O2 in the whole population (R2 = 0.637 and R2 = 0.533, P ≤ 0.001) but not in the sub‐groups. This was confirmed after adjustment for groups.ConclusionsThe 6MWT can be a maximal effort especially in most severe HF patients and suggest that, in absence of prognostic studies related to 6MWT metabolic values, CPET should remain the first method of choice in the functional assessment of patients with HF as well as in sport medicine.

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The Pulmonary Hypertension Treatment: Dogmas and Ghosts

Agostoni,

Mattavelli

2023

The American Journal of Cardiology

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Oxygen Uptake During Activities of Daily Life in Patients Treated With a Left Ventricular Assist Device

Cited by 6 publications

References 24 publications

Cardiopulmonary exercise testing and heart failure: a tale born from oxygen uptake

Cardiopulmonary exercise testing and heart failure: a tale born from oxygen uptake

Taking a walk on the heart failure side: comparison of metabolic variables during walking and maximal exertion

The Pulmonary Hypertension Treatment: Dogmas and Ghosts

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