The interactions between respiratory and cardiovascular systems in systolic heart failure

Cross, Troy J.; Kim, Chul Ho; Johnson, Bruce D.; Lalande, Sophie

doi:10.1152/japplphysiol.00113.2019

Cited by 25 publications

(28 citation statements)

References 96 publications

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“…Hence, fusion of E/A waves and e'/a' waves often occurs beyond heart rates of 100 bpm, thereby compromising the accuracy of this assessment. E and e' are also highly load dependent, which results in a large variability at peak exercise, when the increased respiratory rate induces shifts in preload and afterload ( 21 , 22 ). ExE/e' has a good positive predictive value for diagnosis of elevated exPAWP, but its negative predictive value (55–77%) allows a substantial amount of false negative results ( 12 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Exercise Systolic Reserve and Exercise Pulmonary Hypertension Improve Diagnosis of Heart Failure With Preserved Ejection Fraction

Verwerft

Verbrugge

Claessen

et al. 2022

Front. Cardiovasc. Med.

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AimsDiastolic stress testing (DST) is recommended to confirm heart failure with preserved ejection fraction (HFpEF) in patients with exertional dyspnea, but current algorithms do not detect all patients. We aimed to identify additional echocardiographic markers of elevated pulmonary arterial wedge pressure during exercise (exPAWP) in patients referred for DST.Methods and ResultsWe identified candidate parameters in 22 patients referred for exercise right heart catheterization with simultaneous echocardiography. Elevated exPAWP (≥25 mmHg) was present in 14 patients, and was best identified by peak septal systolic annular velocity <9.5 cm/s [exS', area under the receiver operating characteristic curve (AUC) 0.97, 95% confidence interval 0.92–1.0] and mean pulmonary artery pressure/cardiac output slope ≥3.2 mmHg/L [mPAP/CO, AUC 0.88 (0.72–1.0)]. We propose a decision tree to identify patients with elevated exPAWP. Applying this decision tree to 326 patients in an independent non-invasive DST cohort showed that patients labeled as “high probability of HFpEF” (n = 85) had reduced peak oxygen uptake [13.0 (10.7–15.1) mL/kg/min, p < 0.001 vs. intermediate/low probability], high H2FPEF score [53 (40–72) %, p < 0.001 vs. intermediate/low probability], and typical clinical characteristics. The diagnostic yield of DST increased from 11% using exercise E/e', to 62% using the decision tree.ConclusionIn DST for suspected HFpEF, exS' was the most accurate echocardiographic parameter to identify elevated PAWP. We propose a decision tree including exS' and mPAP/CO for interpretation of DST. Application of this decision tree revealed typical HFpEF characteristics in patients labeled as high probability of HFpEF, and substantially reduced the number of inconclusive results.

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Section: Discussionmentioning

confidence: 99%

Exercise Systolic Reserve and Exercise Pulmonary Hypertension Improve Diagnosis of Heart Failure With Preserved Ejection Fraction

Verwerft

Verbrugge

Claessen

et al. 2022

Front. Cardiovasc. Med.

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“…It is to be assumed that breath-hold-to-breathing differences of parameters under expiratory breath-holding would be different, presumable smaller [41,42]. Patients with heart failure, valvular diseases and atrial fibrillation, arrhythmia or pulmonary diseases were not enrolled, and different results might have been found in these populations due to altered intrathoracal pressures [43][44][45]. Moreover, the average age in our study population was 58 years and breath-hold-induced changes might differ in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Differences in left ventricular and left atrial function assessed during breath-holding and breathing

Reiter

Kräuter

et al. 2021

European Journal of Radiology

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To analyze differences in systolic and diastolic left ventricular (LV) as well as left atrial (LA) function parameters obtained from identical cardiac magnetic resonance (MR) imaging techniques during inspiratory breath-holding and breathing (breath-hold to breathing differences). Method: 56 subjects without signs of heart failure (23/33 male/female, age 58 ± 14 years) underwent 3 T MR cine real-time and transmitral phase contrast imaging with the same spatial and temporal resolution during inspiratory breath-holding and free breathing. LV and LA volumetric function parameters were derived from segmentation of cine series, transmitral peak velocities and early-diastolic myocardial peak velocity from phase contrast series. Corresponding breath-hold and breathing parameters were compared by Bland-Altman analysis; repeatability of breath-hold and breathing measurements was quantified by variance component analysis. p < 0.05 was regarded as statistically significant. Results: Mean differences between results obtained during inspiratory breath-holding vs. breathing were significant for LV volumetric function (end-diastolic volume=− 7 mL, p = 0.002; end-systolic volume=− 7 mL, p < 0.001; ejection fraction = 3 %, p < 0.001; peak ejection rate = 22 mL/s, p = 0.002; early-diastolic peak filling rate=− 34 mL/s, p = 0.025), LA volumetric function (maximum volume=-6 mL, p < 0.001; total ejection fraction=-4%, p < 0.001; active ejection fraction=-2%, p = 0.013; before contraction ejection fraction=-4%, p < 0.001) and early-diastolic velocities (transmitral=-6 cm/s, p < 0.001; tissue velocity=-1.8 cm/s, p < 0.001). Standard deviations of breath-hold-to-breathing differences exceeded the corresponding repeatabilities of breathhold and breathing measurements. Conclusions: Systolic and diastolic LV and LA function parameters acquired during inspiratory breath-holding and breathing differ, and large inter-individual breath-hold-to-breathing variations are possible. Thus, the breathing state should be taken into account, especially when comparing results in patient follow-up acquired in different respiratory states.

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“…The Wb and Pb are cornerstone metrics of dynamic respiratory mechanics, both of which have furthered our understanding of respiratory physiology during exercise in both health and disease. For example, by measuring the Wb and Pb during physical activity, investigators have demonstrated that: 1) the total and flow-resistive component of Pb are systematically higher in women than in men (1,2); 2) the total Pb during exercise is greater in older than in younger individuals (3)(4)(5); 3) the energy expended by respiratory muscles is an important contributor to the "slow component" of O 2 uptake kinetics during strenuous exercise (6); 4) the total Wb and Pb is elevated in patients with stable heart failure (7,8), chronic obstructive pulmonary disease (9,10), and interstitial lung disease (10); and 5) the Pb incurred during severe-to maximal-intensity exercise may be so large that it causes a redistribution of cardiac output away from exercising limbs toward the respiratory muscles, thereby curtailing exercise performance (11,12).…”

Section: Introductionmentioning

confidence: 99%

A comparison of methods used to quantify the work of breathing during exercise

Cross

Gideon

Morris

et al. 2021

Journal of Applied Physiology

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The measurement of the work of breathing (Wb) during exercise provides us with deep insights into respiratory (patho)physiology, and sheds light on the putative factors which lead to respiratory muscle fatigue. There are 4 popular methods available to determine the Wb. Our study demonstrates that no two of these methods produce identical values of Wb during exercise. This paper also discusses the practical and theoretical limitations of each method.

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The interactions between respiratory and cardiovascular systems in systolic heart failure

Cited by 25 publications

References 96 publications

Exercise Systolic Reserve and Exercise Pulmonary Hypertension Improve Diagnosis of Heart Failure With Preserved Ejection Fraction

Exercise Systolic Reserve and Exercise Pulmonary Hypertension Improve Diagnosis of Heart Failure With Preserved Ejection Fraction

Differences in left ventricular and left atrial function assessed during breath-holding and breathing

A comparison of methods used to quantify the work of breathing during exercise

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