Description of a TCD test designed for the clinical investigation of cerebral autoregulation. The Doppler shift frequency of the middle cerebral artery is recorded using of a transducer fixed to the patient's head by an elastic ribbon and a ball joint type probe-holder, and on-line digitally analysed to calculate the TCD flow index (signal power times velocity). Blood pressure is measured every 30 seconds at the right index hold at the level of the heart, using a special sphygmomanometer. The patient sits on a foot-stool. After 1.5 minutes of measurement he rises to remain in upright position for another 2 minutes. The flow index normalised to its average over the sitting period quantitatively indicates the evolution of volume flow brought about by the change of the body position. The change in arterial blood pressure is off-line calculated from its periodic measurements. In a pilot study this test has been successfully used in 30 healthy volunteers and 2 patients suffering from orthostatic dysregulation of blood pressure.
PURPOSE:In childhood acute lymphoblastic leukemia (ALL) survivors, doxorubicin leads to dose-dependent cardiotoxicity, which is the most common cause of morbidity and mortality many years after the end of treatments. To counteract survivors' doxorubicin-induced cardiotoxicity, good cardiorespiratory fitness levels and regular physical activity can increase cardiac health. This study aimed to assess the association between adequate cardiorespiratory fitness and cardiac magnetic resonance (CMR) parameters, and the association between regular physical activity level and CMR parameters. METHODS: Our study included 96 childhood ALL survivors who underwent a maximal CPET. Daily minutes of moderate-to-vigorous leisure physical activities were self-reported. The CMR acquisitions were performed on a 3T MRI system and included a standard ECG-gated SSFP cine sequence for cardiac function, an ECG-gated MOLLI sequence for T1 mapping and an ECGgated T2-prepared TrueFISP sequence for T2 mapping. Post-gadolinium T1 was acquired using Gadovist as a contrast agent. We calculated the odds ratio to obtain the preventive fraction of regular physical activity (≥150min/week) and adequate cardiorespiratory fitness levels (above the median ≥31.4mL.kg -1 .min -1 ) on CMR parameters. RESULTS: A total of 81 childhood ALL survivors were included in our analyses. We reported that an adequate cardiorespiratory fitness was associated with significant preventive fractions in CMR left ventricular (LV) and right ventricular (RV) volumes. We observed significant preventive fractions in the LV and RV volumes (up to 84% in LV end-diastolic volume and up to 88% in RV end-systolic volume). The adjusted analyses highlighted a significant reduction of 36% to 91% in the prevalence of CMR parameters associated with an adequate cardiorespiratory fitness. Similar associations of a regular physical activity on CMR were observed. CONCLUSIONS: An adequate cardiorespiratory fitness level, and a regular physical activity were associated with a higher preventive fraction for most CMR parameters. We reported that a slight increase in cardiorespiratory fitness led to a better preventive fraction on cardiac function. This study provides additional evidence regarding the benefits of exercise for childhood cancer survivors.
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