Association Between Physical Activity Measurements and Key Parameters of Cardiopulmonary Exercise Testing in Patients With Heart Failure

Silva, Vinicius Z M da; Lima, Alexandra; Vargas, Fillippe T.; Cahalin, Lawrence P.; Arena, Ross; Cipriano, Gerson

doi:10.1016/j.cardfail.2013.08.002

Cited by 14 publications

(14 citation statements)

References 33 publications

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“…Nevertheless, there is a constant need for the refinement of such prognostic models, and the inclusion of new variables may help to increase their validity. Thus, the assessment of daily physical activity has gained attention in recent years [22,25,43]. For example, we showed that the amount of physical activity (measured by accelerometry) and the quality of such activity (i.e., intensity) were independent predictors of mortality in patients with chronic HF [56].…”

Section: Introductionmentioning

confidence: 90%

“…However, a large number of other circulatory factors such as natriuretic peptides and cytokines have also been shown to increase in cases of HF [14]. Many of these factors are related to physical capacity, and display biological function(s) that might impact on cardiac and/or skeletal muscle tissues [4,18,25,29,38,41,42,47,60,71]. Thus, physical activity, synergistically with increases in neuroendocrine factors, is critical to connect the reduced myocardial function of patients with HF with the alterations in peripheral tissues (e.g., kidney and skeletal muscle) associated with this disease.…”

Section: Introductionmentioning

confidence: 99%

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Circulatory factors associated with function and prognosis in patients with severe heart failure

et al. 2019

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Background Multiple circulatory factors are increased in heart failure (HF). Many have been linked to cardiac and/or skeletal muscle tissue processes, which in turn might influence physical activity and/or capacity during HF. This study aimed to provide a better understanding of the mechanisms linking HF with the loss of peripheral function. Methods and results Physical capacity measured by maximum oxygen uptake, myocardial function (measured by echocardiography), physical activity (measured by accelerometry), and mortality data was collected for patients with severe symptomatic heart failure an ejection fraction < 35% (n = 66) and controls (n = 28). Plasma circulatory factors were quantified using a multiplex immunoassay. Multivariate (orthogonal projections to latent structures discriminant analysis) and univariate analyses identified many factors that differed significantly between HF and control subjects, mainly involving biological functions related to cell growth and cell adhesion, extracellular matrix organization, angiogenesis, and inflammation. Then, using principal component analysis, links between circulatory factors and physical capacity, daily physical activity, and myocardial function were identified. A subset of ten biomarkers differentially expressed in patients with HF vs controls covaried with physical capacity, daily physical activity, and myocardial function; eight of these also carried prognostic value. These included established plasma biomarkers of HF, such as NT-proBNP and ST2 along with recently identified factors such as GDF15, IGFBP7, and TfR, as well as a new factor, galectin-4. Conclusions These findings reinforce the importance of systemic circulatory factors linked to hemodynamic stress responses and inflammation in the pathogenesis and progress of HF disease. They also support established biomarkers for HF and suggest new plausible markers. Graphic abstract

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Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Circulatory factors associated with function and prognosis in patients with severe heart failure

et al. 2019

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“…The clinically validated Actigraph accelerometer determined counts of 10-s acceleration activities in X-, Y-, and Z- vectors with each count equal to 16 m-g per second where the g is 9.825 m•s −2 [15–17]. The vector magnitude (VM) was calculated as the square root of the sum of the second power of X-, Y-, and Z-vector counts.…”

Section: Methodsmentioning

confidence: 99%

Impaired chronotropic response to physical activities in heart failure patients

Shen¹,

Zhao²,

Zhou³

et al. 2017

BMC Cardiovasc Disord

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BackgroundWhile exercise-based cardiac rehabilitation has a beneficial effect on heart failure hospitalization and mortality, it is limited by the presence of chronotropic incompetence (CI) in some patients. This study explored the feasibility of using wearable devices to assess impaired chronotropic response in heart failure patients.MethodsForty patients with heart failure (left ventricular ejection fraction, LVEF: 44.6 ± 5.8; age: 54.4 ± 11.7) received ECG Holter and accelerometer to monitor heart rate (HR) and physical activities during symptom-limited treadmill exercise testing, 6-min hall walk (6MHW), and 24-h daily living. CI was defined as maximal HR during peak exercise testing failing to reach 70% of age-predicted maximal HR (APMHR, 220 – age). The correlation between HR and physical activities in Holter-accelerometer recording was analyzed.ResultsOf 40 enrolled patients, 26 were able to perform treadmill exercise testing. Based on exercise test reports, 13 (50%) of 26 patients did not achieve at least 70% of APMHR (CI patients). CI patients achieved a lower % APMHR (62.0 ± 6.3%) than non-CI patients who achieved 72.0 ± 1.2% of APMHR (P < 0.0001). When Holter-accelerometer recording was used to assess chronotropic response, the percent APMHR achieved during 6MHW and physical activities was significantly lower in CI patients than in non-CI patients. CI patients had a significantly shorter 6MHW distance and less physical activity intensity than non-CI patients.ConclusionThe study found impaired chronotropic response in 50% of heart failure patients who took treadmill exercise testing. The wearable Holter-accelerometer recording could help to identify impaired chronotropic response to physical activities in heart failure patients.Trial registrationClinicalTrials.gov ID NCT02358603. Registered 16 May 2014.

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“…Overall, these studies demonstrate that physically active patients have a better prognosis than patients who are not physically active, and this also is correlated to the physical capacity of the patient [ 20 ]. An intriguing observation is the linear correlation between time spent being highly physically active and physical capacity/peak VO2 in HF patients [ 29 ]. This questions whether such information has an additive prognostic value in patients whose physical capacity is already known from assessment with peak VO2 CPX [ 22 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…An intriguing observation is the linear correlation between time spent being highly physically active and physical capacity/peak VO2 in HF patients [ 29 ]. This questions whether such information has an additive prognostic value in patients whose physical capacity is already known from assessment with peak VO2 CPX [ 22 , 29 ]. Our data, confirms that time spent being physically active is significantly associated with the prognosis in HF and that it can be assessed by means of a waist-worn accelerometer (see Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Variability in Physical Activity Assessed with Accelerometer Is an Independent Predictor of Mortality in CHF Patients

et al. 2016

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AimsPatients with heart failure often display a distinct pattern of walking characterized by short step-length and frequent short pauses. In the current study we sought to explore if qualitative aspects of movement have any additive value to established factors to predict all-cause mortality in patients with advanced heart failure.Methods and results60 patients with advanced heart failure (NYHA III, peak VO2 <20 ml/kg and LVEF <35%) underwent symptom-limited CPX, echocardiography and routine chemistry. Physical activity was assessed using an accelerometer worn attached to the waist during waking hours for 7 consecutive days. The heart-failure survival score (HFSS) was calculated for each patient. All accelerometer-derived variables were analyzed with regard to all-cause mortality and added to a baseline model utilizing HFSS scores. HFSS score was significantly associated with the incidence of death (P<0.001; c-index 0.71; CI, 0.67–0.73). The addition of peak skewness to the HFSS model significantly improved the predictive ability with an increase in c-index to 0.74 (CI, 0.69–0.78), likelihood ratio P<0.02, establishing skewness as a predictor of increased event rates when accounting for baseline risk.ConclusionThe feature skewness, a measure of asymmetry in the intensity level of periods of high physical activity, was identified to be predictive of all-cause mortality independent of the established prognostic model–HFSS and peak VO2. The findings from the present study emphasize the use of accelerometer analysis in clinical practice to make more accurate prognoses in addition to extract features of physical activity relevant to functional classification.

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Association Between Physical Activity Measurements and Key Parameters of Cardiopulmonary Exercise Testing in Patients With Heart Failure

Cited by 14 publications

References 33 publications

Circulatory factors associated with function and prognosis in patients with severe heart failure

Circulatory factors associated with function and prognosis in patients with severe heart failure

Impaired chronotropic response to physical activities in heart failure patients

Variability in Physical Activity Assessed with Accelerometer Is an Independent Predictor of Mortality in CHF Patients

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