Eccentric Left Ventricular Hypertrophy and Left and Right Cardiac Function in Chronic Heart Failure with or without Coexisting COPD: Impact on Exercise Performance

Santos, P.B. dos; Simões, Rodrigo Polaquini; Goulart, Cássia da Luz; Roscani, Meliza Goi; Marinho, Renan Shida; Camargo, Paula Rezende; Arbex, Renata F.; Casale, Guilherme; Oliveira, Cláudio Ricardo de; Mendes, Renata Gonçalves; Arena, Ross; Borghi‐Silva, Audrey

doi:10.2147/copd.s285812

“…PRPP could be considered an accurate reflection of the myocardial oxygen demand and workload [34,35]. Santos et al reported that myocardial oxygen uptake increases when eccentric left ventricular hypertrophy occurs, leading to coronary blood flow reserve exhaustion [36]. Moreover, we observed that among patients with Kawasaki disease, those without coronary artery involvement had higher PRPP than those with coronary artery dilation [37].…”

Section: Discussionmentioning

confidence: 52%

Comparison of Cardiorespiratory Fitness between Patients with Mitral Valve Prolapse and Healthy Peers: Findings from Serial Cardiopulmonary Exercise Testing

Chung

¹

,

Tsai

²

,

Lin

³

et al. 2023

JCDD

2

0

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Individuals with mitral valve prolapse (MVP) have exercise intolerance even without mitral valve regurgitation. Mitral valve degeneration may progress with aging. We aimed to evaluate the influence of MVP on the cardiopulmonary function (CPF) of individuals with MVP through serial follow-ups from early to late adolescence. Thirty patients with MVP receiving at least two cardiopulmonary exercise tests (CPETs) using a treadmill (MVP group) were retrospectively analyzed. Age-, sex-, and body mass index-matched healthy peers, who also had serial CPETs, were recruited as the control group. The average time from the first CPET to the last CPET was 4.28 and 4.06 years in the MVP and control groups, respectively. At the first CPET, the MVP group had a significantly lower peak rate pressure product (PRPP) than the control group (p = 0.022). At the final CEPT, the MVP group had lower peak metabolic equivalent (MET, p = 0.032) and PRPP (p = 0.031). Moreover, the MVP group had lower peak MET and PRPP as they aged, whereas healthy peers had higher peak MET (p = 0.034) and PRPP (p = 0.047) as they aged. Individuals with MVP had poorer CPF than healthy individuals as they develop from early to late adolescence. It is important for individuals with MVP to receive regular CPET follow-ups.

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“…Patients with no coronary involvement showed higher PRPP than those who had coronary artery dilation [ 44 ]. Santos et al also concluded that when maladaptive eccentric left ventricular hypertrophy occurs, the myocardial oxygen uptake increases, leading to the exhaustion of the coronary blood flow reserve [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Results of Cardiopulmonary Exercise Testing between Healthy Peers and Pediatric Patients with Different Echocardiographic Severity of Mitral Valve Prolapse

Huang

¹

,

Tuan

²

,

Tsai³

et al. 2023

Life

2

0

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Patients with mitral valve prolapse (MVP) have been reported to have exercise intolerance. However, the underlying pathophysiological mechanisms and their physical fitness remain unclear. We aimed to determine the exercise capacity of patients with MVP through the cardiopulmonary exercise test (CPET). We retrospectively collected the data of 45 patients with a diagnosis of MVP. Their CPET and echocardiogram results were compared with 76 healthy individuals as primary outcomes. No significant differences regarding the patient’s baseline characteristics and echocardiographic data were found between the two groups, except for the lower body mass index (BMI) of the MVP group. Patients in the MVP group demonstrated a similar peak metabolic equivalent (MET), but a significantly lower peak rate pressure product (PRPP) (p = 0.048). Patients with MVP possessed similar exercise capacity to healthy individuals. The reduced PRPP may indicate compromised coronary perfusion and subtle left ventricular function impairment.

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“…Nevertheless, HF + COPD presented reduced VP in comparison with HF group (p < 0.05). The VP has been studied as a prognostic marker in cardiopulmonary diseases 58 , 59 . This variable reflects peak cardiac output, alveolar perfusion, peripheral perfusion and the chemo-afferent reflexes of the skeletal muscle, with values below 3.5 mmHg indicating worsening survival 32 .…”

Section: Discussionmentioning

confidence: 99%

Responses to incremental exercise and the impact of the coexistence of HF and COPD on exercise capacity: a follow-up study

Santos

¹

,

Simões

²

,

Goulart

³

et al. 2022

Sci Rep

Self Cite

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Our aim was to evaluate: (1) the prevalence of coexistence of heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the studied patients; (2) the impact of HF + COPD on exercise performance and contrasting exercise responses in patients with only a diagnosis of HF or COPD; and (3) the relationship between clinical characteristics and measures of cardiorespiratory fitness; (4) verify the occurrence of cardiopulmonary events in the follow-up period of up to 24 months years. The current study included 124 patients (HF: 46, COPD: 53 and HF + COPD: 25) that performed advanced pulmonary function tests, echocardiography, analysis of body composition by bioimpedance and symptom-limited incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Key CPET variables were calculated for all patients as previously described. The $${\dot{\text{V}}}$$ V ˙ E/$${\dot{\text{V}}}$$ V ˙ CO2 slope was obtained through linear regression analysis. Additionally, the linear relationship between oxygen uptake and the log transformation of $${\dot{\text{V}}}$$ V ˙ E (OUES) was calculated using the following equation: $${\dot{\text{V}}}$$ V ˙ O2 = a log $${\dot{\text{V}}}$$ V ˙ E + b, with the constant ‘a’ referring to the rate of increase of $${\dot{\text{V}}}$$ V ˙ O2. Circulatory power (CP) was obtained through the product of peak $${\dot{\text{V}}}$$ V ˙ O2 and peak systolic blood pressure and Ventilatory Power (VP) was calculated by dividing peak systolic blood pressure by the $${\dot{\text{V}}}$$ V ˙ E/$${\dot{\text{V}}}$$ V ˙ CO2 slope. After the CPET, all patients were contacted by telephone every 6 months (6, 12, 18, 24) and questioned about exacerbations, hospitalizations for cardiopulmonary causes and death. We found a 20% prevalence of HF + COPD overlap in the studied patients. The COPD and HF + COPD groups were older (HF: 60 ± 8, COPD: 65 ± 7, HF + COPD: 68 ± 7). In relation to cardiac function, as expected, patients with COPD presented preserved ejection fraction (HF: 40 ± 7, COPD: 70 ± 8, HF + COPD: 38 ± 8) while in the HF and HF + COPD demonstrated similar levels of systolic dysfunction. The COPD and HF + COPD patients showed evidence of an obstructive ventilatory disorder confirmed by the value of %FEV1 (HF: 84 ± 20, COPD: 54 ± 21, HF + COPD: 65 ± 25). Patients with HF + COPD demonstrated a lower work rate (WR), peak oxygen uptake ($${\dot{\text{V}}}$$ V ˙ O2), rate pressure product (RPP), CP and VP compared to those only diagnosed with HF and COPD. In addition, significant correlations were observed between lean mass and peak $${\dot{\text{V}}}$$ V ˙ O2 (r: 0.56 p < 0.001), OUES (r: 0.42 p < 0.001), and O2 pulse (r: 0.58 p < 0.001), lung diffusing factor for carbon monoxide (DLCO) and WR (r: 0.51 p < 0.001), DLCO and VP (r: 0.40 p: 0.002), forced expiratory volume in first second (FEV1) and peak $${\dot{\text{V}}}$$ V ˙ O2 (r: 0.52; p < 0.001), and FEV1 and WR (r: 0.62; p < 0.001). There were no significant differences in the occurrence of events and deaths contrasting both groups. The coexistence of HF + COPD induces greater impairment on exercise performance when compared to patients without overlapping diseases, however the overlap of the two diseases did not increase the probability of the occurrence of cardiopulmonary events and deaths when compared to groups with isolated diseases in the period studied. CPET provides important information to guide effective strategies for these patients with the goal of improving exercise performance and functional capacity. Moreover, given our findings related to pulmonary function, body composition and exercise responses, evidenced that the lean mass, FEV1 and DLCO influence important responses to exercise.

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Eccentric Left Ventricular Hypertrophy and Left and Right Cardiac Function in Chronic Heart Failure with or without Coexisting COPD: Impact on Exercise Performance

Cited by 8 publications

References 68 publications

Comparison of Cardiorespiratory Fitness between Patients with Mitral Valve Prolapse and Healthy Peers: Findings from Serial Cardiopulmonary Exercise Testing

Comparison of Cardiorespiratory Fitness between Patients with Mitral Valve Prolapse and Healthy Peers: Findings from Serial Cardiopulmonary Exercise Testing

Comparison of the Results of Cardiopulmonary Exercise Testing between Healthy Peers and Pediatric Patients with Different Echocardiographic Severity of Mitral Valve Prolapse

Responses to incremental exercise and the impact of the coexistence of HF and COPD on exercise capacity: a follow-up study

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