Exercise training improves biventricular oxidative metabolism and left ventricular efficiency in patients with dilated cardiomyopathy

Stolen, Kira Q.; Kemppainen, Jukka; Ukkonen, Heikki; Kalliokoski, Kari K.; Luotolahti, Matti; Lehikoinen, Pertti; Hämäläinen, Helena; Salo, Tiina; Airaksinen, Juhani; Nuutila, Pirjo; Knuuti, Juhani

doi:10.1016/s0735-1097(02)02772-9

Cited by 94 publications

(65 citation statements)

References 35 publications

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“…First, it has long been known that interventions that aim to increase ventricular systolic performance increase the risk of death in patients with heart failure, whereas energy‐sparing treatments, such as angiotensin‐converting enzyme inhibitors or beta‐blockers, improve prognosis in heart failure. It has been thought that exercise‐based cardiac rehabilitation might be an exception to this rule in patients with nonischemic heart failure, given that 2 previous studies showed significant improvements in LV mechanical efficiency in patients with dilated cardiomyopathy 36, 37. Our findings support and extend these findings to patients with systolic heart failure of ischemic origin, in whom efficient energy utilization is of greatest importance.…”

Section: Discussionsupporting

confidence: 85%

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Aslanger

Assous

Bihry

et al. 2015

JAHA

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BackgroundSuccess of cardiac rehabilitation (CR) is generally assessed by the objective improvement in peak volume of inhaled oxygen (VO 2) measured by cardiopulmonary exercise test (CPX). However, cardiac mechanical efficiency and ventricular‐arterial coupling (VAC) are the other important dimensions of the heart failure pathophysiology, which are not included in CPX‐derived data. The effect of cardiac rehabilitation on left ventricular (LV) efficiency or VAC in unselected heart failure patients has not been studied thus far.Methods and ResultsThirty patients with an ejection fraction of ≤45% were recruited for 20 sessions of exercise‐based CR. Noninvasive LV pressure‐volume loops were constructed and VAC was calculated with the help of applanation tonometry and echocardiography before and after CR. VAC showed an improved mechanical efficiency profile and increased significantly from 0.56±0.18 to 0.67±0.21 (P=0.02). LV mechanical efficiency improved from 43.9±9.1% to 48.8±9.1% (P=0.01). The change in peak VO 2 was not in a significant correlation with the change in VAC (r=−0.18; P=0.31), mechanical efficiency (r=−0.16, P=0.39), or the change in ejection fraction (r=−0.07; P=0.68).Conclusions CR is associated with an improvement in VAC and LV mechanical efficiency in heart failure patients. Further studies are needed to determine the incremental value of VAC and mechanical efficiency over CPX‐derived data in predicting clinical outcomes.

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Section: Discussionsupporting

confidence: 85%

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Aslanger

Assous

Bihry

et al. 2015

JAHA

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“…It has been thought that exercise-based cardiac rehabilitation might be an exception to this rule in patients with nonischemic heart failure, given that 2 previous studies showed significant improvements in LV mechanical efficiency in patients with dilated cardiomyopathy. 36,37 Our findings support and extend these findings to patients with systolic heart failure of ischemic origin, in whom efficient energy utilization is of greatest importance. Second, the change in neither VAC nor mechanical efficiency correlated with the change in peak VO 2 in our cohort.…”

Section: -14supporting

confidence: 80%

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

2015

JAHA

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“…In addition, Ukkonen et al demonstrated in patients with congestive heart failure that higher oxidative metabolism in the right ventricle relative to that in the left ventricle was related to an increased ventilatory drive, reflected by the slope of increase of ventilation relative to carbon dioxide production, which in turn was associated with increased mortality in these patients (19). Therapeutic interventions for LV heart failure, such as exercise training in dilated cardiomyopathy patients, were shown to also have a positive effect on RV oxidative metabolism, with a significant reduction of RV K mono (20). Similarly, cardiac resynchronization therapy in patients with idiopathic dilated cardiomyopathy also enhanced RV oxidative metabolism and metabolic reserve during stress (21).…”

Section: Discussionmentioning

confidence: 99%

¹¹C-Acetate Clearance as an Index of Oxygen Consumption of the Right Myocardium in Idiopathic Pulmonary Arterial Hypertension: A Validation Study Using ¹⁵O-Labeled Tracers and PET

et al. 2013

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Idiopathic pulmonary arterial hypertension (IPAH) results in increased right ventricular (RV) workload and oxygen demand. It has been shown that myocardial oxygen consumption (MVO 2 ) of the hypertrophied right ventricle of IPAH patients can be measured using PET and 15 O-labeled tracers. This method is, however, not very suitable for routine clinical practice. The purpose of the present study was to assess whether MVO 2 can also be determined in the right ventricle of IPAH patients from the clearance of 11 C-acetate, a simple method that is in use for MVO 2 measurements of the left myocardium. Methods: Seventeen of 26 IPAH patients performed the total PET study. Nine other patients were scanned only for 11 Cacetate. 15 O-H 2 O, 15 O-O 2 , and 15 O-CO scans were used to derive RV flow, oxygen extraction fraction, and blood volume, respectively, from which RV MVO 2 was calculated. The rate of clearance determined by monoexponential curve fitting (K mono ) and the efflux rate constant k 2 were derived from the 11 C-acetate scan. The RV ratepressure product was also determined by means of right heart catheterization, as an index of the RV MVO 2 , and was calculated as the product of systolic pulmonary artery pressure and heart rate. Results: Both 11 C-acetate clearance rates, K mono (R 2 5 0.41, P 5 0.006) and k 2 (R 2 5 0.45, P 5 0.003), correlated with RV MVO 2 . They also correlated with RV rate-pressure product (K mono , R 2 5 0.41, P 5 0.0005; k 2 , R 2 5 0.48, P , 0.0001). Conclusion: 11 C-acetate clearance rates correlated moderately with quantitative RV MVO 2 measurements in IPAH. Therefore, 11 C-acetate PET can be used only as an index of RV oxidative metabolism in IPAH patients. The oxygen consumption (MVO 2 ) of the normal right myocardium is less than that of the left heart as a result of a lower afterload (1). In idiopathic pulmonary arterial hypertension (IPAH), elevated pulmonary vascular resistance causes right ventricular (RV) hypertrophy and ultimately fatal RV failure. To gain insight on the pathophysiology of reduced pump function in the failing heart, quantification of MVO 2 is important. A noninvasive method using state-of-the-art PET and 15 O-labeled tracers has been validated as a means to measure MVO 2 accurately (2-4). Using this method, it was recently demonstrated that the right ventricle consumes more oxygen in patients with severe IPAH than in those with mild PAH for generating similar RV power output (5). This method is, however, extensive and time-consuming (4), requiring 3 consecutive PET scans ( 15 O-H 2 O, 15 O-CO, and 15 O-O 2 ) and an on-site cyclotron to produce the short-lived 15 O tracers (6). PET using 11 C-acetate has been proposed as a more practical method to estimate MVO 2 . With 11 C-acetate being the precursor of acetyl-CoA in the tricarboxylic acid cycle, the rate of 11 C-acetate clearance determined by monoexponential curve fitting (K mono ) is closely related to MVO 2 of the left heart (4,7-10).It is not known, however, whether 11 C-acetate can also be used to esti...

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Exercise training improves biventricular oxidative metabolism and left ventricular efficiency in patients with dilated cardiomyopathy

Cited by 94 publications

References 35 publications

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

¹¹C-Acetate Clearance as an Index of Oxygen Consumption of the Right Myocardium in Idiopathic Pulmonary Arterial Hypertension: A Validation Study Using ¹⁵O-Labeled Tracers and PET

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Exercise training improves biventricular oxidative metabolism and left ventricular efficiency in patients with dilated cardiomyopathy

Cited by 94 publications

References 35 publications

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

11C-Acetate Clearance as an Index of Oxygen Consumption of the Right Myocardium in Idiopathic Pulmonary Arterial Hypertension: A Validation Study Using 15O-Labeled Tracers and PET

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¹¹C-Acetate Clearance as an Index of Oxygen Consumption of the Right Myocardium in Idiopathic Pulmonary Arterial Hypertension: A Validation Study Using ¹⁵O-Labeled Tracers and PET