How do different indicators of cardiac pump function impact upon the long-term prognosis of patients with chronic heart failure?

Williams, Simon G.; Jackson, Mark; Cooke, G.A.; Barker, Diane; Patwala, Ashish; Wright, David J.; Albuoaini, Khaled; Tan, Lip‐Bun

doi:10.1016/j.ahj.2005.08.018

Cited by 36 publications

(35 citation statements)

References 23 publications

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“…Responsiveness to exercise is an important prognostic indicator for cardiovascular disease [29]. In lieu of exercise, we exposed ΔF508 mice to increasing concentrations of the β-adrenergic agonist, dobutamine.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular and aortic dysfunction in cystic fibrosis mice

Sellers

Kovács

Weinheimer

et al. 2013

Journal of Cystic Fibrosis

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Background Left ventricular (LV) abnormalities have been reported in cystic fibrosis (CF); however, it remains unclear if loss of cystic fibrosis transmembrane conductance regulator (CFTR) function causes heart defects independent of lung disease. Methods Using gut-corrected F508del CFTR mutant mice (ΔF508), which do not develop human lung disease, we examined in vivo heart and aortic function via 2D transthoracic echocardiography and LV catheterization. Results ΔF508 mouse hearts showed LV concentric remodeling along with enhanced inotropy (increased +dP/dt, fractional shortening, decreased isovolumetric contraction time) and greater lusitropy (−dP/dt, Tau). Aortas displayed increased stiffness and altered diastolic flow. β-adrenergic stimulation revealed diminished cardiac reserve (attenuated +dP/dt,−dP/dt, LV pressure). Conclusions In a mouse model of CF, CFTR mutation leads to LV remodeling with alteration of cardiac and aortic functions in the absence of lung disease. As CF patients live longer, more active lives, their risk for cardiovascular disease should be considered.

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Section: Discussionmentioning

confidence: 99%

Left ventricular and aortic dysfunction in cystic fibrosis mice

Sellers

Kovács

Weinheimer

et al. 2013

Journal of Cystic Fibrosis

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“…Studies have demonstrated that noninvasively determined peak CO provides an independent predictor of outcomes that enhances the prognostic utility of peak V ⋅ o 2 . [86][87][88][89][90] More recent reports suggest that noninvasively determined peak cardiac index complements indexes of ventilatory inefficiency and peak V ⋅ o 2 and that combining these markers provides the most powerful stratification of risk. 91,92 Although the Fick and thermodilution methods remain the gold standards for the measurement of CO, 93 several rebreathing methods that use CPX are available.…”

Section: Circulatory Powermentioning

confidence: 99%

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

et al. 2016

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Abstract-In the past several decades, cardiopulmonary exercise testing (CPX) has seen an exponential increase in its evidence base. The growing volume of evidence in support of CPX has precipitated the release of numerous scientific statements by societies and associations. In 2012, the European Association for Cardiovascular Prevention & Rehabilitation and the American Heart Association developed a joint document with the primary intent of redefining CPX analysis and reporting in a way that would streamline test interpretation and increase clinical application. Specifically, the 2012 joint scientific statement on CPX conceptualized an easy-to-use, clinically meaningful analysis based on evidence-vetted variables in color-coded algorithms; single-page algorithms were successfully developed for each proposed test indication. Because of an abundance of new CPX research in recent years and a reassessment of the current algorithms in light of the body of evidence, a focused update to the 2012 scientific statement is now warranted. The purposes of this update are to confirm algorithms included in the initial scientific statement not requiring revision, to propose revisions to algorithms included in the initial scientific statement, to propose new algorithms based on emerging scientific evidence, to further clarify the application of oxygen consumption at ventilatory threshold, to describe CPX variables with an emerging scientific evidence base, to describe the synergistic value of combining CPX with other assessments, to discuss personnel considerations for CPX laboratories, and to provide recommendations for future CPX research. (Circulation. 2016;133:e694-e711.

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“…Because the measurement of cardiac performance has been suggested to be an important complement to peak VO 2 and other CPX responses when assessing circulatory dysfunction and stratifying risk in CHF (Chomsky et al, 1996, Lang et al, 2007, Metra et al, 1999, Williams et al, 2001, Williams et al, 2005, Wilson et al, 1995a, the ability to acquire such data easily and without the need for arterial or mixed venous blood sampling potentially has a great deal of value for both clinical and research applications in these patients. VO 2 = oxygen uptake; CO = cardiac output; CI = cardiac index; VET = ventricular ejection time; OUES = oxygen uptake efficiency slope; NYHA = New York Heart Association; EF = ejection fraction.…”

Section: Discussionmentioning

confidence: 99%

Quantification of the Impaired Cardiac Output Response to Exercise in Heart Failure: Application of a Non-Invasive Device

Myers

Gujja

Neelagaru³

et al. 2008

Journal of Cardiac Failure

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An impaired cardiac output (CO) response to exercise is a hallmark of chronic heart failure (CHF), and the degree to which CO is impaired is related to the severity of CHF and prognosis. However, practical methods for obtaining cardiac output during exercise are lacking, and what constitutes and impaired response is unclear. Forty six CHF patients and 13 normal subjects underwent cardiopulmonary exercise testing (CPX) while CO and other hemodynamic measurements at rest and during exercise were obtained using a novel, non-invasive, bioreactance device based on assessment of relative phase shifts of electric currents injected across the thorax, heart rate and ventricular ejection time. An abnormal cardiac output response to exercise was defined as achieving ≤ 95% of the confidence limits of the slope of the relationship between CO and oxygen uptake (VO 2 ). An impaired CO slope identified patients with more severe CHF as evidenced by a lower peak VO 2 , lower peak CO, heightened VE/VCO 2 slope, and lower oxygen uptake efficiency slope. CO can be estimated during exercise using a novel bioreactance technique; patients with an impaired response to exercise exhibit reduced exercise capacity and inefficient ventilation typical of more severe CHF. Non-invasive measurement of cardiac performance in response to exercise provides a simple method of identifying patients with more severe CHF and may complement the CPX in identifying CHF patients at high risk.

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How do different indicators of cardiac pump function impact upon the long-term prognosis of patients with chronic heart failure?

Cited by 36 publications

References 23 publications

Left ventricular and aortic dysfunction in cystic fibrosis mice

Left ventricular and aortic dysfunction in cystic fibrosis mice

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

Quantification of the Impaired Cardiac Output Response to Exercise in Heart Failure: Application of a Non-Invasive Device

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