Subclinical Cardiac Dysfunction is Associated with Reduced Cardiorespiratory Fitness and Cardiometabolic Risk Factors in Firefighters

Smith, Denise L.; Graham, Elliot; Douglas, Julie A.; Jack, Kepra; Conner, M; Arena, Ross; Chaudhry, Sundeep

doi:10.1016/j.amjmed.2021.12.025

Cited by 10 publications

(11 citation statements)

References 35 publications

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“…Obesity is also associated with cardiovascular effects. In a study of 967 male firefighters from Arizona and Texas, USA, obesity was a risk factor for subclinical myocardial dysfunction identified during cardiopulmonary exercise testing by simultaneous changes in O 2 ‐pulse trajectory and heart rate change per work rate (Δ heart rate‐work rate slope) 25 . Finally, the stronger association between obesity and breathlessness in women than men is not fully explained, but may relate to their narrower airways and lower lung capacity, 5 the higher levels of pro‐inflammatory adipokines secreted by adipose tissue in women than men, 26 or to the effects of female hormones on neural processing 27 …”

Section: Discussionmentioning

confidence: 99%

Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults

et al. 2022

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Background and Objective Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults. Methods A cross‐sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self‐reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant‐reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults. Results Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co‐morbid conditions, the aRR was slightly attenuated to around 1.85–1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1–29.1) and after further adjustment for co‐morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men. Conclusion Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity.

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Section: Discussionmentioning

confidence: 99%

Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults

et al. 2022

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“…This study’s FFs displayed superior left ventricular diastolic function compared to OWs; on average, this study’s FFs also exhibited a higher E/A ratio, a parameter indicative of notably improved left ventricular diastolic function. Conversely, Smith et al 52 noted in that nearly two-thirds of a group of 207 American firefighters exhibited signs of subclinical cardiac dysfunction. Subclinical cardiac dysfunction in firefighters has been significantly associated with reduced cardiorespiratory fitness and insufficiently managed cardiometabolic risk factors.…”

Section: Discussionmentioning

confidence: 97%

Structural and functional cardiac parameters across occupations: a cross-sectional study in differing work environments

Leischik,

Foshag,

Krittanawong

et al. 2024

Sci Rep

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Previous investigations have highlighted notable variations in cardiovascular risk indicators associated with various professional categories. However, only a few studies have examined structural and functional cardiac parameters using echocardiography within distinct occupational groups. Hence, this study endeavored to assess cardiac structural and functional parameters in three additional occupations: firefighters (FFs), police officers (POs), and office workers (OWs). This prospective study encompassed 197 male participants (97 FFs, 54 POs, and 46 OWs) from Germany. All participants underwent 2D and Doppler echocardiography in resting conditions; standard parasternal and apical axis views were employed to evaluate structural (diastolic and systolic) and functional (systolic and diastolic function, and strain) cardiac parameters. All three occupational groups exhibited a tendency towards septal hypertrophy. Notably, OWs exhibited the largest diastolic interventricular septum diameter (IVSd), at 1.33 ± 0.25 cm. IVSd significantly varied between POs and OWs (p = 0.000) and between POs and FFs (p = 0.025). Additionally, during diastole a substantially larger left ventricular posterior wall diameter (LVPWd) was observed in OWs compared to FFs (p = 0.001) and POs (p = 0.013). The left ventricular diastolic cavity diameter (LVIDd) and the left ventricular systolic cavity diameter (LVIDs) were significantly higher in POs than they were in FFs (LVIDd: p = 0.001; LVIDs: p = 0.009), and the LVIDd was notably higher in FFs (p = 0.015) and POs compared to OWs (p = 0.000). FFs exhibited significantly better diastolic function, indicated by higher diastolic peak velocity ratios (MV E/A ratio) and E/E’ ratios, compared to POs (E/A ratio: p = 0.025; E/E’ ratio: p = 0.014). No significant difference in diastolic performance was found between OWs and FFs. Significantly higher E’(lateral) values were noted in POs compared to FFs (p = 0.003) and OWs (p = 0.004). Ejection fraction did not significantly differ among FFs, POs, and OWs (p > 0.6). The left ventricular mass (LV Mass) was notably higher in POs than it was in FFs (p = 0.039) and OWs (p = 0.033). Strain parameter differences were notably improved in two- (p = 0.006) and four-chamber (p = 0.018) views for FFs compared to POs. Concentric remodeling was the predominant change observed in all three occupational groups. Significant differences in the presence of various forms of hypertrophy were observed in FFs, POs, and OWs (exact Fisher test p-values: FFs vs. OWs = 0.021, POs vs. OWs = 0.002). OWs demonstrated notably higher rates of concentric remodeling than FFs did (71.77% vs. 47.9%). This study underscores disparities in both functional and structural parameters in diverse occupational groups. Larger prospective studies are warranted to investigate and delineate differences in structural and functional cardiac parameters across occupational groups, and to discern their associated effects and risks on the cardiovascular health of these distinct professional cohorts.

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“…Previous CPET research has mostly focused on symptomatic individuals and few investigative studies have been published utilizing CPET to assess the cardiovascular and pulmonary function in asymptomatic at-risk individuals ( 6 ). However, evidence of the utility of CPET as a unique diagnostic tool is emerging.…”

Section: Discussionmentioning

confidence: 99%

Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents

Edwards

Tas

Leclerc³

et al. 2023

Front. Pediatr.

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Noninvasive cardiopulmonary exercise testing (CPET) provides the valuable capacity to analyze pulmonary gas exchange and cardiovascular responses that can be used to differentiate normal cardiopulmonary responses from abnormal. This case report highlights a proposed role for CPET in identifying potential cardiac pathologies in at-risk adolescents. An abnormal CPET response in an asymptomatic adolescent revealed a family history of early-age CAD. The significance of the abnormal CPET response was further supported by the presence of an elevated concentration of circulating high sensitivity C-reactive protein (hs-CRP). These findings emphasize the importance of a thorough clinical evaluation in at-risk adolescents, as CPET can aid in the early detection and management of cardiac pathologies, especially when combined with other relevant biomarkers such as plasma hs-CRP concentration, which can further suggest underlying pathology. Management considerations using serial CPET evaluations are recommended. Thus, CPET abnormalities combined with elevated hs-CRP should be taken seriously and provide justification for further evaluation and monitoring in adolescents at risk for cardiovascular disease.

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Subclinical Cardiac Dysfunction is Associated with Reduced Cardiorespiratory Fitness and Cardiometabolic Risk Factors in Firefighters

Cited by 10 publications

References 35 publications

Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults

Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults

Structural and functional cardiac parameters across occupations: a cross-sectional study in differing work environments

Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents

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