Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives:...Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives: In this retrospective pilot study, we evaluated patients with hematologic and solid malignancies by CPET to determine the primary source of their dyspnea. Methods: Subjects were exercised on a cycle ergometer with increasing workloads. Minute ventilation, heart rate, breathing reserve, oxygen uptake (V’O<sub>2</sub>), O<sub>2</sub>-pulse, ventilatory equivalents for carbon dioxide and oxygen (V’<sub>E</sub>/V’CO<sub>2</sub> and V’<sub>E</sub>/V’O<sub>2</sub>, respectively) were measured at baseline and peak exercise. The slope and intercept for V’<sub>E</sub>/V’CO<sub>2</sub> was computed for all subjects. Peak V’O<sub>2</sub> 4% predicted indicated a circulatory or ventilatory limitation. Results: Complete clinical and physiological data were available for 36 patients (M/F 20/16);32 (89%) exhibited ventilatory or circulatory limitation as shown by a reduced peak V’O<sub>2</sub> and 10 subjects with normal physiologic data. The largest cohort comprised the pulmonary vascular group (n = 18) whose mean ± SD peak V’O<sub>2</sub> was 61% ± 17% predicted. There were close associations between V’O<sub>2</sub> and spirometric values. Peak V’<sub>E</sub>/V’O<sub>2</sub> and V’<sub>E</sub>/V’CO<sub>2</sub> were highest in the circulatory and ventilatory cohorts, consistent with increase in dead space breathing. The intercept of the V’<sub>E</sub>-V’CO<sub>2</sub> relationship was lowest in patients with cardiovascular impairment. Conclusion: Dyspneic patients with malignancies exhibit dead space breathing, many exhibiting a circulatory source for exercise limitation with a prominent pulmonary vascular component. Potential factors include effects of chemo- and radiation therapy on cardiac function and pulmonary vascular endothelium.展开更多
Objectives This study aims to assess the impacts of hypertension on health-related quality of life (HRQOL), as well as cardiovascular functional status (CVFS). Methods An instrument was presented based on WHOQOL-BREF ...Objectives This study aims to assess the impacts of hypertension on health-related quality of life (HRQOL), as well as cardiovascular functional status (CVFS). Methods An instrument was presented based on WHOQOL-BREF and SP-16 questionnaire and exercise testing. 57 normotensive and 76 hypertensive subjects aged 35-65 year-old participated the health survey using this instrument. Based on the exercise testing results of the two groups, a discriminate function was established and used to investigate cardiovascular risk factors for hypertensive population. Results The results showed that persons with hypertension rated significantly lower scores on physical health (i.e. limitation in performing daily activities and problems with work or mobility) than did normotensives (P < 0.01). The discriminant score obtained from the exercise testing results was capable of reflecting the impacts of hypertension on CVFS. Conclusions The method presented in this paper provides a more powerful tool to estimate the effects of health interventions and medical therapy for hypertensive population than just self-rated HRQOL questionnaire.展开更多
Vasovagal syncope(VVS),which is triggered by physical exertion,is typically observed in athletes or patients with structural heart disease.There have been few reported cases among sedentary individuals.This case repor...Vasovagal syncope(VVS),which is triggered by physical exertion,is typically observed in athletes or patients with structural heart disease.There have been few reported cases among sedentary individuals.This case report details the experience of a 42-year-old sedentary woman who fainted during a treadmill stress test.Despite the absence of abnormalities in baseline cardiac and neurological evaluations,the patient exhibited sinus arrest(lasting 5–12 seconds)with significant ST-segment depression during haemodynamic collapse.Comprehensive assessments,incorporating coronary angiography,echocardiography,cranial computed tomography(CT),and biochemical testing,excluded the presence of structural or ischemic heart disease,arrhythmogenic syndromes,and cerebrovascular disorders.A Calgary Syncope Symptom Score of 3 confirmed the diagnosis of VVS,a diagnosis that was further substantiated by the patient’s symptoms resolving spontaneously when she was positioned supine.This case demonstrates that exercise-induced syncope can occur in individuals who are physically unfit and have no cardiac abnormalities.Transient ST-segment changes in such cases reflect autonomic nervous system dysfunction rather than myocardial ischaemia.It is incumbent upon clinicians to consider a neurocardiogenic mechanism in sedentary patients presenting with exertional syncope despite a negative standard cardiac evaluation.展开更多
We hypothesized that slowed oxygen uptake(VO_(2))kinetics for exercise transitions to higher power outputs(PO)within the steady state(SS)domain would increase the mean response time(MRT)with increasing exercise intens...We hypothesized that slowed oxygen uptake(VO_(2))kinetics for exercise transitions to higher power outputs(PO)within the steady state(SS)domain would increase the mean response time(MRT)with increasing exercise intensity during incremental exercise.Fourteen highly trained cyclists(mean±standard deviation[SD]);age(39±6)years[yr];and VO_(2) peak=(61±9)mL/kg/min performed a maximal,ramp incremental cycling test and on separate days,four 6-min bouts of cycling at 30%,45%,65%&75% of their incremental peak PO(Wpeak).SS trial data were used to calculate the MRT and verified by mono-exponential and linear curve fitting.When the ramp protocol attained the value from SS,the PO,in Watts(W),was converted to time(min)based on the ramp function W to quantify the incremental MRT(iMRT).Slope analyses for the VO_(2) responses of the SS versus incremental exercise data below the gas exchange threshold(GET)revealed a significant difference(p=0.003;[0.437±0.08]vs.[0.382±0.05]L·min^(-1)).There was a significant difference between the 45%Wpeak steady state VO_(2)(ss VO_(2))([3.08±0.30]L·min^(-1),respectively),and 30% Wpeak ss VO_(2)(2.26±0.24)(p<0.0001;[3.61±0.80]vs.[2.20±0.39]L·min^(-1))and between the iMRT for 45% and 30% Wpeak ss VO_(2) values([50.58±36.85]s vs.[32.20±43.28]s).These data indicate there is no single iMRT,which is consistent with slowed VO_(2) kinetics and an increasing VO_(2) deficit for higher exercise intensities within the SS domain.展开更多
Background Congenital long QT syndrome （LQTS） is an inherited ion channel disorder resulting in abnormal cardiac repolarization that can cause syncope and sudden death associated with a prolonged rate-corrected QT i...Background Congenital long QT syndrome （LQTS） is an inherited ion channel disorder resulting in abnormal cardiac repolarization that can cause syncope and sudden death associated with a prolonged rate-corrected QT interval and polymorphic ventricular tachycardia. Several studies in adults showed that LQTS patients have altered QT adaptation to heart rate changes compared with normal subjects which forming a ＂hysteresis loop＂ in the QT-circle length plot. This study was to observe the QT interval changing during exercise testing in children long QT syndrome （LQTS） patients, explore the new diagnosis methods of LQTS. Methods The subjects were divided into 3 groups according to 1993 LQTS diagnostic criteria. Group 1： LQTS group （n=17） who scored 〉 or = 4 points indicating definite LQTS. Group 2： Middle group （n=16）, patients who have prolonged QT interval but scored 1.5 to 3.5. Group 3： Normal control group （n=18）. The average age of all study population is （12.3±5.8） years. No case had beta-adrenergic antagonists administration before exercise testing. All subjects were underwent tread mill exercise testing and electrocardiograph in whole exercise testing and recovery were recorded. QT and heart rate changing during whole exercise testing period were recorded. /kQT, the QT interval at 1, 2, 4, 6 minutes into recovery subtract from the QT interval at a similar heart rate during exercise, were calculated. Results In all three groups, QT intervals were shortening with the increasing of heart rate, but QTc had no significant change. ΔQT at 1 minute （（45±11） ms）, 2 minutes （（37±15） ms）, 4 minutes （（23±12） ms） into recovery in LQTS group were significantly greater than that of the other two groups （P〈0.05, P〈0.01, P〈0.01, respectively）. There was no ΔQT significant difference between middle group and normal control group at recovery time. During the recovery phase in LQTS group, the QT interval remained shortened despite a decelerating heart rate, forming a hysteresis ＂loop＂ in the curve relating the QT interval to the cycle length. Conclusions In children LQTS patients, there is significant QT hysteresis loop in the relation of QT interval with heart rate during recovery of exercise testing, which could be useful to the early diagnosis for LQTS.展开更多
Background It is still unclear whether pulmonary function tests （PFTs） are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test （CPET）...Background It is still unclear whether pulmonary function tests （PFTs） are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test （CPET） for further assessment.Thus, this study was designed to evaluate the CPET and compare the results of CPET and conventional PFTs to identify which parameters are more reliable and valuable in predicting perioperative risks for high risk patients with lung cancer.Methods From January 2005 to August 2008, 297 consecutive lung cancer patients underwent conventional PFTs （spirometry ＋ single-breath carbon monoxide diffusing capacity of the lungs （DLCOsb） for diffusion capacity） and CPET preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET was retrospectively analyzed using the chi-square test, independent sample t test and binary Logistic regression analysis.Results Of the 297 patients, 78 did not receive operation due to advanced disease stage or poor cardiopulmonary function. The remaining 219 underwent different modes of operations. Twenty-one cases were excluded from this study due to exploration alone （15 cases） and operation-related complications （6 cases）. Thus, 198 cases were eligible for evaluation. Fifty of the 198 patients （25.2%） had postoperative cardiopulmonary complications. Three patients （1.5%）died of complications within 30 postoperative days. The patients were stratified into groups based on VO2max/pred respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with cardiopulmonary complications were significantly correlated with age, comorbidities, and poor PFT and CPET results.used to stratify the patients＇ cardiopulmonary function status and to predict the risk of postoperative cardiopulmonary predicting perioperative risk. If available, cardiopulmonary exercise testing is strongly suggested for high-risk lung cancer patients in addition to conventional pulmonary function tests, and both should be combined to assess cardiopulmonary function status.展开更多
The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional...The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.展开更多
BACKGROUND Morphomics,a computed tomography-based body composition assessment,helps predicting esophageal cancer outcomes,but its link to bioelectrical impedance analysis(BIA)and functional assessments such as hand gr...BACKGROUND Morphomics,a computed tomography-based body composition assessment,helps predicting esophageal cancer outcomes,but its link to bioelectrical impedance analysis(BIA)and functional assessments such as hand grip strength(HGS)and cardiopulmonary exercise testing(CPET)remains unclear.AIM To investigate correlations between morphomics and BIA,HGS,CPET,and assess its ability to predict low cardiorespiratory fitness(CRF).METHODS Fifty esophageal cancer patients underwent multi-level morphomics,BIA,HGS,and CPET.Correlations were analyzed using heatmaps and scatter plots,and logistic regression assessed morphomic predictive value for low CRF.RESULTS T11 is the only level with complete morphomic data,making it the most applicable.To ensure reliability,T11 and its adjacent levels,T10-12,were included in the subsequent analysis.Dorsal muscle group volume from T10-12 morphomics all correlated positively with BIA muscle components(r=0.56-0.68,all P<0.001),HGS(r=0.4-0.48,all P<0.001),and CPET variables(r=0.43-0.51,all P<0.001).Subcutaneous fat area and visceral fat area from morphomics correlated with body fat percentage(r=0.58-0.67,all P<0.001)and negatively with CPET parameters(r=-0.33 to-0.52,all P<0.05).Morphomics also showed potential in identifying low CRF,with an area under the receiver operating characteristic curve of 0.778.CONCLUSION T11 morphomics shows strong correlation with BIA,HGS,and CPET,and may serve as a practical tool for preoperative risk assessment in esophageal cancer patients.展开更多
Measuring cardiorespiratory fitness(CRF)is an important predictor of morbidity and mortality in epidemiological studies and clinical settings.1 However,the feasibility of measuring maximal CRF is low due to the time,e...Measuring cardiorespiratory fitness(CRF)is an important predictor of morbidity and mortality in epidemiological studies and clinical settings.1 However,the feasibility of measuring maximal CRF is low due to the time,equipment,and expertise needed to conduct laboratory cardiopulmonary exercise testing(CPET)to determine the maximal rate of oxygen uptake(VO2max)as an objective measure of CRF.Alternatively,indirect estimates of CRF have been applied by measuring maximal duration on treadmill or cycle ergometer tests,2,3 extrapolating maximal CRF from workload or heart rate during submaximal fitness tests,4,5 and using non-exercise algorithms to estimate CRF from an individual’s age,sex,body mass,and physical activity habits.6 It is assumed that objectively measured VO2max is superior to extrapolated and estimated values due to errors associated with the estimated values;7,8 however,until Singh et al.9 newly released article in the Journal of Sport and Health Science,the comparability of these methods in identifying risks for all-cause and cardiovascular disease(CVD)mortality was unknown.展开更多
Background:Acute mountain sickness(AMS)is the mildest form of acute altitude illnesses,and consists of nonspecific symptoms when unacclimatized persons ascend to elevation of≥2500 m.Risk factors of AMS include:the al...Background:Acute mountain sickness(AMS)is the mildest form of acute altitude illnesses,and consists of nonspecific symptoms when unacclimatized persons ascend to elevation of≥2500 m.Risk factors of AMS include:the altitude,individual susceptibility,ascending rate and degree of pre-acclimatization.In the current study,we examined whether physiological response at low altitude could predict the development of AMS.Methods:A total of 111 healthy adult healthy volunteers participated in this trial;and 99(67 men and 32 women)completed the entire study protocol.Subjects were asked to complete a 9-min exercise program using a mechanically braked bicycle ergometer at low altitude(500 m).Heart rate,blood pressure(BP)and pulse oxygen saturation(SpO2)were recorded prior to and during the last minute of exercise.The ascent from 500 m to 4100 m was completed in 2 days.AMS was defined as≥3 points in a 4-item Lake Louise Score,with at least one point from headache wat 6–8 h after the ascent.Results:Among the 99 assessable subjects,47(23 men and 24 women)developed AMS at 4100 m.In comparison to the subjects without AMS,those who developed AMS had lower proportion of men(48.9%vs.84.6%,P<0.001),height(168.4±5.9 cm vs.171.3±6.1 cm,P=0.019),weight(62.0±10.0 kg vs.66.7±8.6 kg,P=0.014)and proportion of smokers(23.4%vs.51.9%,P=0.004).Multivariate regression analysis revealed the following independent risks for AMS:female sex(odds ratio(OR)=6.32,P<0.001),SpO2 change upon exercise at low altitude(OR=0.63,P=0.002)and systolic BP change after the ascent(OR=0.96,P=0.029).Women had larger reduction in SpO2 after the ascent,higher AMS percentage and absolute AMS score.Larger reduction of SpO2 after exercise was associated with both AMS incidence(P=0.001)and AMS score(P<0.001)in men but not in women.Conclusions:Larger SpO2 reduction after exercise at low altitude was an independent risk for AMS upon ascent.Such an association was more robust in men than in women.Trial registration:Chinese Clinical Trial Registration,ChiCTR1900025728.Registered 6 September 2019.展开更多
BACKGROUND Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure(CHF).Patients with CHF are characterized by impaired vasodilation and inflammation of the vascular endot...BACKGROUND Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure(CHF).Patients with CHF are characterized by impaired vasodilation and inflammation of the vascular endothelium.They also have low levels of endothelial progenitor cells(EPCs).EPCs are bone marrow derived cells involved in endothelium regeneration,homeostasis,and neovascularization.Exercise has been shown to improve vasodilation and stimulate the mobilization of EPCs in healthy people and patients with cardiovascular comorbidities.However,the effects of exercise on EPCs in different stages of CHF remain under investigation.AIM To evaluate the effect of a symptom-limited maximal cardiopulmonary exercise testing(CPET)on EPCs in CHF patients of different severity.METHODS Forty-nine consecutive patients(41 males)with stable CHF[mean age(years):56±10,ejection fraction(EF,%):32±8,peak oxygen uptake(VO2,mL/kg/min):18.1±4.4]underwent a CPET on a cycle ergometer.Venous blood was sampled before and after CPET.Five circulating endothelial populations were quantified by flow cytometry:Three subgroups of EPCs[CD34+/CD45-/CD133+,CD34+/CD45-/CD133+/VEGFR2 and CD34+/CD133+/vascular endothelial growth factor receptor 2(VEGFR2)]and two subgroups of circulating endothelial cells(CD34+/CD45-/CD133-and CD34+/CD45-/CD133-/VEGFR2).Patients were divided in two groups of severity according to the median value of peak VO2(18.0 mL/kg/min),predicted peak VO2(65.5%),ventilation/carbon dioxide output slope(32.5)and EF(reduced and mid-ranged EF).EPCs values are expressed as median(25th-75th percentiles)in cells/106 enucleated cells.RESULTS Patients with lower peak VO2 increased the mobilization of CD34+/CD45-/CD133+[pre CPET:60(25-76)vs post CPET:90(70-103)cells/106 enucleated cells,P<0.001],CD34+/CD45-/CD133+/VEGFR2[pre CPET:1(1-4)vs post CPET:5(3-8)cells/106 enucleated cells,P<0.001],CD34+/CD45-/CD133-[pre CPET:186(141-361)vs post CPET:488(247-658)cells/106 enucleated cells,P<0.001]and CD34+/CD45-/CD133-/VEGFR2[pre CPET:2(1-2)vs post CPET:3(2-5)cells/106 enucleated cells,P<0.001],while patients with higher VO2 increased the mobilization of CD34+/CD45-/CD133+[pre CPET:42(19-73)vs post CPET:90(39-118)cells/106 enucleated cells,P<0.001],CD34+/CD45-/CD133+/VEGFR2[pre CPET:2(1-3)vs post CPET:6(3-9)cells/106 enucleated cells,P<0.001],CD34+/CD133+/VEGFR2[pre CPET:10(7-18)vs post CPET:14(10-19)cells/106 enucleated cells,P<0.01],CD34+/CD45-/CD133-[pre CPET:218(158-247)vs post CPET:311(254-569)cells/106 enucleated cells,P<0.001]and CD34+/CD45-/CD133-/VEGFR2[pre CPET:1(1-2)vs post CPET:4(2-6)cells/106 enucleated cells,P<0.001].A similar increase in the mobilization of at least four out of five cellular populations was observed after maximal exercise within each severity group regarding predicted peak,ventilation/carbon dioxide output slope and EF as well(P<0.05).However,there were no statistically significant differences in the mobilization of endothelial cellular populations between severity groups in each comparison(P>0.05).CONCLUSION Our study has shown an increased EPCs and circulating endothelial cells mobilization after maximal exercise in CHF patients,but this increase was not associated with syndrome severity.Further investigation,however,is needed.展开更多
Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Me...Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing (TET) was conducted in 88 patients (40 CAD patients, 48 control subjects) with or without hypertension, each of whom underwent selective coronary angiography (CAG). The abnormal increase of postexercise SBP was defined as 10mmHg higher than earlier periods during the recovery phase (6 minutes) of exercise testing. Results The abnormal increase of postexercise SBP had higher sensitivity, specificity, and accuracy for detecting CAD than those of ST - segment depression in patients with or without hypertension. Its accuracy increased with the severity of CAD while decreased in patients with hypertension, and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. The combination of ST - segment depression and abnormal increase of postexercise SBP diagnosed CAD most accurately in patients with hypertension. Conclusions Abnormal increase of postexercise SBP may be a useful index for diagnosing CAD.展开更多
Objectives:To describe the current state of exercise capacity as well as to identify its predictors in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) or coronary artery ...Objectives:To describe the current state of exercise capacity as well as to identify its predictors in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the mainland of China.Methods:A retrospective study design was employed.We evaluated 230 CAD patients following PCI or CABG in a cardiac rehabilitation center from January 2019 to October 2019.The patients were referred to undergo incremental cardiopulmonary exercise testing with a cycle ergometer.The Zung Self-Rating Anxiety Scale and the Zung Self-Rating Depression Scale were used to evaluate patients' mental health.Statistical analysis was performed using the chi-square test,Fisher's exact test,t-test,Mann-Whitney U test,and binary logistic regression.Results:Among the 230 patients,223 patients demonstrated reduced exercise capacity.Resutlts of the logistic regression analysis showed that anxiety (OR =1.13,95% CI 1.01-1.32,P =0.029) was an independent risk factor for reduced exercise capacity in patients following the PCI or CABG.Conclusions:Exercise capacity of Chinese CAD patients after PCI or CABG was relatively poor.Alleviating symptoms of anxiety and making exercise prescriptions according to the results of the cardiopulmonary exercise test should be considered during the intervention to improve CAD patients' exercise capacity.展开更多
The aim of this present study was to investigate the effects of training on exercise tolerance of patients with coronary heart disease after percutaneous coronary intervention.Fifty-seven cases of coronary heart disea...The aim of this present study was to investigate the effects of training on exercise tolerance of patients with coronary heart disease after percutaneous coronary intervention.Fifty-seven cases of coronary heart disease after percutaneous coronary intervention were divided randomly into the rehabilitation training group（26 cases） and control group（31 cases）.Patients in the rehabilitation training group received rehabilitation training at different stages and exercise intensities 3 d after percutaneous coronary intervention for 3 months.The heart rate,blood pressure,ECG changes in treadmill exercise test,and the frequency of anginal episodes were observed.The results showed that NST and ΣST of ECG and the frequency of anginal episodes were significantly reduced in the rehabilitation training group.In addition,exercise tolerance was improved and the total exercise time was lengthened in these patients.Moreover,ST segment depression time and emergence time of angina with exercise were also lengthened compared with controls（P 〈 0.05,or 0.01）.However,the heart rate and blood pressure before and after exercise of the two groups were similar.The study indicated that rehabilitation training could significantly relieve angina,amend ischemic features of ECG,and improve exercise tolerance of coronary heart disease patients after percutaneous coronary intervention.展开更多
Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how ca...Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Conclusion:HRR during submaximal exercise is associated with future risk for delirium.Given that HRR is potentially modifiable,it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.展开更多
Objective: Although after pacing animal and human studies have demonstrated a rate-dependent effect of sotalol on ventricular repolarization, there is little information on the effects of sotalol on ventricular repola...Objective: Although after pacing animal and human studies have demonstrated a rate-dependent effect of sotalol on ventricular repolarization, there is little information on the effects of sotalol on ventricular repolarization during exercise. This study attempted to show the effects of sotalol on ventricular repolarization during physiological exercise. Methods: Thirty-one healthy volunteers (18 males, 13 females) were enrolled in the study. Each performed a maximal treadmill exercise test according to the Bruce protocol after random treatment with sotalol, propranolol and placebo. Results: Sotalol significantly prolonged QTc (corrected QT) and JTc (corrected JT) intervals at rest compared with propranolol (QTc 324.86 ms vs 305.21 ms, P<0.001; JTc 245.04 ms vs 224.17 ms, P<0.001) and placebo (QTc 324.86 ms vs 314.06 ms, P<0.01; JTc 245.04 ms vs. 232.69 ms, P<0.001). The JTc percent reduction increased progressively with each stage of exercise and correlated positively with exercise heart rate (r=0.148, P<0.01). The JTc percent reduction correlation with exercise heart rate did not exist with either propranolol or placebo. Conclusions: These results imply that with sotalol ventricular repolarization is progressively shortened after exercise. Thus the specific class III antiarrhythmic activity of sotalol, present as delay of ventricular repolarization, may be attenuated during exercise. Such findings may imply the need to consider other antiarrythmic therapy during periods of stress-induced tachycardia.展开更多
BACKGROUND Lung resection represents the main curative treatment modality of non-small cell lung cancer.Patients with high-risk to develop postoperative pulmonary complications have been classified as“high-risk patie...BACKGROUND Lung resection represents the main curative treatment modality of non-small cell lung cancer.Patients with high-risk to develop postoperative pulmonary complications have been classified as“high-risk patients.”Characterizing this population could be important to improve their approach and rehabilitation.AIM To identify the differences between high and low-risk patients in exercise capacity and self-perceived health status after hospitalization.METHODS A longitudinal observational prospective cohort study was carried out.Patients undergoing lung resection were recruited from the“Hospital Virgen de las Nieves”(Granada)and divided into two groups according to the risk profile criteria(age≥70 years,forced expiratory volume in 1 s≤70%predicted,carbon monoxide diffusion capacity≤70%predicted or scheduled pneumonectomy).Outcomes included were exercise capacity(Fatigue Severity Scale,Unsupported Upper-Limb Exercise,handgrip dynamometry,Five Sit-to-stand test,and quadriceps hand-held dynamometry)and patient-reported outcome(Euroqol-5 dimensions 5 Levels Visual Analogue Scale).RESULTS In total,115 participants were included in the study and divided into three groups:high-risk,low-risk and control group.At discharge high-risk patients presented a poorer exercise capacity and a worse self-perceived health status(P<0.05).One month after discharge patients in the high-risk group maintained these differences compared to the other groups.CONCLUSION Our results show a poorer recovery in high-risk patients at discharge and 1 mo after surgery,with lower self-perceived health status and a poorer upper and lower limb exercise capacity.These results are important in the rehabilitation field.展开更多
To evaluate the values of abnormal heart rate recovery （HRR） after treadmill exercise test in patients with coronary artery disease （CAD）. Methods One hundred and seventy-eight consecutive cases of suspected CAD w...To evaluate the values of abnormal heart rate recovery （HRR） after treadmill exercise test in patients with coronary artery disease （CAD）. Methods One hundred and seventy-eight consecutive cases of suspected CAD who underwent symptom-limited treadmill exercise test （TET） and coronary angiography （CAG） were enrolled and divided into normal and abnormal HRR group based on the status of the values of HRR one or two minutes after TET. The clinical characteristics, TET parameters and CAG results of the two groups were compared attempted to assess the value of HRR on patients with CAD. Results （ 1 ） The cases of smoking, diabetes mellitus （DM） and ST segment deviation at rest in abnormal HRR group were more significantly than those in normal HRR group （ all P 〈 0. 05 ）. （2） The subjects of abnormal HRR usually had higher basal heart rate, more cases exhibited ST segment abnormality and or exercise-limited angina during or after TET（P 〈 0. 01 and P 〈 0. 05, respectively）, but lower level of peak heart rate attained （ P 〈 0. 05 ） than those in normal group. The values of metabolism equivalents and duration of TET between the two groups displayed phenomenal difference （ P 〈 0. 05 ）. There were more samples acquired moderate to high level of Duke test score and chronotropic incompetence in the group of abnormal HRR, compared to the normal HRR group （P 〈 0. 01 ）. （3） The cases of negative CAG results in the group of normal and abnormal HRR group were 73 （66. 97 % ） and 24 （34. 78 % ）. Cases of significant coronary lesions （ at least one major coronary vessel ≥ 50 % stenosis） amongst the subgroup of positive CAG were 36 （ 33.03 % ） and 45 （65.22 % ）, severe coronary lesions （ three-vessel, left main or the equivalents of left main） were 10 （9. 17 % ） and 17 （24. 64 % ） for normal and abnormal HRR respectively （P 〈 0. 01 ）. Accordingly, the Gensini scores in the subunit of abnormal HRR increased. （4）Linear correlation analysis indicate there was a negative correlation between the values of HRR in the first and second minutes and indices of severity of CAD （ all P 〈 0. 01 ）. The analysis of auxiliary diagnostic value of abnormal HRR indicated the annexed HRR standard had higher negative predictive value. Conclusions The status of HRR after TET are not only influenced by the clinical factors related to the cardiac autonomic function, but also associated with the extent of CAD. （ S Chin J Cardiol 2009 ; 10（1）：1-8）展开更多
Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,sur...Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of life.These complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality rates.Despite the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac surgery.Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength.Early mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance exercises.Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity.During the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac rehabilitation.By incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.展开更多
Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs ...Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs during graded EST and analyzed via a post-processing method. Autonomic function was determined by Power Spectral Analysis of the very low frequency (VLF), low frequency (LF), high frequency (HF), and the ratio of LF/HF. We correlated HRV indices with resting, exercise, and recovery data. Results: No differences were found in anthropometric measurements, peak EST HR, and METS between individuals with slow HRR (below 18 b/min) compared with controls (HRR > 18 b/min). Only the VLF component of the HRV indices was statistically different (p = 0.03) at one-minute post-exercise compared with controls. Additionally, a significant correlation between HRR and resting LF and HF indices was found in the individuals with slow HRR but not in the controls. Conclusion: In apparently healthy individuals with slow HRR post-EST, autonomic function did not demonstrate any differences at any phase of the EST, including at one minute of recovery. However, a significant correlation was found between resting LF and HF powers and HRR in individuals with slow vagal reactivation post-exercise. The clinical and prognostic implications of such observation deserve further investigation.展开更多
文摘Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives: In this retrospective pilot study, we evaluated patients with hematologic and solid malignancies by CPET to determine the primary source of their dyspnea. Methods: Subjects were exercised on a cycle ergometer with increasing workloads. Minute ventilation, heart rate, breathing reserve, oxygen uptake (V’O<sub>2</sub>), O<sub>2</sub>-pulse, ventilatory equivalents for carbon dioxide and oxygen (V’<sub>E</sub>/V’CO<sub>2</sub> and V’<sub>E</sub>/V’O<sub>2</sub>, respectively) were measured at baseline and peak exercise. The slope and intercept for V’<sub>E</sub>/V’CO<sub>2</sub> was computed for all subjects. Peak V’O<sub>2</sub> 4% predicted indicated a circulatory or ventilatory limitation. Results: Complete clinical and physiological data were available for 36 patients (M/F 20/16);32 (89%) exhibited ventilatory or circulatory limitation as shown by a reduced peak V’O<sub>2</sub> and 10 subjects with normal physiologic data. The largest cohort comprised the pulmonary vascular group (n = 18) whose mean ± SD peak V’O<sub>2</sub> was 61% ± 17% predicted. There were close associations between V’O<sub>2</sub> and spirometric values. Peak V’<sub>E</sub>/V’O<sub>2</sub> and V’<sub>E</sub>/V’CO<sub>2</sub> were highest in the circulatory and ventilatory cohorts, consistent with increase in dead space breathing. The intercept of the V’<sub>E</sub>-V’CO<sub>2</sub> relationship was lowest in patients with cardiovascular impairment. Conclusion: Dyspneic patients with malignancies exhibit dead space breathing, many exhibiting a circulatory source for exercise limitation with a prominent pulmonary vascular component. Potential factors include effects of chemo- and radiation therapy on cardiac function and pulmonary vascular endothelium.
文摘Objectives This study aims to assess the impacts of hypertension on health-related quality of life (HRQOL), as well as cardiovascular functional status (CVFS). Methods An instrument was presented based on WHOQOL-BREF and SP-16 questionnaire and exercise testing. 57 normotensive and 76 hypertensive subjects aged 35-65 year-old participated the health survey using this instrument. Based on the exercise testing results of the two groups, a discriminate function was established and used to investigate cardiovascular risk factors for hypertensive population. Results The results showed that persons with hypertension rated significantly lower scores on physical health (i.e. limitation in performing daily activities and problems with work or mobility) than did normotensives (P < 0.01). The discriminant score obtained from the exercise testing results was capable of reflecting the impacts of hypertension on CVFS. Conclusions The method presented in this paper provides a more powerful tool to estimate the effects of health interventions and medical therapy for hypertensive population than just self-rated HRQOL questionnaire.
文摘Vasovagal syncope(VVS),which is triggered by physical exertion,is typically observed in athletes or patients with structural heart disease.There have been few reported cases among sedentary individuals.This case report details the experience of a 42-year-old sedentary woman who fainted during a treadmill stress test.Despite the absence of abnormalities in baseline cardiac and neurological evaluations,the patient exhibited sinus arrest(lasting 5–12 seconds)with significant ST-segment depression during haemodynamic collapse.Comprehensive assessments,incorporating coronary angiography,echocardiography,cranial computed tomography(CT),and biochemical testing,excluded the presence of structural or ischemic heart disease,arrhythmogenic syndromes,and cerebrovascular disorders.A Calgary Syncope Symptom Score of 3 confirmed the diagnosis of VVS,a diagnosis that was further substantiated by the patient’s symptoms resolving spontaneously when she was positioned supine.This case demonstrates that exercise-induced syncope can occur in individuals who are physically unfit and have no cardiac abnormalities.Transient ST-segment changes in such cases reflect autonomic nervous system dysfunction rather than myocardial ischaemia.It is incumbent upon clinicians to consider a neurocardiogenic mechanism in sedentary patients presenting with exertional syncope despite a negative standard cardiac evaluation.
文摘We hypothesized that slowed oxygen uptake(VO_(2))kinetics for exercise transitions to higher power outputs(PO)within the steady state(SS)domain would increase the mean response time(MRT)with increasing exercise intensity during incremental exercise.Fourteen highly trained cyclists(mean±standard deviation[SD]);age(39±6)years[yr];and VO_(2) peak=(61±9)mL/kg/min performed a maximal,ramp incremental cycling test and on separate days,four 6-min bouts of cycling at 30%,45%,65%&75% of their incremental peak PO(Wpeak).SS trial data were used to calculate the MRT and verified by mono-exponential and linear curve fitting.When the ramp protocol attained the value from SS,the PO,in Watts(W),was converted to time(min)based on the ramp function W to quantify the incremental MRT(iMRT).Slope analyses for the VO_(2) responses of the SS versus incremental exercise data below the gas exchange threshold(GET)revealed a significant difference(p=0.003;[0.437±0.08]vs.[0.382±0.05]L·min^(-1)).There was a significant difference between the 45%Wpeak steady state VO_(2)(ss VO_(2))([3.08±0.30]L·min^(-1),respectively),and 30% Wpeak ss VO_(2)(2.26±0.24)(p<0.0001;[3.61±0.80]vs.[2.20±0.39]L·min^(-1))and between the iMRT for 45% and 30% Wpeak ss VO_(2) values([50.58±36.85]s vs.[32.20±43.28]s).These data indicate there is no single iMRT,which is consistent with slowed VO_(2) kinetics and an increasing VO_(2) deficit for higher exercise intensities within the SS domain.
文摘Background Congenital long QT syndrome （LQTS） is an inherited ion channel disorder resulting in abnormal cardiac repolarization that can cause syncope and sudden death associated with a prolonged rate-corrected QT interval and polymorphic ventricular tachycardia. Several studies in adults showed that LQTS patients have altered QT adaptation to heart rate changes compared with normal subjects which forming a ＂hysteresis loop＂ in the QT-circle length plot. This study was to observe the QT interval changing during exercise testing in children long QT syndrome （LQTS） patients, explore the new diagnosis methods of LQTS. Methods The subjects were divided into 3 groups according to 1993 LQTS diagnostic criteria. Group 1： LQTS group （n=17） who scored 〉 or = 4 points indicating definite LQTS. Group 2： Middle group （n=16）, patients who have prolonged QT interval but scored 1.5 to 3.5. Group 3： Normal control group （n=18）. The average age of all study population is （12.3±5.8） years. No case had beta-adrenergic antagonists administration before exercise testing. All subjects were underwent tread mill exercise testing and electrocardiograph in whole exercise testing and recovery were recorded. QT and heart rate changing during whole exercise testing period were recorded. /kQT, the QT interval at 1, 2, 4, 6 minutes into recovery subtract from the QT interval at a similar heart rate during exercise, were calculated. Results In all three groups, QT intervals were shortening with the increasing of heart rate, but QTc had no significant change. ΔQT at 1 minute （（45±11） ms）, 2 minutes （（37±15） ms）, 4 minutes （（23±12） ms） into recovery in LQTS group were significantly greater than that of the other two groups （P〈0.05, P〈0.01, P〈0.01, respectively）. There was no ΔQT significant difference between middle group and normal control group at recovery time. During the recovery phase in LQTS group, the QT interval remained shortened despite a decelerating heart rate, forming a hysteresis ＂loop＂ in the curve relating the QT interval to the cycle length. Conclusions In children LQTS patients, there is significant QT hysteresis loop in the relation of QT interval with heart rate during recovery of exercise testing, which could be useful to the early diagnosis for LQTS.
文摘Background It is still unclear whether pulmonary function tests （PFTs） are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test （CPET） for further assessment.Thus, this study was designed to evaluate the CPET and compare the results of CPET and conventional PFTs to identify which parameters are more reliable and valuable in predicting perioperative risks for high risk patients with lung cancer.Methods From January 2005 to August 2008, 297 consecutive lung cancer patients underwent conventional PFTs （spirometry ＋ single-breath carbon monoxide diffusing capacity of the lungs （DLCOsb） for diffusion capacity） and CPET preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET was retrospectively analyzed using the chi-square test, independent sample t test and binary Logistic regression analysis.Results Of the 297 patients, 78 did not receive operation due to advanced disease stage or poor cardiopulmonary function. The remaining 219 underwent different modes of operations. Twenty-one cases were excluded from this study due to exploration alone （15 cases） and operation-related complications （6 cases）. Thus, 198 cases were eligible for evaluation. Fifty of the 198 patients （25.2%） had postoperative cardiopulmonary complications. Three patients （1.5%）died of complications within 30 postoperative days. The patients were stratified into groups based on VO2max/pred respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with cardiopulmonary complications were significantly correlated with age, comorbidities, and poor PFT and CPET results.used to stratify the patients＇ cardiopulmonary function status and to predict the risk of postoperative cardiopulmonary predicting perioperative risk. If available, cardiopulmonary exercise testing is strongly suggested for high-risk lung cancer patients in addition to conventional pulmonary function tests, and both should be combined to assess cardiopulmonary function status.
文摘The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.
基金Supported by Chang Gung Memorial Hospital,Taiwan,No.CMRPG3N1171,No.CMRPG3N1172,No.CORPVVN0071,No.CMRPVVK0111-3 and No.CMRPVVL0121-3National Science and Technology Council,Taiwan,No.MOST 114-2314-B-182A-066-.
文摘BACKGROUND Morphomics,a computed tomography-based body composition assessment,helps predicting esophageal cancer outcomes,but its link to bioelectrical impedance analysis(BIA)and functional assessments such as hand grip strength(HGS)and cardiopulmonary exercise testing(CPET)remains unclear.AIM To investigate correlations between morphomics and BIA,HGS,CPET,and assess its ability to predict low cardiorespiratory fitness(CRF).METHODS Fifty esophageal cancer patients underwent multi-level morphomics,BIA,HGS,and CPET.Correlations were analyzed using heatmaps and scatter plots,and logistic regression assessed morphomic predictive value for low CRF.RESULTS T11 is the only level with complete morphomic data,making it the most applicable.To ensure reliability,T11 and its adjacent levels,T10-12,were included in the subsequent analysis.Dorsal muscle group volume from T10-12 morphomics all correlated positively with BIA muscle components(r=0.56-0.68,all P<0.001),HGS(r=0.4-0.48,all P<0.001),and CPET variables(r=0.43-0.51,all P<0.001).Subcutaneous fat area and visceral fat area from morphomics correlated with body fat percentage(r=0.58-0.67,all P<0.001)and negatively with CPET parameters(r=-0.33 to-0.52,all P<0.05).Morphomics also showed potential in identifying low CRF,with an area under the receiver operating characteristic curve of 0.778.CONCLUSION T11 morphomics shows strong correlation with BIA,HGS,and CPET,and may serve as a practical tool for preoperative risk assessment in esophageal cancer patients.
文摘Measuring cardiorespiratory fitness(CRF)is an important predictor of morbidity and mortality in epidemiological studies and clinical settings.1 However,the feasibility of measuring maximal CRF is low due to the time,equipment,and expertise needed to conduct laboratory cardiopulmonary exercise testing(CPET)to determine the maximal rate of oxygen uptake(VO2max)as an objective measure of CRF.Alternatively,indirect estimates of CRF have been applied by measuring maximal duration on treadmill or cycle ergometer tests,2,3 extrapolating maximal CRF from workload or heart rate during submaximal fitness tests,4,5 and using non-exercise algorithms to estimate CRF from an individual’s age,sex,body mass,and physical activity habits.6 It is assumed that objectively measured VO2max is superior to extrapolated and estimated values due to errors associated with the estimated values;7,8 however,until Singh et al.9 newly released article in the Journal of Sport and Health Science,the comparability of these methods in identifying risks for all-cause and cardiovascular disease(CVD)mortality was unknown.
基金supported by grants from the Research Project of PLA(BLJ18J007)the National Natural Science Foundation of China(81730054)the Ministry of Health of China(201002012)。
文摘Background:Acute mountain sickness(AMS)is the mildest form of acute altitude illnesses,and consists of nonspecific symptoms when unacclimatized persons ascend to elevation of≥2500 m.Risk factors of AMS include:the altitude,individual susceptibility,ascending rate and degree of pre-acclimatization.In the current study,we examined whether physiological response at low altitude could predict the development of AMS.Methods:A total of 111 healthy adult healthy volunteers participated in this trial;and 99(67 men and 32 women)completed the entire study protocol.Subjects were asked to complete a 9-min exercise program using a mechanically braked bicycle ergometer at low altitude(500 m).Heart rate,blood pressure(BP)and pulse oxygen saturation(SpO2)were recorded prior to and during the last minute of exercise.The ascent from 500 m to 4100 m was completed in 2 days.AMS was defined as≥3 points in a 4-item Lake Louise Score,with at least one point from headache wat 6–8 h after the ascent.Results:Among the 99 assessable subjects,47(23 men and 24 women)developed AMS at 4100 m.In comparison to the subjects without AMS,those who developed AMS had lower proportion of men(48.9%vs.84.6%,P<0.001),height(168.4±5.9 cm vs.171.3±6.1 cm,P=0.019),weight(62.0±10.0 kg vs.66.7±8.6 kg,P=0.014)and proportion of smokers(23.4%vs.51.9%,P=0.004).Multivariate regression analysis revealed the following independent risks for AMS:female sex(odds ratio(OR)=6.32,P<0.001),SpO2 change upon exercise at low altitude(OR=0.63,P=0.002)and systolic BP change after the ascent(OR=0.96,P=0.029).Women had larger reduction in SpO2 after the ascent,higher AMS percentage and absolute AMS score.Larger reduction of SpO2 after exercise was associated with both AMS incidence(P=0.001)and AMS score(P<0.001)in men but not in women.Conclusions:Larger SpO2 reduction after exercise at low altitude was an independent risk for AMS upon ascent.Such an association was more robust in men than in women.Trial registration:Chinese Clinical Trial Registration,ChiCTR1900025728.Registered 6 September 2019.
基金Greece and the European Union(European Social Fund-ESF)through the Operational Programme“Human Resources Development,Education and Lifelong Learning”in the context of the project“Strengthening Human Resources Research Potential via Doctorate Research”(MIS-5000432),implemented by the State Scholarships Foundation(ΙΚΥ)the special account for research grants of the National and Kapodistrian University of Athens,Athens,Greece.
文摘BACKGROUND Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure(CHF).Patients with CHF are characterized by impaired vasodilation and inflammation of the vascular endothelium.They also have low levels of endothelial progenitor cells(EPCs).EPCs are bone marrow derived cells involved in endothelium regeneration,homeostasis,and neovascularization.Exercise has been shown to improve vasodilation and stimulate the mobilization of EPCs in healthy people and patients with cardiovascular comorbidities.However,the effects of exercise on EPCs in different stages of CHF remain under investigation.AIM To evaluate the effect of a symptom-limited maximal cardiopulmonary exercise testing(CPET)on EPCs in CHF patients of different severity.METHODS Forty-nine consecutive patients(41 males)with stable CHF[mean age(years):56±10,ejection fraction(EF,%):32±8,peak oxygen uptake(VO2,mL/kg/min):18.1±4.4]underwent a CPET on a cycle ergometer.Venous blood was sampled before and after CPET.Five circulating endothelial populations were quantified by flow cytometry:Three subgroups of EPCs[CD34+/CD45-/CD133+,CD34+/CD45-/CD133+/VEGFR2 and CD34+/CD133+/vascular endothelial growth factor receptor 2(VEGFR2)]and two subgroups of circulating endothelial cells(CD34+/CD45-/CD133-and CD34+/CD45-/CD133-/VEGFR2).Patients were divided in two groups of severity according to the median value of peak VO2(18.0 mL/kg/min),predicted peak VO2(65.5%),ventilation/carbon dioxide output slope(32.5)and EF(reduced and mid-ranged EF).EPCs values are expressed as median(25th-75th percentiles)in cells/106 enucleated cells.RESULTS Patients with lower peak VO2 increased the mobilization of CD34+/CD45-/CD133+[pre CPET:60(25-76)vs post CPET:90(70-103)cells/106 enucleated cells,P<0.001],CD34+/CD45-/CD133+/VEGFR2[pre CPET:1(1-4)vs post CPET:5(3-8)cells/106 enucleated cells,P<0.001],CD34+/CD45-/CD133-[pre CPET:186(141-361)vs post CPET:488(247-658)cells/106 enucleated cells,P<0.001]and CD34+/CD45-/CD133-/VEGFR2[pre CPET:2(1-2)vs post CPET:3(2-5)cells/106 enucleated cells,P<0.001],while patients with higher VO2 increased the mobilization of CD34+/CD45-/CD133+[pre CPET:42(19-73)vs post CPET:90(39-118)cells/106 enucleated cells,P<0.001],CD34+/CD45-/CD133+/VEGFR2[pre CPET:2(1-3)vs post CPET:6(3-9)cells/106 enucleated cells,P<0.001],CD34+/CD133+/VEGFR2[pre CPET:10(7-18)vs post CPET:14(10-19)cells/106 enucleated cells,P<0.01],CD34+/CD45-/CD133-[pre CPET:218(158-247)vs post CPET:311(254-569)cells/106 enucleated cells,P<0.001]and CD34+/CD45-/CD133-/VEGFR2[pre CPET:1(1-2)vs post CPET:4(2-6)cells/106 enucleated cells,P<0.001].A similar increase in the mobilization of at least four out of five cellular populations was observed after maximal exercise within each severity group regarding predicted peak,ventilation/carbon dioxide output slope and EF as well(P<0.05).However,there were no statistically significant differences in the mobilization of endothelial cellular populations between severity groups in each comparison(P>0.05).CONCLUSION Our study has shown an increased EPCs and circulating endothelial cells mobilization after maximal exercise in CHF patients,but this increase was not associated with syndrome severity.Further investigation,however,is needed.
文摘Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing (TET) was conducted in 88 patients (40 CAD patients, 48 control subjects) with or without hypertension, each of whom underwent selective coronary angiography (CAG). The abnormal increase of postexercise SBP was defined as 10mmHg higher than earlier periods during the recovery phase (6 minutes) of exercise testing. Results The abnormal increase of postexercise SBP had higher sensitivity, specificity, and accuracy for detecting CAD than those of ST - segment depression in patients with or without hypertension. Its accuracy increased with the severity of CAD while decreased in patients with hypertension, and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. The combination of ST - segment depression and abnormal increase of postexercise SBP diagnosed CAD most accurately in patients with hypertension. Conclusions Abnormal increase of postexercise SBP may be a useful index for diagnosing CAD.
文摘Objectives:To describe the current state of exercise capacity as well as to identify its predictors in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the mainland of China.Methods:A retrospective study design was employed.We evaluated 230 CAD patients following PCI or CABG in a cardiac rehabilitation center from January 2019 to October 2019.The patients were referred to undergo incremental cardiopulmonary exercise testing with a cycle ergometer.The Zung Self-Rating Anxiety Scale and the Zung Self-Rating Depression Scale were used to evaluate patients' mental health.Statistical analysis was performed using the chi-square test,Fisher's exact test,t-test,Mann-Whitney U test,and binary logistic regression.Results:Among the 230 patients,223 patients demonstrated reduced exercise capacity.Resutlts of the logistic regression analysis showed that anxiety (OR =1.13,95% CI 1.01-1.32,P =0.029) was an independent risk factor for reduced exercise capacity in patients following the PCI or CABG.Conclusions:Exercise capacity of Chinese CAD patients after PCI or CABG was relatively poor.Alleviating symptoms of anxiety and making exercise prescriptions according to the results of the cardiopulmonary exercise test should be considered during the intervention to improve CAD patients' exercise capacity.
文摘The aim of this present study was to investigate the effects of training on exercise tolerance of patients with coronary heart disease after percutaneous coronary intervention.Fifty-seven cases of coronary heart disease after percutaneous coronary intervention were divided randomly into the rehabilitation training group（26 cases） and control group（31 cases）.Patients in the rehabilitation training group received rehabilitation training at different stages and exercise intensities 3 d after percutaneous coronary intervention for 3 months.The heart rate,blood pressure,ECG changes in treadmill exercise test,and the frequency of anginal episodes were observed.The results showed that NST and ΣST of ECG and the frequency of anginal episodes were significantly reduced in the rehabilitation training group.In addition,exercise tolerance was improved and the total exercise time was lengthened in these patients.Moreover,ST segment depression time and emergence time of angina with exercise were also lengthened compared with controls（P 〈 0.05,or 0.01）.However,the heart rate and blood pressure before and after exercise of the two groups were similar.The study indicated that rehabilitation training could significantly relieve angina,amend ischemic features of ECG,and improve exercise tolerance of coronary heart disease patients after percutaneous coronary intervention.
基金funded by National Institutes of Health(NIH)Grant R03AG067985Foundation for Anesthesia Education and Research+1 种基金funded by the BrightFocus Foundation Alzheimer’s Disease Research Program(A2020886S)funded by NIH Grants RF1AG059867 and RF1AG064312,funded by NIH Grant R01HL140574。
文摘Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Conclusion:HRR during submaximal exercise is associated with future risk for delirium.Given that HRR is potentially modifiable,it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.
文摘Objective: Although after pacing animal and human studies have demonstrated a rate-dependent effect of sotalol on ventricular repolarization, there is little information on the effects of sotalol on ventricular repolarization during exercise. This study attempted to show the effects of sotalol on ventricular repolarization during physiological exercise. Methods: Thirty-one healthy volunteers (18 males, 13 females) were enrolled in the study. Each performed a maximal treadmill exercise test according to the Bruce protocol after random treatment with sotalol, propranolol and placebo. Results: Sotalol significantly prolonged QTc (corrected QT) and JTc (corrected JT) intervals at rest compared with propranolol (QTc 324.86 ms vs 305.21 ms, P<0.001; JTc 245.04 ms vs 224.17 ms, P<0.001) and placebo (QTc 324.86 ms vs 314.06 ms, P<0.01; JTc 245.04 ms vs. 232.69 ms, P<0.001). The JTc percent reduction increased progressively with each stage of exercise and correlated positively with exercise heart rate (r=0.148, P<0.01). The JTc percent reduction correlation with exercise heart rate did not exist with either propranolol or placebo. Conclusions: These results imply that with sotalol ventricular repolarization is progressively shortened after exercise. Thus the specific class III antiarrhythmic activity of sotalol, present as delay of ventricular repolarization, may be attenuated during exercise. Such findings may imply the need to consider other antiarrythmic therapy during periods of stress-induced tachycardia.
文摘BACKGROUND Lung resection represents the main curative treatment modality of non-small cell lung cancer.Patients with high-risk to develop postoperative pulmonary complications have been classified as“high-risk patients.”Characterizing this population could be important to improve their approach and rehabilitation.AIM To identify the differences between high and low-risk patients in exercise capacity and self-perceived health status after hospitalization.METHODS A longitudinal observational prospective cohort study was carried out.Patients undergoing lung resection were recruited from the“Hospital Virgen de las Nieves”(Granada)and divided into two groups according to the risk profile criteria(age≥70 years,forced expiratory volume in 1 s≤70%predicted,carbon monoxide diffusion capacity≤70%predicted or scheduled pneumonectomy).Outcomes included were exercise capacity(Fatigue Severity Scale,Unsupported Upper-Limb Exercise,handgrip dynamometry,Five Sit-to-stand test,and quadriceps hand-held dynamometry)and patient-reported outcome(Euroqol-5 dimensions 5 Levels Visual Analogue Scale).RESULTS In total,115 participants were included in the study and divided into three groups:high-risk,low-risk and control group.At discharge high-risk patients presented a poorer exercise capacity and a worse self-perceived health status(P<0.05).One month after discharge patients in the high-risk group maintained these differences compared to the other groups.CONCLUSION Our results show a poorer recovery in high-risk patients at discharge and 1 mo after surgery,with lower self-perceived health status and a poorer upper and lower limb exercise capacity.These results are important in the rehabilitation field.
文摘To evaluate the values of abnormal heart rate recovery （HRR） after treadmill exercise test in patients with coronary artery disease （CAD）. Methods One hundred and seventy-eight consecutive cases of suspected CAD who underwent symptom-limited treadmill exercise test （TET） and coronary angiography （CAG） were enrolled and divided into normal and abnormal HRR group based on the status of the values of HRR one or two minutes after TET. The clinical characteristics, TET parameters and CAG results of the two groups were compared attempted to assess the value of HRR on patients with CAD. Results （ 1 ） The cases of smoking, diabetes mellitus （DM） and ST segment deviation at rest in abnormal HRR group were more significantly than those in normal HRR group （ all P 〈 0. 05 ）. （2） The subjects of abnormal HRR usually had higher basal heart rate, more cases exhibited ST segment abnormality and or exercise-limited angina during or after TET（P 〈 0. 01 and P 〈 0. 05, respectively）, but lower level of peak heart rate attained （ P 〈 0. 05 ） than those in normal group. The values of metabolism equivalents and duration of TET between the two groups displayed phenomenal difference （ P 〈 0. 05 ）. There were more samples acquired moderate to high level of Duke test score and chronotropic incompetence in the group of abnormal HRR, compared to the normal HRR group （P 〈 0. 01 ）. （3） The cases of negative CAG results in the group of normal and abnormal HRR group were 73 （66. 97 % ） and 24 （34. 78 % ）. Cases of significant coronary lesions （ at least one major coronary vessel ≥ 50 % stenosis） amongst the subgroup of positive CAG were 36 （ 33.03 % ） and 45 （65.22 % ）, severe coronary lesions （ three-vessel, left main or the equivalents of left main） were 10 （9. 17 % ） and 17 （24. 64 % ） for normal and abnormal HRR respectively （P 〈 0. 01 ）. Accordingly, the Gensini scores in the subunit of abnormal HRR increased. （4）Linear correlation analysis indicate there was a negative correlation between the values of HRR in the first and second minutes and indices of severity of CAD （ all P 〈 0. 01 ）. The analysis of auxiliary diagnostic value of abnormal HRR indicated the annexed HRR standard had higher negative predictive value. Conclusions The status of HRR after TET are not only influenced by the clinical factors related to the cardiac autonomic function, but also associated with the extent of CAD. （ S Chin J Cardiol 2009 ; 10（1）：1-8）
文摘Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of life.These complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality rates.Despite the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac surgery.Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength.Early mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance exercises.Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity.During the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac rehabilitation.By incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.
文摘Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs during graded EST and analyzed via a post-processing method. Autonomic function was determined by Power Spectral Analysis of the very low frequency (VLF), low frequency (LF), high frequency (HF), and the ratio of LF/HF. We correlated HRV indices with resting, exercise, and recovery data. Results: No differences were found in anthropometric measurements, peak EST HR, and METS between individuals with slow HRR (below 18 b/min) compared with controls (HRR > 18 b/min). Only the VLF component of the HRV indices was statistically different (p = 0.03) at one-minute post-exercise compared with controls. Additionally, a significant correlation between HRR and resting LF and HF indices was found in the individuals with slow HRR but not in the controls. Conclusion: In apparently healthy individuals with slow HRR post-EST, autonomic function did not demonstrate any differences at any phase of the EST, including at one minute of recovery. However, a significant correlation was found between resting LF and HF powers and HRR in individuals with slow vagal reactivation post-exercise. The clinical and prognostic implications of such observation deserve further investigation.
