Jonathan Myers1, Jeffrey W Christle2, Amanda Tun3, Bilge Yilmaz4, Kegan J Moneghetti2, Elizabeth Yuen3, Muhammad Soofi5, Euan Ashley2. 1. VA Palo Alto Health Care System, Division of Cardiovascular Medicine, Palo Alto, California; Stanford University, Stanford California. Electronic address: drj993@aol.com. 2. Stanford University, Stanford California; Division of Cardiovascular Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford California. 3. VA Palo Alto Health Care System, Division of Cardiovascular Medicine, Palo Alto, California; Stanford University, Stanford California. 4. Eastern Virginia Medical School, Norfolk, Virginia. 5. Ohio State University School of Medicine, Columbus, Ohio.
Abstract
BACKGROUND: An impaired cardiac output response to exercise is a hallmark of chronic heart failure (HF). We determined the extent to which impedance cardiography (ICG) during exercise in combination with cardiopulmonary exercise test (CPX) responses reclassified risk for adverse events in patients with HF. METHODS AND RESULTS: CPX and ICG were performed in 1236 consecutive patients (48±15 years) evaluated for HF. Clinical, ICG and CPX variables were acquired at baseline and subjects were followed for the composite outcome of cardiac-related death, hospitalization for worsening HF, cardiac transplantation, and left ventricular assist device implantation. Cox proportional hazards analyses including clinical, noninvasive hemodynamic, and CPX variables were performed to determine their association with the composite endpoint. Net reclassification improvement (NRI) was calculated to quantify the impact of adding hemodynamic responses to a model including established CPX risk markers on reclassifying risk. There were 422 events. Among CPX variables, peak VO2 and indices of ventilatory inefficiency (VE/VCO2 slope, oxygen uptake efficiency slope) were significant predictors of risk for adverse events. Among hemodynamic variables, change in cardiac index, peak cardiac time interval, and peak left cardiac work index were the strongest predictors of risk. Having 5 impaired CPX and ICG responses to exercise yielded a sevenfold higher risk for adverse events compared with having no abnormal responses. Combining ICG responses to CPX resulted in NRIs ranging between 0.34 and 0.89, attributable to better reclassification of events. CONCLUSION: Cardiac hemodynamics determined by ICG complement established CPX measures in reclassifying risk among patients with HF. Published by Elsevier Inc.
BACKGROUND: An impaired cardiac output response to exercise is a hallmark of chronic heart failure (HF). We determined the extent to which impedance cardiography (ICG) during exercise in combination with cardiopulmonary exercise test (CPX) responses reclassified risk for adverse events in patients with HF. METHODS AND RESULTS: CPX and ICG were performed in 1236 consecutive patients (48±15 years) evaluated for HF. Clinical, ICG and CPX variables were acquired at baseline and subjects were followed for the composite outcome of cardiac-related death, hospitalization for worsening HF, cardiac transplantation, and left ventricular assist device implantation. Cox proportional hazards analyses including clinical, noninvasive hemodynamic, and CPX variables were performed to determine their association with the composite endpoint. Net reclassification improvement (NRI) was calculated to quantify the impact of adding hemodynamic responses to a model including established CPX risk markers on reclassifying risk. There were 422 events. Among CPX variables, peak VO2 and indices of ventilatory inefficiency (VE/VCO2 slope, oxygen uptake efficiency slope) were significant predictors of risk for adverse events. Among hemodynamic variables, change in cardiac index, peak cardiac time interval, and peak left cardiac work index were the strongest predictors of risk. Having 5 impaired CPX and ICG responses to exercise yielded a sevenfold higher risk for adverse events compared with having no abnormal responses. Combining ICG responses to CPX resulted in NRIs ranging between 0.34 and 0.89, attributable to better reclassification of events. CONCLUSION: Cardiac hemodynamics determined by ICG complement established CPX measures in reclassifying risk among patients with HF. Published by Elsevier Inc.
Authors: Małgorzata Kurpaska; Paweł Krzesiński; Grzegorz Gielerak; Karina Gołębiewska; Katarzyna Piotrowicz Journal: BMC Sports Sci Med Rehabil Date: 2022-07-17
Authors: Florent Besnier; Béatrice Bérubé; Christine Gagnon; Miloudza Olmand; Paula Aver Bretanha Ribeiro; Anil Nigam; Martin Juneau; Lucie Blondeau; Michel White; Vincent Gremeaux; Louis Bherer; Mathieu Gayda Journal: Int J Environ Res Public Health Date: 2020-11-19 Impact factor: 3.390