Troy J. Cross

The resistive and elastic work of breathing during exercise in patients with chronic Heart Failure

Patients with heart failure (HF) display numerous derangements in ventilatory function, which together serve to increase the work of breathing (Wb) during exercise. However, the extent to which the resistive and elastic properties of the respiratory system contribute to the higher Wb in these patients is unknown. We quantified the resistive and elastic Wb in patients with stable HF (n=9; New York Heart Association functional class I–II) and healthy control subjects (n=9) at standardised levels of minute ventilation (V′E) during graded exercise. Dynamic lung compliance was systematically lower for a given level of V′E in HF patients than controls (p<0.05). HF patients displayed slightly higher levels of inspiratory elastic Wb with greater amounts of ventilatory constraint and resistive Wb than control subjects during exercise (p<0.05). Our data indicates that the higher Wb in HF patients is primarily due to a greater resistive, rather than elastic, load to breathing. The greater resistive Wb in these patients probably reflects an increased hysteresivity of the airways and lung tissues. The marginally higher inspiratory elastic Wb observed in HF patients appears related to a combined decrease in the compliances of the lungs and chest wall. The clinical and physiological implications of our findings are discussed.

Breathing He-O2 attenuates the slow component of O2 uptake kinetics during exercise performed above the respiratory compensation threshold.

The contribution of respiratory muscle O2 uptake to the development of the slow component of O2 uptake kinetics is unclear. The aim of the present study was to examine the impact of respiratory muscle unloading (via breathing, a He–O2 mixture) on the amplitude of during exercise performed below (B‐RCT) and above the respiratory compensation threshold (A‐RCT). We hypothesized that breathing He–O2 would reduce the amplitude of the by a greater amount during exercise performed A‐RCT than B‐RCT. Eight healthy male recreational cyclists performed constant‐load cycling in four sets of conditions: (1) B‐RCT breathing normal air; (2) B‐RCT breathing He–O2; (3) A‐RCT breathing normal air; and (4) A‐RCT breathing He–O2. Breathing He–O2 did not significantly attenuate the during exercise performed B‐RCT (–3 ± 14%, P > 0.05). However, breathing He–O2 significantly reduced the during exercise A‐RCT (–45 ± 6%, P < 0.05). The attenuated while breathing He–O2 is likely to reflect a decreased . Minute ventilation was not different between normal air and He–O2 breathing trials either B‐RCT or A‐RCT. However, operating lung volume was significantly lower when breathing He–O2 during exercise performed A‐RCT (–12 ± 3%, P < 0.05). These findings suggest that comprises a greater proportion of the when exercise is performed A‐RCT compared with B‐RCT. Therefore, the impact of breathing He–O2 was more pronounced during exercise A‐RCT. Furthermore, changes in operating lung volume and the work of breathing appear to play an important role in the development of the .

The Effects of Involuntary Respiratory Contractions on Cerebral Blood Flow during Maximal Apnoea in Trained Divers

The effects of involuntary respiratory contractions on the cerebral blood flow response to maximal apnoea is presently unclear. We hypothesised that while respiratory contractions may augment left ventricular stroke volume, cardiac output and ultimately cerebral blood flow during the struggle phase, these contractions would simultaneously cause marked ‘respiratory’ variability in blood flow to the brain. Respiratory, cardiovascular and cerebrovascular parameters were measured in ten trained, male apnoea divers during maximal ‘dry’ breath holding. Intrathoracic pressure was estimated via oesophageal pressure. Left ventricular stroke volume, cardiac output and mean arterial pressure were monitored using finger photoplethysmography, and cerebral blood flow velocity was obtained using transcranial ultrasound. The increasingly negative inspiratory intrathoracic pressure swings of the struggle phase significantly influenced the rise in left ventricular stroke volume (R 2 = 0.63, P<0.05), thereby contributing to the increase in cerebral blood flow velocity throughout this phase of apnoea. However, these contractions also caused marked respiratory variability in left ventricular stroke volume, cardiac output, mean arterial pressure and cerebral blood flow velocity during the struggle phase (R 2 = 0.99, P<0.05). Interestingly, the magnitude of respiratory variability in cerebral blood flow velocity was inversely correlated with struggle phase duration (R 2 = 0.71, P<0.05). This study confirms the hypothesis that, on the one hand, involuntary respiratory contractions facilitate cerebral haemodynamics during the struggle phase while, on the other, these contractions produce marked respiratory variability in blood flow to the brain. In addition, our findings indicate that such variability in cerebral blood flow negatively impacts on struggle phase duration, and thus impairs breath holding performance.

Dynamic cerebral autoregulation is acutely impaired during maximal apnoea in trained divers.

Aims To examine whether dynamic cerebral autoregulation is acutely impaired during maximal voluntary apnoea in trained divers. Methods Mean arterial pressure (MAP), cerebral blood flow-velocity (CBFV) and end-tidal partial pressures of O2 and CO2 (PETO2 and PETCO2) were measured in eleven trained, male apnoea divers (28±2 yr; 182±2 cm, 76±7 kg) during maximal “dry” breath holding. Dynamic cerebral autoregulation was assessed by determining the strength of phase synchronisation between MAP and CBFV during maximal apnoea. Results The strength of phase synchronisation between MAP and CBFV increased from rest until the end of maximal voluntary apnoea (P<0.05), suggesting that dynamic cerebral autoregulation had weakened by the apnoea breakpoint. The magnitude of impairment in dynamic cerebral autoregulation was strongly, and positively related to the rise in PETCO2 observed during maximal breath holding (R 2 = 0.67, P<0.05). Interestingly, the impairment in dynamic cerebral autoregulation was not related to the fall in PETO2 induced by apnoea (R 2 = 0.01, P = 0.75). Conclusions This study is the first to report that dynamic cerebral autoregulation is acutely impaired in trained divers performing maximal voluntary apnoea. Furthermore, our data suggest that the impaired autoregulatory response is related to the change in PETCO2, but not PETO2, during maximal apnoea in trained divers.

The Respiratory Compensation Point is Not a Valid Surrogate for Critical Power

Purpose It is unclear whether the respiratory compensation point (RCP) may be used as a valid surrogate for critical power (CP). Accordingly, we sought to determine the measurement agreement between the CP and the RCP obtained during incremental cycling of varying ramp slopes. Methods Eleven recreationally active men completed three separate ramp-incremental cycling protocols, where the work rate increment was slow (SR, 15 W·min−1), medium (MR, 30 W·min−1), or fast (FR, 45 W·min−1). The RCP was obtained using the ventilatory equivalent for CO2 output method. The CP was determined via Mortons model for ramp-incremental exercise. The assumption that the RCP and the CP occur at equivalent external work rates was assessed by one-way repeated-measures ANOVA and by evaluating the concordance correlation coefficient (CCC) and typical error (root-mean-square error [RMSE]) for each ramp protocol, separately. Results The external work rate corresponding to the RCP increased with increases in the ramp-incremental slope (P < 0.05). The RCP values in MR (268 ± 37 W) and FR (292 ± 41 W), but not SR (243 ± 35 W), were different (P < 0.05) from CP (247 ± 43 W). The degree to which the relationship between the CP and the RCP approximated the line of identity was relatively poor for SR (CCC = 0.73 and RMSE = 28 W), MR (CCC = 0.63 and RMSE = 36 W), and FR (CCC = 0.42 and RMSE = 55 W). Conclusions Our data confirm that the external work rate associated with the RCP is labile and that these power outputs display poor measurement agreement with the CP. Taken together, these findings indicate that the RCP does not provide an accurate estimation of CP.

The impact of venous occlusion per se on forearm muscle blood flow: implications for the near-infrared spectroscopy venous occlusion technique

The purpose of this study was to examine the effect of venous occlusion per se on forearm muscle blood flow, as determined by the near‐infrared spectroscopy (NIRS) venous occlusion technique (NIRS‐VOT). NIRS data were obtained from the flexor digitorum superficialis (FDS) muscle on the dominant arm of 16 young, ostensibly healthy participants (14 men and two women; 30 ± 6 year; 73 ± 7 kg). Participants completed a series of five venous occlusion trials while seated at rest, and a series of 12 venous occlusion trials during a reactive hyperaemia induced by 5 min of forearm arterial occlusion. The NIRS‐VOT was used to assess FDS muscle blood flow ( Q˙mus ), beat‐by‐beat, over the first four cardiac beats during venous occlusions. Q˙mus was also reported as a cumulative value, wherein the first two, first three and first four cardiac beats were used to calculate muscle blood flow. We observed that Q˙mus was highest when calculated over the first cardiac beat during venous occlusions performed at rest and throughout reactive hyperaemia (P<0·05). Moreover, the inclusion of more than one cardiac beat in the calculation of Q˙mus underestimated muscle blood flows, irrespective of the prevailing level of arterial inflow. These findings support the idea that venous occlusion per se affects the measurement of Q˙mus via the NIRS‐VOT. Accordingly, it is recommended that Q˙mus is determined over the first cardiac beat when using the NIRS‐VOT to assess microvascular blood flow of human forearm muscles.

Influence of Thoracic Fluid Compartments on Pulmonary Congestion in Chronic Heart Failure

INTRODUCTION Pulmonary congestion is a common finding of heart failure (HF), but it remains unclear how pulmonary and heart blood volumes (Vp and Vh, respectively) and extravascular lung water (EVLW) change in stable HF and affect lung function. METHODS Fourteen patients with HF (age 68 ± 11 y, LVEF 33 ± 8%) and 12 control subjects (age 65 ± 9 y) were recruited. A pulmonary function test, thoracic computerized tomographic (CT) scan, and contrast perfusion scan were performed. From the thoracic scan, a histogram of CT attenuation of lung tissue was generated and skew, kurtosis, and full-width half-max (FWHM) calculated as surrogates of EVLW. Blood volumes were calculated from the transit time of the contrast through the great vessels of the heart. RESULTS Patients with HF had greater Vp and Vh (Vp 0.55 ± 0.21 L vs 0.41 ± 0.13 L; Vh 0.53 ± 0.33 L vs 0.40 ± 0.15 L) and EVLW (skew 3.2 ± 0.5 vs 3.7 ± 0.7; kurtosis 19.4 ± 6.6 vs 25.9 ± 9.4; FWHM 73 ± 13 HU vs 59 ± 9 HU). Spirometric measures were decreased in HF (percentage of predicted: forced vital capacity 86 ± 17% vs 104 ± 9%; forced expiratory volume in 1 second 83 ± 20% vs 105 ± 11%; maximal mid-expiratory flow 82 ± 42% vs 115 ± 43%). Vp was associated with decreased expiratory flows, and EVLW was associated with decreased lung volumes. CONCLUSIONS Congestion in stable patients with HF includes expanded Vp and Vh and increased EVLW associated with reductions in lung volumes and expiratory flows.

Response characteristics of esophageal balloon catheters handmade using latex and nonlatex materials

The measurement of esophageal pressure allows for the calculation of several important and clinically useful parameters of respiratory mechanics. Esophageal pressure is often measured with balloon‐tipped catheters. These catheters may be handmade from natural latex condoms and polyethylene tubing. Given the potential of natural latex to cause allergic reaction, it is important to determine whether esophageal catheter balloons can be fabricated, by hand, using nonlatex condoms as construction materials. To determine the static and dynamic response characteristics of esophageal balloon catheters handmade from latex and nonlatex materials, six esophageal catheter balloons were constructed from each of the following condom materials: natural latex, synthetic polyisoprene, and polyurethane (18 total). Static compliance and working volume range of each balloon catheter was obtained from their pressure‐volume characteristics in water. The dynamic response of balloon catheters were measured via a pressure “step” test, from which a third‐order underdamped transfer function was modeled. The dynamic ranges of balloon catheters were characterized by the frequencies corresponding to ±5% amplitude‐ and phase‐distortion (fA5% and fφ5%). Balloon catheters handmade from polyurethane condoms displayed the smallest working volume range and lowest static balloon compliance. Despite this lower compliance, fA5% and fφ5% were remarkably similar between all balloon materials. Our findings suggest that polyisoprene condoms are an ideal nonlatex construction material to use when fabricating esophageal catheter balloons by hand.

Measurement of regional forearm muscle haemodynamics via the near-infrared spectroscopy venous occlusion technique: the impact of hand circulatory occlusion

The purpose of this study was to examine whether circulatory occlusion of the hand impacts on regional forearm muscle haemodynamics as determined by the near-infrared spectroscopy (NIRS) venous occlusion technique (NIRSVOT). Twenty-five young, healthy participants (18 males and 7 females; 28 ± 4 years; 71 ± 7 kg) completed two experimental protocols that were performed on the dominant arm: (1) a series of five venous occlusion trials with a suprasystolic cuff (>260 mmHg) applied to the wrist and (2) five venous occlusion trials without hand-occlusion. Both protocols were performed twice in a counterbalanced manner. NIRS data were obtained from the flexor digitorum superficialis (FDS) muscle using a dual wavelength, continuous-wave spectrophotometer. FDS muscle blood flow (Q(FDS)), vascular conductance (C(FDS)), O2 consumption (Vo(2FDS)), and venous O2 saturation (SvO2) were calculated from NIRS data during the initial 5 s of venous occlusion. Circulatory occlusion of the hand via wrist cuffing significantly (P < 0.05) reduced Q(FDS) (-36 ± 23%), CFDS (-37 ± 23%), Vo2(FDS) (-14 ± 31%) and SvO2 (-14 ± 12%). These findings indicate that hand-occlusion, via wrist cuffing, adversely impacts on regional forearm haemodynamics as determined by the NIRS-VOT. Consequently, it is recommended that future investigators avoid hand-occlusion when using the NIRS-VOT to quantify spontaneous haemodynamics of regional forearm muscle.

Load-induced changes in older individual's hand-finger tremor are ameliorated with targeting

The purpose of this study was to investigate hand-finger tremor dynamics when a load was applied to the finger in a group of healthy older adults. Moreover, we sought to determine if projecting a representation of the subjects finger tremor on a target was capable of overcoming the effects of loading so that hand-finger interactions returned to a state that was similar to normal tremor. Eight healthy older males (67 ± 1 year) performed a postural pointing task, where tremor was assessed using lightweight accelerometers attached to the hand and finger. Tremor was then assessed when a laser pointer was attached to the finger and switched off (the load), and then with the laser pointer attached and switched on pointing at targets of 40 mm and 20mm in diameter. The main findings of this study were that 1) loading the finger resulted in a reduction in finger tremor amplitude and increased finger tremor regularity, but no change in hand tremor, 2) loading caused increased hand-finger 8-12 Hz cross wavelet coherence and phase synchrony, and 3) pointing at different targets while the finger was loaded resulted in an increase in finger tremor amplitude, and changes in inter-segmental coupling to the extent that hand-finger dynamics reflected normal unloaded conditions. Overall, these results illustrate that the damping effects of limb loading can be offset, in part, by altering the accuracy demands of the task to make the pointing action more challenging.