Valeria Donghi

Role of Right Ventricle and Dynamic Pulmonary Hypertension on Determining ΔVO2/ΔWork Rate Flattening: Insights from Cardiopulmonary Exercise Test Combined with Exercise Echocardiography

Background—Several cardiovascular diseases are characterized by an impaired O2 kinetic during exercise. The lack of a linear increase of &Dgr;oxygen consumption (VO2)/&Dgr;Work Rate (WR) relationship, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of &Dgr;VO2/&Dgr;WR flattening in a symptomatic population of cardiac patients, characterizing its functional profile, and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role as cardiac determinants. Methods and Results—We studied 136 patients, with different cardiovascular diseases, referred for exertional dyspnoea. Cardiopulmonary exercise test combined with simultaneous exercise echocardiography was performed using a symptom-limited protocol. &Dgr;VO2/&Dgr;WR flattening was observed in 36 patients (group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak VO2, anaerobic threshold, O2 pulse, impaired VE/VCO2). At univariate analysis, exercise ejection fraction, exercise mitral regurgitation, rest and exercise tricuspid annular plane systolic excursion, exercise systolic pulmonary artery pressure, and exercise cardiac output were all significantly (P<0.05) impaired in group A. The multivariate analysis identified exercise systolic pulmonary artery pressure (odds ratio, 1.06; confidence interval, 1.01–1.11; P=0.01) and exercise tricuspid annular plane systolic excursion (odds ratio, 0.88; confidence interval, 0.80–0.97; P=0.01) as main cardiac determinants of &Dgr;VO2/&Dgr;WR flattening; female sex was strongly associated (odds ratio, 6.10; confidence interval, 2.11–17.7; P<0.01). Conclusions—In patients symptomatic for dyspnea, the occurrence of &Dgr;VO2/&Dgr;WR flattening reflects a significantly impaired functional phenotype whose main cardiac determinants are the excessive systolic pulmonary artery pressure increase and the reduced peak right ventricular longitudinal systolic function.Background—Several cardiovascular diseases are characterized by an impaired O2 kinetic during exercise. The lack of a linear increase of Δoxygen consumption (VO2)/ΔWork Rate (WR) relationship, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of ΔVO2/ΔWR flattening in a symptomatic population of cardiac patients, characterizing its functional profile, and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role as cardiac determinants. Methods and Results—We studied 136 patients, with different cardiovascular diseases, referred for exertional dyspnoea. Cardiopulmonary exercise test combined with simultaneous exercise echocardiography was performed using a symptom-limited protocol. ΔVO2/ΔWR flattening was observed in 36 patients (group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak VO2, anaerobic threshold,...

CARDIAC DETERMINANTS OF FUNCTIONAL CAPACITY: CARDIOPULMONARY EXERCISE TESTING COMBINED WITH EXERCISE-ECHOCARDIOGRAPHY

Left ventricular (LV) diastolic pressure can be estimated by the echo-derived ratio of early diastolic transmitral velocity (E) and tissue septal velocity (e’). Cardiopulmonary exercise testing (CPET) provides indices of functional capacity such as peak oxygen consumption (VO2), which are related

INCREASED EXERCISE PERIPHERAL EXTRACTION IN GROUP 2 PULMONARY HYPERTENSION AND EXERCISE OSCILLATORY VENTILATION

Group 2 pulmonary hypertension (PH) and exercise oscillatory ventilation (EOV) are prognostic signs in heart failure (HF). It is unknown what may characterize the exercise response of PH patients and EOV. Aim: To define the functional pattern in HF reduced ejection fraction (HFrEF) with PH according

EXERCISE VENTILATORY POWER IN HEART FAILURE PATIENTS: FUNCTIONAL PHENOTYPES DEFINITION BY COMBINING CARDIOPULMONARY EXERCISE TESTING WITH STRESS ECHOCARDIOGRAPHY

Exercise Ventilatory Power (EVP; peak systolic blood pressure/exercise ventilation to CO2 production slope) is a new powerful prognostic marker that combines ventilator abnormalities with systemic hemodynamic during exercise. The phenotype and clinical relevance of patients with a worse EVP is

EXERCISE GAS EXCHANGE PHENOTYPES IN DIABETIC SUBJECTS: FINDINGS FROM THE EURO(PEAN) EX(ERCISE) POPULATION-BASED STUDY

Diabetes mellitus (DM) is a risk condition that may determine overall exercise limitation and reduced oxygen consumption (VO2). No study has addressed the cardiopulmonary exercise testing phenotype in diabetic subjects with normal left ventricular function. Their functional characterization by

ASSESSING EXERCISE PERFORMANCE BY COMBINING CARDIOPULMONARY TEST TO STRESS ECHO IN AORTIC STENOSIS

Aortic stenosis (AS) is characterized by increased afterload and functional disability. Exercise intolerance may incur even without overt symptoms. Cardiopulmonary exercise testing (CPET) provides pathophysiological insights on mechanisms affecting exercise intolerance. Nonetheless, it has never

Role of Right Ventricle and Dynamic Pulmonary Hypertension on Determining ΔVO2/ΔWork Rate Flattening

Background—Several cardiovascular diseases are characterized by an impaired O2 kinetic during exercise. The lack of a linear increase of &Dgr;oxygen consumption (VO2)/&Dgr;Work Rate (WR) relationship, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of &Dgr;VO2/&Dgr;WR flattening in a symptomatic population of cardiac patients, characterizing its functional profile, and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role as cardiac determinants. Methods and Results—We studied 136 patients, with different cardiovascular diseases, referred for exertional dyspnoea. Cardiopulmonary exercise test combined with simultaneous exercise echocardiography was performed using a symptom-limited protocol. &Dgr;VO2/&Dgr;WR flattening was observed in 36 patients (group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak VO2, anaerobic threshold, O2 pulse, impaired VE/VCO2). At univariate analysis, exercise ejection fraction, exercise mitral regurgitation, rest and exercise tricuspid annular plane systolic excursion, exercise systolic pulmonary artery pressure, and exercise cardiac output were all significantly (P<0.05) impaired in group A. The multivariate analysis identified exercise systolic pulmonary artery pressure (odds ratio, 1.06; confidence interval, 1.01–1.11; P=0.01) and exercise tricuspid annular plane systolic excursion (odds ratio, 0.88; confidence interval, 0.80–0.97; P=0.01) as main cardiac determinants of &Dgr;VO2/&Dgr;WR flattening; female sex was strongly associated (odds ratio, 6.10; confidence interval, 2.11–17.7; P<0.01). Conclusions—In patients symptomatic for dyspnea, the occurrence of &Dgr;VO2/&Dgr;WR flattening reflects a significantly impaired functional phenotype whose main cardiac determinants are the excessive systolic pulmonary artery pressure increase and the reduced peak right ventricular longitudinal systolic function.Background—Several cardiovascular diseases are characterized by an impaired O2 kinetic during exercise. The lack of a linear increase of Δoxygen consumption (VO2)/ΔWork Rate (WR) relationship, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of ΔVO2/ΔWR flattening in a symptomatic population of cardiac patients, characterizing its functional profile, and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role as cardiac determinants. Methods and Results—We studied 136 patients, with different cardiovascular diseases, referred for exertional dyspnoea. Cardiopulmonary exercise test combined with simultaneous exercise echocardiography was performed using a symptom-limited protocol. ΔVO2/ΔWR flattening was observed in 36 patients (group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak VO2, anaerobic threshold,...

Role of Right Ventricle and Dynamic Pulmonary Hypertension on Determining ΔVO2/ΔWork Rate FlatteningCLINICAL PERSPECTIVE

Background—Several cardiovascular diseases are characterized by an impaired O2 kinetic during exercise. The lack of a linear increase of &Dgr;oxygen consumption (VO2)/&Dgr;Work Rate (WR) relationship, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of &Dgr;VO2/&Dgr;WR flattening in a symptomatic population of cardiac patients, characterizing its functional profile, and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role as cardiac determinants. Methods and Results—We studied 136 patients, with different cardiovascular diseases, referred for exertional dyspnoea. Cardiopulmonary exercise test combined with simultaneous exercise echocardiography was performed using a symptom-limited protocol. &Dgr;VO2/&Dgr;WR flattening was observed in 36 patients (group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak VO2, anaerobic threshold, O2 pulse, impaired VE/VCO2). At univariate analysis, exercise ejection fraction, exercise mitral regurgitation, rest and exercise tricuspid annular plane systolic excursion, exercise systolic pulmonary artery pressure, and exercise cardiac output were all significantly (P<0.05) impaired in group A. The multivariate analysis identified exercise systolic pulmonary artery pressure (odds ratio, 1.06; confidence interval, 1.01–1.11; P=0.01) and exercise tricuspid annular plane systolic excursion (odds ratio, 0.88; confidence interval, 0.80–0.97; P=0.01) as main cardiac determinants of &Dgr;VO2/&Dgr;WR flattening; female sex was strongly associated (odds ratio, 6.10; confidence interval, 2.11–17.7; P<0.01). Conclusions—In patients symptomatic for dyspnea, the occurrence of &Dgr;VO2/&Dgr;WR flattening reflects a significantly impaired functional phenotype whose main cardiac determinants are the excessive systolic pulmonary artery pressure increase and the reduced peak right ventricular longitudinal systolic function.Background—Several cardiovascular diseases are characterized by an impaired O2 kinetic during exercise. The lack of a linear increase of Δoxygen consumption (VO2)/ΔWork Rate (WR) relationship, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of ΔVO2/ΔWR flattening in a symptomatic population of cardiac patients, characterizing its functional profile, and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role as cardiac determinants. Methods and Results—We studied 136 patients, with different cardiovascular diseases, referred for exertional dyspnoea. Cardiopulmonary exercise test combined with simultaneous exercise echocardiography was performed using a symptom-limited protocol. ΔVO2/ΔWR flattening was observed in 36 patients (group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak VO2, anaerobic threshold,...