Severely Impaired Cardiorespiratory Fitness in Patients With Recently Decompensated Systolic Heart Failure
Hospital admission for decompensated heart failure marks a critical inflection point in a patient's health. Despite the improvement in signs or symptoms during hospitalization, patients have a high likelihood of readmission, reflecting a lack of resolution of the underlying condition. Surprisin...
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| Veröffentlicht in: | The American journal of cardiology 2017-11, Vol.120 (10), p.1854-1857 |
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| creator | Canada, Justin McNair Trankle, Cory Ross Buckley, Leo Francis Carbone, Salvatore Abouzaki, Nayef Antar Kadariya, Dinesh Shah, Keyur Cooke, Richard Kontos, Michael Christopher Patel, Jaideep Mankad, Pranav Schatz, Aaron Bhatnagar, Amit Arena, Ross Van Tassell, Benjamin Wallace Abbate, Antonio |
| description | Hospital admission for decompensated heart failure marks a critical inflection point in a patient's health. Despite the improvement in signs or symptoms during hospitalization, patients have a high likelihood of readmission, reflecting a lack of resolution of the underlying condition. Surprisingly, no studies have characterized the cardiorespiratory fitness of such patients. Fifty-two patients (38 [73%] male, age 57 [52 to 65] years, left ventricular ejection fraction 31% [24 to 38]) underwent cardiopulmonary exercise testing 4 (1 to 10) days after hospital discharge, when stable and without overt signs of volume overload. Transthoracic Doppler echocardiography, measurement of N-terminal pro-B-natriuretic peptide, and quality of life were also assessed. Aerobic exercise capacity was severely reduced: peak oxygen consumption (pVO2) was 14.1 (11.2 to 16.3) ml/kg/min. Ventilatory inefficiency as indicated by the minute ventilation carbon dioxide production relation (VE/VCO2 slope) >30 and oxygen uptake efficiency slope |
| doi_str_mv | 10.1016/j.amjcard.2017.07.099 |
| format | Article |
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Despite the improvement in signs or symptoms during hospitalization, patients have a high likelihood of readmission, reflecting a lack of resolution of the underlying condition. Surprisingly, no studies have characterized the cardiorespiratory fitness of such patients. Fifty-two patients (38 [73%] male, age 57 [52 to 65] years, left ventricular ejection fraction 31% [24 to 38]) underwent cardiopulmonary exercise testing 4 (1 to 10) days after hospital discharge, when stable and without overt signs of volume overload. Transthoracic Doppler echocardiography, measurement of N-terminal pro-B-natriuretic peptide, and quality of life were also assessed. Aerobic exercise capacity was severely reduced: peak oxygen consumption (pVO2) was 14.1 (11.2 to 16.3) ml/kg/min. Ventilatory inefficiency as indicated by the minute ventilation carbon dioxide production relation (VE/VCO2 slope) >30 and oxygen uptake efficiency slope <2.0 was noted in 41 (77%) and 39 (75%) patients, respectively. Forty-five (87%) patients had 1 of 2 high-risk features (pVO2 < 14 ml/kg/min or VE/VCO2 >30). Perceived functional capacity, measured by the Duke Activity Status Index, was also severely reduced and correlated with pVO2. N-terminal pro-B-natriuretic peptide levels and early transmitral velocity/early mitral annulus velocity (E/e′) ratio at echocardiography showed a modest correlation with lower pVO2. In conclusion, patients with recently decompensated systolic heart failure demonstrate severe impairment in cardiorespiratory fitness, severely limiting quality of life.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2017.07.099</identifier><identifier>PMID: 28867128</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aerobic capacity ; Aged ; Carbon dioxide ; Cardiorespiratory fitness ; Cardiorespiratory Fitness - physiology ; Councils ; Doppler effect ; Dyspnea ; Echocardiography ; Echocardiography, Doppler ; Efficiency ; Exercise ; Exercise Tolerance ; Female ; Follow-Up Studies ; Heart ; Heart diseases ; Heart failure ; Heart Failure, Systolic - diagnosis ; Heart Failure, Systolic - physiopathology ; Humans ; Male ; Mechanical ventilation ; Metabolism ; Middle Aged ; Oxygen Consumption ; Oxygen uptake ; Patients ; Physical fitness ; Prognosis ; Quality of Life ; Regression analysis ; Severity of Illness Index ; Software ; Stroke Volume - physiology ; Time Factors ; Velocity ; Ventilation ; Ventricle ; Ventricular Function, Left - physiology</subject><ispartof>The American journal of cardiology, 2017-11, Vol.120 (10), p.1854-1857</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Sequoia S.A. Nov 15, 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-5d93a35a4821e4b7302e7936004d7ee6404c634452337ee62065d9f8ccaf8f7d3</citedby><cites>FETCH-LOGICAL-c495t-5d93a35a4821e4b7302e7936004d7ee6404c634452337ee62065d9f8ccaf8f7d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S000291491731305X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28867128$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Canada, Justin McNair</creatorcontrib><creatorcontrib>Trankle, Cory Ross</creatorcontrib><creatorcontrib>Buckley, Leo Francis</creatorcontrib><creatorcontrib>Carbone, Salvatore</creatorcontrib><creatorcontrib>Abouzaki, Nayef Antar</creatorcontrib><creatorcontrib>Kadariya, Dinesh</creatorcontrib><creatorcontrib>Shah, Keyur</creatorcontrib><creatorcontrib>Cooke, Richard</creatorcontrib><creatorcontrib>Kontos, Michael Christopher</creatorcontrib><creatorcontrib>Patel, Jaideep</creatorcontrib><creatorcontrib>Mankad, Pranav</creatorcontrib><creatorcontrib>Schatz, Aaron</creatorcontrib><creatorcontrib>Bhatnagar, Amit</creatorcontrib><creatorcontrib>Arena, Ross</creatorcontrib><creatorcontrib>Van Tassell, Benjamin Wallace</creatorcontrib><creatorcontrib>Abbate, Antonio</creatorcontrib><title>Severely Impaired Cardiorespiratory Fitness in Patients With Recently Decompensated Systolic Heart Failure</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Hospital admission for decompensated heart failure marks a critical inflection point in a patient's health. Despite the improvement in signs or symptoms during hospitalization, patients have a high likelihood of readmission, reflecting a lack of resolution of the underlying condition. Surprisingly, no studies have characterized the cardiorespiratory fitness of such patients. Fifty-two patients (38 [73%] male, age 57 [52 to 65] years, left ventricular ejection fraction 31% [24 to 38]) underwent cardiopulmonary exercise testing 4 (1 to 10) days after hospital discharge, when stable and without overt signs of volume overload. Transthoracic Doppler echocardiography, measurement of N-terminal pro-B-natriuretic peptide, and quality of life were also assessed. Aerobic exercise capacity was severely reduced: peak oxygen consumption (pVO2) was 14.1 (11.2 to 16.3) ml/kg/min. Ventilatory inefficiency as indicated by the minute ventilation carbon dioxide production relation (VE/VCO2 slope) >30 and oxygen uptake efficiency slope <2.0 was noted in 41 (77%) and 39 (75%) patients, respectively. Forty-five (87%) patients had 1 of 2 high-risk features (pVO2 < 14 ml/kg/min or VE/VCO2 >30). Perceived functional capacity, measured by the Duke Activity Status Index, was also severely reduced and correlated with pVO2. N-terminal pro-B-natriuretic peptide levels and early transmitral velocity/early mitral annulus velocity (E/e′) ratio at echocardiography showed a modest correlation with lower pVO2. In conclusion, patients with recently decompensated systolic heart failure demonstrate severe impairment in cardiorespiratory fitness, severely limiting quality of life.</description><subject>Aerobic capacity</subject><subject>Aged</subject><subject>Carbon dioxide</subject><subject>Cardiorespiratory fitness</subject><subject>Cardiorespiratory Fitness - physiology</subject><subject>Councils</subject><subject>Doppler effect</subject><subject>Dyspnea</subject><subject>Echocardiography</subject><subject>Echocardiography, Doppler</subject><subject>Efficiency</subject><subject>Exercise</subject><subject>Exercise Tolerance</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart Failure, Systolic - diagnosis</subject><subject>Heart Failure, Systolic - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Mechanical ventilation</subject><subject>Metabolism</subject><subject>Middle Aged</subject><subject>Oxygen Consumption</subject><subject>Oxygen uptake</subject><subject>Patients</subject><subject>Physical fitness</subject><subject>Prognosis</subject><subject>Quality of Life</subject><subject>Regression analysis</subject><subject>Severity of Illness Index</subject><subject>Software</subject><subject>Stroke Volume - physiology</subject><subject>Time Factors</subject><subject>Velocity</subject><subject>Ventilation</subject><subject>Ventricle</subject><subject>Ventricular Function, Left - physiology</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkV-L1DAUxYso7uzqR1AKvvjSMWn-NHlRZHR2FxYUV_ExZNNbN6VtapIOzLf3DjMu6otwIVzyOyf35hTFC0rWlFD5pl_bsXc2tuua0GZNsLR-VKyoanRFNWWPixUhpK405fqsOE-px5ZSIZ8WZ7VSsqG1WhX9LewgwrAvr8fZ-ghtuUFTHyKk2UebQ9yXW58nSKn0U_nZZg9TTuV3n-_LL-CwQfEHcGGcYUo2o8PtPuUweFdegY253Fo_LBGeFU86OyR4fjovim_bj183V9XNp8vrzfubynEtciVazSwTlquaAr9rGKmh0UwSwtsGQHLCnWSci5qxQ18TiZJOOWc71TUtuyjeHn3n5W6E9jBhtIOZox9t3Jtgvfn7ZvL35kfYGSEFl0qiweuTQQw_F0jZjD45GAY7QViSoZoJjl-rOKKv_kH7sMQJ10NKcKaQE0iJI-ViSClC9zAMJeaQpunNKU1zSNMQLK1R9_LPTR5Uv-ND4N0RAPzPnYdoksN4HLSYpMumDf4_T_wCxAi0-Q</recordid><startdate>20171115</startdate><enddate>20171115</enddate><creator>Canada, Justin McNair</creator><creator>Trankle, Cory Ross</creator><creator>Buckley, Leo Francis</creator><creator>Carbone, Salvatore</creator><creator>Abouzaki, Nayef Antar</creator><creator>Kadariya, Dinesh</creator><creator>Shah, Keyur</creator><creator>Cooke, Richard</creator><creator>Kontos, Michael Christopher</creator><creator>Patel, Jaideep</creator><creator>Mankad, Pranav</creator><creator>Schatz, Aaron</creator><creator>Bhatnagar, Amit</creator><creator>Arena, Ross</creator><creator>Van Tassell, Benjamin Wallace</creator><creator>Abbate, Antonio</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20171115</creationdate><title>Severely Impaired Cardiorespiratory Fitness in Patients With Recently Decompensated Systolic Heart Failure</title><author>Canada, Justin McNair ; Trankle, Cory Ross ; Buckley, Leo Francis ; Carbone, Salvatore ; Abouzaki, Nayef Antar ; Kadariya, Dinesh ; Shah, Keyur ; Cooke, Richard ; Kontos, Michael Christopher ; Patel, Jaideep ; Mankad, Pranav ; Schatz, Aaron ; Bhatnagar, Amit ; Arena, Ross ; Van Tassell, Benjamin Wallace ; Abbate, Antonio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-5d93a35a4821e4b7302e7936004d7ee6404c634452337ee62065d9f8ccaf8f7d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aerobic capacity</topic><topic>Aged</topic><topic>Carbon dioxide</topic><topic>Cardiorespiratory fitness</topic><topic>Cardiorespiratory Fitness - 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Despite the improvement in signs or symptoms during hospitalization, patients have a high likelihood of readmission, reflecting a lack of resolution of the underlying condition. Surprisingly, no studies have characterized the cardiorespiratory fitness of such patients. Fifty-two patients (38 [73%] male, age 57 [52 to 65] years, left ventricular ejection fraction 31% [24 to 38]) underwent cardiopulmonary exercise testing 4 (1 to 10) days after hospital discharge, when stable and without overt signs of volume overload. Transthoracic Doppler echocardiography, measurement of N-terminal pro-B-natriuretic peptide, and quality of life were also assessed. Aerobic exercise capacity was severely reduced: peak oxygen consumption (pVO2) was 14.1 (11.2 to 16.3) ml/kg/min. Ventilatory inefficiency as indicated by the minute ventilation carbon dioxide production relation (VE/VCO2 slope) >30 and oxygen uptake efficiency slope <2.0 was noted in 41 (77%) and 39 (75%) patients, respectively. Forty-five (87%) patients had 1 of 2 high-risk features (pVO2 < 14 ml/kg/min or VE/VCO2 >30). Perceived functional capacity, measured by the Duke Activity Status Index, was also severely reduced and correlated with pVO2. N-terminal pro-B-natriuretic peptide levels and early transmitral velocity/early mitral annulus velocity (E/e′) ratio at echocardiography showed a modest correlation with lower pVO2. In conclusion, patients with recently decompensated systolic heart failure demonstrate severe impairment in cardiorespiratory fitness, severely limiting quality of life.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28867128</pmid><doi>10.1016/j.amjcard.2017.07.099</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aerobic capacity Aged Carbon dioxide Cardiorespiratory fitness Cardiorespiratory Fitness - physiology Councils Doppler effect Dyspnea Echocardiography Echocardiography, Doppler Efficiency Exercise Exercise Tolerance Female Follow-Up Studies Heart Heart diseases Heart failure Heart Failure, Systolic - diagnosis Heart Failure, Systolic - physiopathology Humans Male Mechanical ventilation Metabolism Middle Aged Oxygen Consumption Oxygen uptake Patients Physical fitness Prognosis Quality of Life Regression analysis Severity of Illness Index Software Stroke Volume - physiology Time Factors Velocity Ventilation Ventricle Ventricular Function, Left - physiology |
| title | Severely Impaired Cardiorespiratory Fitness in Patients With Recently Decompensated Systolic Heart Failure |
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