1
|
Wijma AG, Driessens H, Jeneson JAL, Janssen-Heijnen MLG, Willems TP, Klaase JM, Bongers BC. Cardiac and intramuscular adaptations following short-term exercise prehabilitation in unfit patients scheduled to undergo hepatic or pancreatic surgery: study protocol of a multinuclear MRI study. BMJ Open Gastroenterol 2023; 10:e001243. [PMID: 37996121 PMCID: PMC10668156 DOI: 10.1136/bmjgast-2023-001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Short-term exercise prehabilitation programmes have demonstrated promising results in improving aerobic capacity of unfit patients prior to major abdominal surgery. However, little is known about the cardiac and skeletal muscle adaptations explaining the improvement in aerobic capacity following short-term exercise prehabilitation. METHODS AND ANALYSIS In this single-centre study with a pretest-post-test design, 12 unfit patients with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min and/or VO2 at peak exercise ≤18 mL/kg/min, who are scheduled to undergo hepatopancreatobiliary surgery at the University Medical Center Groningen (UMCG), the Netherlands, will be recruited. As part of standard care, unfit patients are advised to participate in a home-based exercise prehabilitation programme, comprising high-intensity interval training and functional exercises three times per week, combined with nutritional support, during a 4-week period. Pre-intervention and post-intervention, patients will complete a cardiopulmonary exercise test. Next to this, study participants will perform additional in-vivo exercise cardiac magnetic resonance (MR) imaging and phosphorus 31-MR spectroscopy of the quadriceps femoris muscle before and after the intervention to assess the effect on respectively cardiac and skeletal muscle function. ETHICS AND DISSEMINATION This study was approved in May 2023 by the Medical Research Ethics Committee of the UMCG (registration number NL83611.042.23, March 2023) and is registered in the ClinicalTrials.gov register. Results of this study will be submitted for presentation at (inter)national congresses and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05772819.
Collapse
Affiliation(s)
- Allard G Wijma
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Heleen Driessens
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeroen A L Jeneson
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
- Department of Epidemiology, School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
| | - Tineke P Willems
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joost M Klaase
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
2
|
Canada JM, McCarty J, Jordan JH, Trankle CR, DeCamp K, West JD, Reynolds MA, Myers R, Sweat K, McGhee V, Arena R, Abbate A, Hundley WG. Simultaneous exercise stress cardiac magnetic resonance and cardiopulmonary exercise testing to elucidate the Fick components of aerobic exercise capacity: a feasibility and reproducibility study and pilot study in hematologic cancer survivors. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:31. [PMID: 37430330 PMCID: PMC10331991 DOI: 10.1186/s40959-023-00182-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/15/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Patients treated for hematologic malignancy often experience reduced exercise capacity and increased fatigue; however whether this reduction is related to cardiac dysfunction or impairment of skeletal muscle oxygen extraction during activity is unknown. Cardiopulmonary exercise testing (CPET) coupled with stress cardiac magnetic resonance (ExeCMR), may provide a noninvasive method to identify the abnormalities of cardiac function or skeletal muscle oxygen extraction. This study was performed to determine the feasibility and reproducibility of a ExeCMR + CPET technique to measure the Fick components of peak oxygen consumption (VO2) and pilot its discriminatory potential in hematologic cancer patients experiencing fatigue. METHODS We studied 16 individuals undergoing ExeCMR to determine exercise cardiac reserve with simultaneous measures of VO2. The arteriovenous oxygen content difference (a-vO2diff) was calculated as the quotient of VO2/cardiac index (CI). Repeatability in measurements of peak VO2, CI, and a-vO2diff was assessed in seven healthy controls. Finally, we measured the Fick determinants of peak VO2 in hematologic cancer survivors with fatigue (n = 6) and compared them to age/gender-matched healthy controls (n = 6). RESULTS Study procedures were successfully completed without any adverse events in all subjects (N = 16, 100%). The protocol demonstrated good-excellent test-retest reproducibility for peak VO2 (intraclass correlation coefficient [ICC] = 0.992 [95%CI:0.955-0.999]; P < 0.001), peak CI (ICC = 0.970 [95%CI:0.838-0.995]; P < 0.001), and a-vO2diff (ICC = 0.953 [95%CI:0.744-0.992]; P < 0.001). Hematologic cancer survivors with fatigue demonstrated a significantly lower peak VO2 (17.1 [13.5-23.5] vs. 26.0 [19.7-29.5] mL·kg-1·min-1, P = 0.026) and lower peak CI (5.0 [4.7-6.3] vs. 7.4 [7.0-8.8] L·min-1/m2, P = 0.004) without a significant difference in a-vO2diff (14.4 [11.8-16.9] vs. 13.6 [10.9-15.4] mLO2/dL, P = 0.589). CONCLUSIONS Noninvasive measurement of peak VO2 Fick determinants is feasible and reliable with an ExeCMR + CPET protocol in those treated for a hematologic malignancy and may offer insight into the mechanisms of exercise intolerance in those experiencing fatigue.
Collapse
Affiliation(s)
- Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA.
| | - John McCarty
- Division of Hematology, Oncology & Palliative Care, VCU Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer H Jordan
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Cory R Trankle
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA
| | - Kevin DeCamp
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Josh D West
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA
| | - Mary Ann Reynolds
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA
| | - Rachel Myers
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA
| | - Katey Sweat
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA
| | - Virginia McGhee
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA
- Berne Cardiovascular Research Center, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - W Gregory Hundley
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 E. Broad Street, P.O. Box 980335, Richmond, VA, 23298, USA
| |
Collapse
|
3
|
Mabudian L, Jordan JH, Bottinor W, Hundley WG. Cardiac MRI assessment of anthracycline-induced cardiotoxicity. Front Cardiovasc Med 2022; 9:903719. [PMID: 36237899 PMCID: PMC9551168 DOI: 10.3389/fcvm.2022.903719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
The objective of this review article is to discuss how cardiovascular magnetic resonance (CMR) imaging measures left ventricular (LV) function, characterizes tissue, and identifies myocardial fibrosis in patients receiving anthracycline-based chemotherapy (Anth-bC). Specifically, CMR can measure LV ejection fraction (EF), volumes at end-diastole (LVEDV), and end-systole (LVESV), LV strain, and LV mass. Tissue characterization is accomplished through T1/T2-mapping, late gadolinium enhancement (LGE), and CMR perfusion imaging. Despite CMR’s accuracy and efficiency in collecting data about the myocardium, there are challenges that persist while monitoring a cardio-oncology patient undergoing Anth-bC, such as the presence of other cardiovascular risk factors and utility controversies. Furthermore, CMR can be a useful adjunct during cardiopulmonary exercise testing to pinpoint cardiovascular mediated exercise limitations, as well as to assess myocardial microcirculatory damage in patients undergoing Anth-bC.
Collapse
Affiliation(s)
- Leila Mabudian
- Division of Cardiology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, United States
| | - Jennifer H. Jordan
- Division of Cardiology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, United States
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States
| | - Wendy Bottinor
- Division of Cardiology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, United States
| | - W. Gregory Hundley
- Division of Cardiology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA, United States
- *Correspondence: W. Gregory Hundley,
| |
Collapse
|