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van der Velden RM, Hermans AN, Pluymaekers NA, Gawalko M, Elliott A, Hendriks JM, Franssen FM, Slats AM, van Empel VP, Van Gelder IC, Thijssen DH, Eijsvogels TM, Leue C, Crijns HJ, Linz D, Simons SO. Dyspnea in patients with atrial fibrillation: Mechanisms, assessment and an interdisciplinary and integrated care approach. IJC HEART & VASCULATURE 2022; 42:101086. [PMID: 35873859 PMCID: PMC9304702 DOI: 10.1016/j.ijcha.2022.101086] [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: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is often associated with symptoms that can significantly impact quality of life and daily functioning. Palpitations are the cardinal symptom of AF and many AF therapies are targeted towards relieving this symptom. However, up to two-third of patients also complain of dyspnea as a predominant self-reported symptom. In clinical practice it is often challenging to ascertain whether dyspnea represents an AF-related symptom or a symptom of concomitant cardiovascular and non-cardiovascular comorbidities, since common AF comorbidities such as heart failure and chronic obstructive pulmonary disease share similar symptoms. In addition, therapeutic approaches specifically targeting dyspnea have not been well validated. Thus, assessing and treating dyspnea can be difficult. This review describes the latest knowledge on the burden and pathophysiology of dyspnea in AF patients. We discuss the role of heart rhythm control interventions as well as the management of AF risk factors and comorbidities with the goal to achieve maximal relief of dyspnea. Given the different and often complex mechanistic pathways leading to dyspnea, dyspneic AF patients will likely profit from an integrated multidisciplinary approach to tackle all factors and mechanisms involved. Therefore, we propose an interdisciplinary and integrated care pathway for the work-up of dyspnea in AF patients.
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Affiliation(s)
- Rachel M.J. van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Astrid N.L. Hermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Nikki A.H.A. Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Germany
- 1st Department of Cardiology, Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Adrian Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Jeroen M. Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Annelies M. Slats
- Department of Respiratory Medicine, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Vanessa P.M. van Empel
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Isabelle C. Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dick H.J. Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thijs M.H. Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
- School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Harry J.G.M. Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Corresponding author at: Maastricht UMC+, Maastricht Heart+Vascular Center, 6202 AZ Maastricht.
| | - Sami O. Simons
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Palau P, Domínguez E, Seller J, Sastre C, Sanchis J, López L, Bodí V, Llàcer P, Miñana G, Espriella RDELA, Bayés-Genís A, Núñez J. Chronotropic index and long-term outcomes in heart failure with preserved ejection fraction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022:S1885-5857(22)00211-0. [PMID: 36038124 DOI: 10.1016/j.rec.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Little is known about the usefulness of heart rate (HR) response to exercise for risk stratification in heart failure with preserved ejection fraction (HFpEF). Therefore, this study aimed to assess the association between HR response to exercise and the risk of total episodes of worsening heart failure (WHF) in symptomatic stable patients with HFpEF. METHODS This single-center study included 133 patients with HFpEF (NYHA II-III) who performed maximal cardiopulmonary exercise testing. HR response to exercise was evaluated using the chronotropic index (CIx) formula. A negative binomial regression method was used. RESULTS The mean age of the sample was 73.2± 10.5 years; 56.4% were female, and 51.1% were in atrial fibrillation. The median for CIx was 0.4 [0.3-0.55]. At a median follow-up of 2.4 [1.6-5.3] years, a total of 146 WHF events in 58 patients and 41 (30.8%) deaths were registered. In the whole sample, CIx was not associated with adverse outcomes (death, P=.319, and WHF events, P=.573). However, we found a differential effect across electrocardiographic rhythms for WHF events (P for interaction=.002). CIx was inversely and linearly associated with the risk of WHF events in patients with sinus rhythm and was positively and linearly associated with those with atrial fibrillation. CONCLUSIONS In patients with HFpEF, CIx was differentially associated with the risk of total WHF events across rhythm status. Lower CIx emerged as a risk factor for predicting higher risk in patients with sinus rhythm. In contrast, higher CIx identified a higher risk in those with atrial fibrillation.
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Affiliation(s)
- Patricia Palau
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain.
| | - Eloy Domínguez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Universitat Jaume I, Castellón, Spain.
| | - Julia Seller
- Servicio de Cardiología, Hospital de Denia, Denia, Alicante, Spain
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Laura López
- Facultad de Fisioterapia. Universitat de València, Valencia, Spain
| | - Vicent Bodí
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pau Llàcer
- Servicio de Medicina Interna, Hospital Ramón y Cajal, Madrid, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rafael dE lA Espriella
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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3
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Kogel A, Hepp P, Stegmann T, Tünnemann-Tarr A, Falz R, Fischer P, Mahfoud F, Laufs U, Fikenzer S. Effects of surgical and FFP2 masks on cardiopulmonary exercise capacity in patients with heart failure. PLoS One 2022; 17:e0269470. [PMID: 35998172 PMCID: PMC9397906 DOI: 10.1371/journal.pone.0269470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/22/2022] [Indexed: 11/25/2022] Open
Abstract
Aims Surgical and FFP2 masks are recommended to reduce transmission of SARS-CoV-2. The cardiopulmonary effects of facemasks in patients with chronic heart failure are unknown. This prospective, cross-over study quantified the effects of wearing no mask (nm), surgical mask (sm), and FFP2 mask (ffpm) in patients with stable heart failure. Methods 12 patients with clinically stable chronic heart failure (HF) (age 63.8±12 years, left ventricular ejection fraction (LVEF) 43.8±11%, NTProBNP 573±567 pg/ml) underwent spiroergometry with and without masks in a randomized sequence. Comfort/discomfort was assessed using a standardized questionnaire. Results Maximum power was reduced with both types of masks (nm: 108.3 W vs. sm: 101.2 W vs. ffpm: 95.6 W, p<0.01). Maximum respiratory oxygen uptake (1499ml/min vs. 1481 ml/min vs. 1300 ml/min, p = 0.95 and <0.01), peak ventilation (62.1 l/min vs. 56.4 l/min vs. 50.3 l/min, p = 0.15 and p<0.05) and O2-pulse (11.6 ml/beat vs. 11.8 ml/beat vs. 10.6 ml/beat, p = 0.87 and p<0.01) were significantly changed with ffpm but not sm. Discomfort was moderately but significantly increased (nm: 1.6 vs. sm: 3.4 vs. ffpm: 4.4, p<0.05). Conclusion Both surgical and FFP masks reduce exercise capacity in heart failure patients, while FFP2 masks reduce oxygen uptake and peak ventilation. This reduction in cardiopulmonary performance should be considered in heart failure patients whose daily life activities are often just as challenging as exercise is for healthy adults.
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Affiliation(s)
- Alexander Kogel
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
- * E-mail:
| | - Pierre Hepp
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Tina Stegmann
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Roberto Falz
- Institute of Sport Medicine and Prevention, University of Leipzig, Leipzig, Germany
| | - Patrick Fischer
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg (Saar), Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg (Saar), Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Sven Fikenzer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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Bingel A, Messroghli D, Weimar A, Runte K, Salcher-Konrad M, Kelle S, Pieske B, Berger F, Kuehne T, Goubergrits L, Fuerstenau D, Kelm M. Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:718114. [PMID: 35514442 PMCID: PMC9062977 DOI: 10.3389/fcvm.2022.718114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Although disease etiologies differ, heart failure patients with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively) both present with clinical symptoms when under stress and impaired exercise capacity. The extent to which the adaptation of heart rate (HR), stroke volume (SV), and cardiac output (CO) under stress conditions is altered can be quantified by stress testing in conjunction with imaging methods and may help to detect the diminishment in a patient’s condition early. The aim of this meta-analysis was to quantify hemodynamic changes during physiological and pharmacological stress testing in patients with HF. A systematic literature search (PROSPERO 2020:CRD42020161212) in MEDLINE was conducted to assess hemodynamic changes under dynamic and pharmacological stress testing at different stress intensities in HFpEF and HFrEF patients. Pooled mean changes were estimated using a random effects model. Altogether, 140 study arms with 7,248 exercise tests were analyzed. High-intensity dynamic stress testing represented 73% of these data (70 study arms with 5,318 exercise tests), where: HR increased by 45.69 bpm (95% CI 44.51–46.88; I2 = 98.4%), SV by 13.49 ml (95% CI 6.87–20.10; I2 = 68.5%), and CO by 3.41 L/min (95% CI 2.86–3.95; I2 = 86.3%). No significant differences between HFrEF and HFpEF groups were found. Despite the limited availability of comparative studies, these reference values can help to estimate the expected hemodynamic responses in patients with HF. No differences in chronotropic reactions, changes in SV, or CO were found between HFrEF and HFpEF. When compared to healthy individuals, exercise tolerance, as well as associated HR and CO changes under moderate-high dynamic stress, was substantially impaired in both HF groups. This may contribute to a better disease understanding, future study planning, and patient-specific predictive models.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42020161212].
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Affiliation(s)
- Anne Bingel
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Daniel Messroghli
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Weimar
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Kilian Runte
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Maximilian Salcher-Konrad
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Felix Berger
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Titus Kuehne
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center Digital Future (ECDF), Berlin, Germany
| | - Daniel Fuerstenau
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Digitalization, Copenhagen Business School, Frederiksberg, Denmark
| | - Marcus Kelm
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- *Correspondence: Marcus Kelm,
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Caru M, Curnier D. The pediatric oncology exercise field speeds up to address important issues regarding chemotherapy-related cardiotoxicity. Front Pediatr 2022; 10:998337. [PMID: 36313894 PMCID: PMC9614334 DOI: 10.3389/fped.2022.998337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/28/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Maxime Caru
- Department of Pediatric, Division of Hematology and Oncology, Penn State College of Medicine, Hershey, PA, United States.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Daniel Curnier
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Division of Pediatric Hematology and Oncology, Sainte-Justine University Health Center, Research Center, Montreal, QC, Canada
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Bertrand É, Caru M, Lemay V, Andelfinger G, Laverdiere C, Krajinovic M, Sinnett D, Curnier D. Heart rate response and chronotropic incompetence during cardiopulmonary exercise testing in childhood acute lymphoblastic leukemia survivors. Pediatr Hematol Oncol 2021; 38:564-580. [PMID: 33792487 DOI: 10.1080/08880018.2021.1894279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cardiopulmonary exercise tests (CPET) focusing on analyses of heart rate (HR) responses and chronotropic incompetence (CI) could provide early information about treatment's negative cardiac effects. We examined childhood acute lymphoblastic leukemia (ALL) survivors' HR response during maximal CPET and identified survivors with CI. A total of 250 childhood ALL survivors underwent a CPET on ergocycle to assess their HR response. We used a multiparametric structure of three methods to assess survivors' CI, as follows: 1) age-predicted HRmax (APMHR): failure to achieve 85% of the APMHR at the peak of CPET; 2) HR reserve (HRR): failure to achieve 80% of the HRR at the peak of CPET; and 3) metabolic chronotropic relationship (MCR): failure to reach an MCR slope ratio >0.8 at each stage of the CPET. Among 250 childhood ALL survivors, 216 survivors performed a maximum CPET. We observed that 73 males and 74 females did not achieve their predicted HRmax. We found that 6 survivors did not achieve 85% of their APMHR (80.9 ± 3.9%) and had an MCR below 80% (53.9 ± 13.8%). In addition, 16 survivors did not achieve 80% of their HRR (71.0 ± 7.4%) and among them, 15 survivors had an MCR below 80% (61.0 ± 12.1%). Survivors with CI had a significantly lower cardiorespiratory fitness than those without CI. This study shows that survivors are at risk of developing altered HR responses and CI many years after the end of their cancer treatments. These findings highlight the importance of early detection of cardiac damage due to cancer treatments.
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Affiliation(s)
- Émilie Bertrand
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Center, Sainte-Justine University Health Center, Montreal, Quebec, Canada
| | - Maxime Caru
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Center, Sainte-Justine University Health Center, Montreal, Quebec, Canada.,Laboratoire EA 4430 - Clinique Psychanalyse Developpement (CliPsyD), Department of Psychology, University of Paris Nanterre, Nanterre, Ile-de-France, France
| | - Valérie Lemay
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Center, Sainte-Justine University Health Center, Montreal, Quebec, Canada
| | - Gregor Andelfinger
- Research Center, Sainte-Justine University Health Center, Montreal, Quebec, Canada.,Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Caroline Laverdiere
- Research Center, Sainte-Justine University Health Center, Montreal, Quebec, Canada.,Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Maja Krajinovic
- Research Center, Sainte-Justine University Health Center, Montreal, Quebec, Canada.,Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Daniel Sinnett
- Research Center, Sainte-Justine University Health Center, Montreal, Quebec, Canada.,Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Daniel Curnier
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Center, Sainte-Justine University Health Center, Montreal, Quebec, Canada
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Nashimoto S, Morishita S, Iida S, Hotta K, Tsubaki A. Relationship between the face scale for rating of perceived exertion and physiological parameters in older adults and patients with atrial fibrillation. Physiol Rep 2021; 9:e14759. [PMID: 33650814 PMCID: PMC7923560 DOI: 10.14814/phy2.14759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Borg scale is used to determine exercise intensity in rehabilitation but can be difficult for older adults to understand. By contrast, face scale that are used to evaluate pain are much easier to understand thanks to the inclusion of illustrations. On the other hand, the prevalence of atrial fibrillation (AF) increases with age. This study aimed to determine the validity of the face scale for rating perceived exertion (RPE-face scale) in older adults and patients with AF during cardiopulmonary exercise test. Furthermore, the relationship between face scale and anaerobic threshold (AT) was also investigated. METHODS A total of 90 patients with sinus rhythm (SR) (74 men, 16 women) and 22 with AF were enrolled. Participants' responses were recorded using the RPE-face scale and compared with exercise intensity, heart rate, oxygen uptake, and minute ventilation during the exercise test. We determined the AT by the V-slope method. RESULTS Correlations between RPE-face scale and physiological parameters were significantly positive for men with SR and women with SR and AF. However, differences in the correlation coefficient between age and SR or AF were not statistically significant. The cutoff value for AT of the RPE-face scale was "4," showing high sensitivity and specificity. CONCLUSIONS The RPE-face scale can be used to determine the intensity of physical exercise, unaffected by age, gender, SR, or AF.
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Affiliation(s)
- Satoshi Nashimoto
- Department of RehabilitationNiigata Medical CenterNiigata‐city, NiigataJapan
| | - Shinichiro Morishita
- Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigata‐city, NiigataJapan
| | - Susumu Iida
- Department of RehabilitationNiigata Medical CenterNiigata‐city, NiigataJapan
| | - Kazuki Hotta
- Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigata‐city, NiigataJapan
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigata‐city, NiigataJapan
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Cardiac Rehabilitation in Heart Failure. ACTA ACUST UNITED AC 2021; 3:1-14. [PMID: 36263110 PMCID: PMC9536716 DOI: 10.36628/ijhf.2020.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/06/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022]
Abstract
Heart failure (HF) is a complex clinical syndrome caused by a structural and/or functional cardiac abnormality, resulting in reduced organ perfusion. The goals of treatment in patients with HF are to improve functional capacity and quality of life, and to reduce mortality. Cardiac rehabilitation (CR) including exercise training is one of the treatment options, and current guidelines recommend CR as safe and effective for patients with HF. CR has been known to improve exercise capacity and quality of life, minimize HF progression, and lower mortality in patients with HF. Improvement of vascular endothelial function, activation of the neurohormonal system, increase of mitochondrial oxygen utilization in peripheral muscles, and increase of chronotropic responses are possible mechanisms of the beneficial effects of exercise-based CR in HF. Although CR has been shown to decrease morbidity and mortality, it is underutilized in clinical practice. Despite the existence of concrete evidence of clinical benefits, the CR participation rates of patients with HF range from only 14% to 43% worldwide, with high dropout rates after enrollment. These low participation rates have been attributed to several barriers, including patient factors, professional factors, and service factors. The motivation for participating in CR and for overcoming the patients' barriers for CR before discharge should be provided to each patient. Current guidelines strongly recommend applying a CR program to all eligible patients with HF.
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