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Ting SMS, Iqbal H, Hamborg T, Imray CHE, Hewins S, Banerjee P, Bland R, Higgins R, Zehnder D. Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation. PLoS One 2013; 8:e64335. [PMID: 23724043 PMCID: PMC3664577 DOI: 10.1371/journal.pone.0064335] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 04/13/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There is currently no effective preoperative assessment for patients undergoing kidney transplantation that is able to identify those at high perioperative risk requiring admission to critical care unit (CCU). We sought to determine if functional measures of cardiovascular reserve, in particular the anaerobic threshold (VO₂AT) could identify these patients. METHODS Adult patients were assessed within 4 weeks prior to kidney transplantation in a University hospital with a 37-bed CCU, between April 2010 and June 2012. Cardiopulmonary exercise testing (CPET), echocardiography and arterial applanation tonometry were performed. RESULTS There were 70 participants (age 41.7±14.5 years, 60% male, 91.4% living donor kidney recipients, 23.4% were desensitized). 14 patients (20%) required escalation of care from the ward to CCU following transplantation. Reduced anaerobic threshold (VO₂AT) was the most significant predictor, independently (OR = 0.43; 95% CI 0.27-0.68; p<0.001) and in the multivariate logistic regression analysis (adjusted OR = 0.26; 95% CI 0.12-0.59; p = 0.001). The area under the receiver-operating-characteristic curve was 0.93, based on a risk prediction model that incorporated VO₂AT, body mass index and desensitization status. Neither echocardiographic nor measures of aortic compliance were significantly associated with CCU admission. CONCLUSIONS To our knowledge, this is the first prospective observational study to demonstrate the usefulness of CPET as a preoperative risk stratification tool for patients undergoing kidney transplantation. The study suggests that VO₂AT has the potential to predict perioperative morbidity in kidney transplant recipients.
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Affiliation(s)
- Stephen M. S. Ting
- Department of Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
- * E-mail: (ST); (DZ)
| | - Hasan Iqbal
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Thomas Hamborg
- Division of Health Sciences Statistics and Epidemiology, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Chris H. E. Imray
- Department of Vascular and Renal Transplantation Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Susan Hewins
- Department of Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Prithwish Banerjee
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Rosemary Bland
- Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Robert Higgins
- Department of Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Daniel Zehnder
- Department of Renal Medicine and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Division of Metabolic and Vascular Health, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
- * E-mail: (ST); (DZ)
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Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, Arena R, Fletcher GF, Forman DE, Kitzman DW, Lavie CJ, Myers J. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation 2012; 126:2261-74. [PMID: 22952317 PMCID: PMC4777325 DOI: 10.1161/cir.0b013e31826fb946] [Citation(s) in RCA: 509] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, Arena R, Fletcher GF, Forman DE, Kitzman DW, Lavie CJ, Myers J. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J 2012; 33:2917-27. [DOI: 10.1093/eurheartj/ehs221] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Marco Guazzi
- Department of Medical Sciences, Cardiology, I.R.C.C.S. San Donato Hospital, University of Milan, San Donato Milanese, P.za Malan, 2, 20097, Milan, Italy
| | - Volker Adams
- Department of Cardiology, University Leipzig–Heart Center Leipzig, Leipzig, Germany
| | - Viviane Conraads
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Martin Halle
- Department of Prevention and Sports Medicine, Technische Universität München, Munich, Germany
| | - Alessandro Mezzani
- Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, S. Maugeri Foundation IRCCS, Scientific Institute of Veruno, Veruno (NO), Italy
| | - Luc Vanhees
- Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven (University of Leuven), Leuven, Belgium
| | - Ross Arena
- Department of Orthopaedics and Rehabilitation – Division of Physical Therapy and Department of Internal Medicine – Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Daniel E. Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dalane W. Kitzman
- Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carl J. Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto Health Care System, Stanford University, Palo Alto, CA, USA
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Perim RR, Signorelli GR, Araújo CGS. Stability of relative oxygen pulse curve during repeated maximal cardiopulmonary testing in professional soccer players. Braz J Med Biol Res 2011; 44:700-6. [PMID: 21837356 DOI: 10.1590/s0100-879x2011007500073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 05/24/2011] [Indexed: 12/17/2022] Open
Abstract
During cardiopulmonary exercise testing (CPET), stroke volume can be indirectly assessed by O(2) pulse profile. However, for a valid interpretation, the stability of this variable over time should be known. The objective was to analyze the stability of the O(2) pulse curve relative to body mass in elite athletes. VO(2), heart rate (HR), and relative O(2) pulse were compared at every 10% of the running time in two maximal CPETs, from 2005 to 2010, of 49 soccer players. Maximal values of VO(2) (63.4 ± 0.9 vs 63.5 ± 0.9 mL O(2)•kg(-1)•min(-1)), HR (190 ± 1 vs188 ± 1 bpm) and relative O(2) pulse (32.9 ± 0.6 vs 32.6 ± 0.6 mL O(2)•beat(-1)•kg(-1)) were similar for the two CPETs (P > 0.05), while the final treadmill velocity increased from 18.5 ± 0.9 to 18.9 ± 1.0 km/h (P < 0.01). Relative O(2) pulse increased linearly and similarly in both evaluations (r(2) = 0.64 and 0.63) up to 90% of the running time. Between 90 and 100% of the running time, the values were less stable, with up to 50% of the players showing a tendency to a plateau in the relative O(2) pulse. In young healthy men in good to excellent aerobic condition, the morphology of the relative O(2) pulse curve is consistent up to close to the peak effort for a CPET repeated within a 1-year period. No increase in relative O(2)pulse at peak effort could represent a physiologic stroke volume limitation in these athletes.
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Affiliation(s)
- R R Perim
- Programa de Pós-Graduação em Educação Física, Universidade Gama Filho, Rio de Janeiro, Brasil
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Arena R, Sietsema KE. Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation 2011; 123:668-80. [PMID: 21321183 DOI: 10.1161/circulationaha.109.914788] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Richmond Virginia 23298-0224, USA.
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Perim RR, Signorelli GR, Myers J, Arena R, de Araújo CGS. The slope of the oxygen pulse curve does not depend on the maximal heart rate in elite soccer players. Clinics (Sao Paulo) 2011; 66:829-35. [PMID: 21789388 PMCID: PMC3109383 DOI: 10.1590/s1807-59322011000500020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 04/01/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It is unknown whether an extremely high heart rate can affect oxygen pulse profile during progressive maximal exercise in healthy subjects. OBJECTIVE Our aim was to compare relative oxygen pulse (adjusted for body weight) curves in athletes at their maximal heart rate during treadmill cardiopulmonary exercise testing. METHODS A total of 180 elite soccer players were categorized in quartiles according to their maximum heart rate values (n = 45). Oxygen consumption, maximum heart rate and relative oxygen pulse curves in the extreme quartiles, Q1 and Q4, were compared at intervals corresponding to 10% of the total duration of a cardiopulmonary exercise testing. RESULTS Oxygen consumption was similar among all subjects during cardiopulmonary exercise testing; however subjects in Q1 started to exhibit lower maximum heart rate values when 20% of the test was complete. Conversely, the relative oxygen pulse was higher in this group when cardiopulmonary exercise testing was 40% complete (p<.01). Although the slopes of the lines were similar (p = .25), the regression intercepts differed (p<.01) between Q1 and Q4. During the last two minutes of testing, a flat or decreasing oxygen pulse was identified in 20% of the soccer players, and this trend was similar between subjects in Q1 and Q4. CONCLUSION Relative oxygen pulse curve slopes, which serve as an indirect and non-invasive surrogate for stroke volume, suggest that the stroke volume is similar in young and aerobically fit subjects regardless of the maximum heart rate reached.
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Arena R, Myers J, Guazzi M. The future of aerobic exercise testing in clinical practice: is it the ultimate vital sign? Future Cardiol 2010; 6:325-42. [PMID: 20462339 DOI: 10.2217/fca.10.21] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The four traditional vital signs: resting heart rate, blood pressure, respiratory rate and body temperature, serve as the cornerstone of a physical examination. Other assessments such as pain have been proposed as additional vital signs. To this point however, there has been limited consideration for aerobic exercise assessment as a vital sign. A wealth of literature demonstrating the prognostic, diagnostic and interventional value of the aerobic exercise assessment now exists, supporting its use in numerous clinical scenarios. Moreover, the assessment of the aerobic exercise response allows for the manifestation of physiologic abnormalities that are not readily apparent during the collection of resting data. This review will provide evidence supporting the assertion that the aerobic exercise assessment may be afforded vital sign status in future clinical practice.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA.
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