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Allen D, Carlson B, Allen D, Carlson B, Boele F, Zant M, Heine E, Aaronson N, Taphoorn M, Reijneveld J, Heimans J, Klein M, Bradshaw M, Noll K, Ziu M, Weinberg J, Strange C, Turner C, Wefel J, Carlson-Green B, Puig J, Bendel A, Lu Y, Clark K, Conklin H, Merchant T, Klimo P, Panandiker AP, Conklin H, Ashford J, Clark K, Martin-Elbahesh K, Hardy K, Merchant T, Ogg R, Jeha S, Huang L, Zhang H, Correa D, Satagopan J, Baser R, Cheung K, Lin M, Karimi S, Lyo J, DeAngelis L, Orlow I, De Witte E, Satoer D, Erik R, Colle H, Visch-Brink E, Marien P, De Witte E, Marien P, Gehring K, Hoogendoorn P, Sitskoorn M, Gondi V, Mehta M, Pugh S, Tome W, Corn B, Caine C, Kanner A, Rowley H, Kundapur V, Greenspoon J, Konski A, Bauman G, Shi W, Kavadi V, Kachnic L, Driever PH, Soelva V, Rueckriegel S, Bruhn H, Thomale U, Lambourn C, Corbett A, Linville C, Mintz A, Hampson R, Deadwyler S, Peiffer A, Noll K, Weinberg J, Ziu M, Turner C, Strange C, Wefel J, Peters K, Kenjale A, West M, Hornsby W, Herndon J, McSherry F, Desjardins A, Friedman H, Jones L, Peters K, Woodring S, Affronti ML, Threatt S, Lindhorst S, Levacic D, Desjardins A, Ranjan T, Vlahovic G, Friedman A, Friedman H, Resendiz CV, Armstrong TS, Acquaye A, Vera-Bolanos E, Gilbert M, Wefel JS, Turner C, Strange C, Bradshaw M, Noll K, Wefel J, Wefel J, Pugh S, Armstrong T, Gilbert M, Won M, Wendland M, Brachman D, Brown P, Crocker I, Robins HI, Lee RJ, Mehta M, Ziu M, Noll K, Weinberg J, Benveniste R, Turner C, Strange C, Suki D, Wefel J, Caine C, Anderson SK, Harel BT, Brown P, Cerhan JH. NEURO-COGNITIVE. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chase PJ, Kenjale A, Cahalin LP, Arena R, Davis PG, Myers J, Guazzi M, Forman DE, Ashley E, Peberdy MA, West E, Kelly CT, Bensimhon DR. Effects of respiratory exchange ratio on the prognostic value of peak oxygen consumption and ventilatory efficiency in patients with systolic heart failure. JACC Heart Fail 2013; 1:427-32. [PMID: 24621975 DOI: 10.1016/j.jchf.2013.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 05/02/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this analysis was to evaluate the prognostic characteristics of peak oxygen consumption (Vo2) and the minute ventilation/carbon dioxide (VE/Vco2) slope of different peak respiratory exchange ratios (RERs) obtained from cardiopulmonary exercise testing in patients with heart failure (HF). BACKGROUND For patients with HF, peak Vo2 and the VE/Vco2 slope are used for assessing prognosis. Peak Vo2 is assessed in association with peak RER ≥1.10, indicating maximal effort and prognostic sensitivity. Conversely, the VE/Vco2 slope provides effort-independent prognostic discrimination. METHODS Patients with HF scheduled to undergo cardiopulmonary exercise testing were enrolled. Patients were subclassified by peak RER (RER <1.00, RER 1.00 to 1.04, RER 1.05 to 1.09, RER ≥1.10) and followed for up to 3 years for major cardiac-related events (death, left ventricular assist device implantation, or cardiac transplantation). RESULTS Included were 1,728 patients with HF (75% males; 40% ischemic etiology; age: 55 ± 14 years; left ventricular ejection fraction: 28 ± 10%). Two hundred seventy major events occurred, with no proportional differences across the RER subgroups. Multivariate Cox regression analysis indicated that the VE/Vco2 slope and peak Vo2 remained prognostic within each subgroup; the VE/Vco2 slope remained the strongest predictor. Receiver-operating characteristic analysis demonstrated equitable prognostic cutoffs for the VE/Vco2 slope (range: 34.9 to 35.7; area under the curve [AUC] range: 0.69 to 0.75) and peak Vo2 (range: 13.8 to 14.0 ml·kg(-1)·min(-1); AUC range: 0.68 to 0.75). CONCLUSIONS Peak Vo2 provided a sensitive assessment of prognosis in patients with HF in all RER subgroups. The VE/Vco2 slope provided greater prognostic discrimination in all RER subgroups. Clinical consideration may be warranted for patients with low RER, low peak Vo2, and an elevated VE/Vco2 slope.
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Affiliation(s)
- Paul J Chase
- LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina; Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina.
| | - Aarti Kenjale
- LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina; Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Lawrence P Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois
| | - Paul G Davis
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, California
| | - Marco Guazzi
- Cardiology, IRCCS Policlinico San Donato, University of Milano, San Donato Milanese, Milan, Italy
| | - Daniel E Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Euan Ashley
- Cardiovascular Medicine, Stanford University, Palo Alto, California
| | - Mary Ann Peberdy
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Erin West
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Allen JD, Stabler T, Kenjale A, Ham KL, Robbins JL, Duscha BD, Dobrosielski DA, Annex BH. Plasma nitrite flux predicts exercise performance in peripheral arterial disease after 3months of exercise training. Free Radic Biol Med 2010; 49:1138-44. [PMID: 20620208 PMCID: PMC2922965 DOI: 10.1016/j.freeradbiomed.2010.06.033] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 06/29/2010] [Accepted: 06/30/2010] [Indexed: 01/03/2023]
Abstract
Plasma nitrite is a major oxidation product of nitric oxide. It has also recently been suggested to perform an endocrine-like function as a nitric oxide donor in hypoxic tissues, allowing vasodilation. Exercise performance is limited in peripheral arterial disease because of an inadequate blood supply to working tissues. We hypothesized that exercise training in peripheral arterial disease subjects will improve "plasma nitrite flux" and endothelial function, to accompany increased exercise performance. Peripheral arterial disease subjects were tested at baseline and after 3 months supervised or home exercise training. Venous blood (arm) was drawn at rest and 10 min after a maximal graded treadmill test. Samples were added to heparin and centrifuged and plasma was snap-frozen for analysis by reductive chemiluminescence. Brachial artery endothelial function was measured in response to a hyperemic stimulus (flow-mediated dilation). At 3 months the peripheral arterial disease-supervised exercise group showed increases in claudication onset pain time (+138 s, p< or =0.05), peak walking time (+260 s, p< or =0.01), VO(2peak) (1.3 ml/kg/min, p< or =0.05), brachial artery flow-mediated dilation (+2%, p< or =0.05), and plasma nitrite flux (+33% p< or =0.05). There were no changes in the peripheral arterial disease-home exercise group. The change in plasma nitrite flux predicted the change in claudication onset pain (r(2)=0.59, p< or =0.01). These findings suggest that changes in plasma nitrite are related to endothelial function and predict exercise performance in peripheral arterial disease.
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Affiliation(s)
- Jason D Allen
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Chase P, Arena R, Myers J, Abella J, Peberdy MA, Guazzi M, Kenjale A, Bensimhon D. Prognostic usefulness of dyspnea versus fatigue as reason for exercise test termination in patients with heart failure. Am J Cardiol 2008; 102:879-82. [PMID: 18805115 DOI: 10.1016/j.amjcard.2008.05.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 05/07/2008] [Accepted: 05/07/2008] [Indexed: 11/17/2022]
Abstract
Cardiopulmonary exercise testing (CPX) is an integral tool for assessing the clinical status and prognosis of patients with heart failure (HF). The present investigation examined differences in CPX variables and prognosis according to reason for test termination. One hundred eighty-three patients with HF (69% men, 31% women; mean age 53 +/- 13 years, left ventricular ejection fraction at rest 24.3 +/- 9.9%) underwent CPX in which the minute ventilation/carbon dioxide production slope, peak oxygen consumption, and peak respiratory exchange ratio were determined. Subjects were tracked for cardiac-related events for 2 years after CPX. Dyspnea and fatigue (general fatigue/leg fatigue) were the primary reasons for test termination in 79 and 104 patients, respectively. Peak oxygen consumption (15.4 +/- 5.7 vs 17.5 +/- 5.9 ml o(2) . kg(-1) . min(-1)) was significantly lower, whereas minute ventilation/carbon dioxide production slope (38.5 +/- 12.8 vs 33.9 +/- 9.8) was significantly higher in the dyspnea subgroup (p <0.05). There were 41 cardiac-related events during the 2-year tracking period. Patients with dyspnea were at significantly higher risk of adverse events (hazard ratio 2.1, 95% confidence interval 1.1 to 4.0, p = 0.02). In conclusion, these results indicate that patients with HF terminating an exercise test primarily because of dyspnea have an increased incidence of cardiac-related events and poorer CPX markers than those limited by fatigue.
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Affiliation(s)
- Paul Chase
- LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina, USA.
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