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  • Roskamm, Helmut  (7)
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  • 1
    Language: English
    In: American Journal of Noninvasive Cardiology, 8/11/2017, Vol.8(6), pp.340-345
    Description: In view of the frequent follow-up evaluations of patients with severe chronic heart failure, the purpose of this study was to assess whether noninvasive gas exchange parameters from cardiopulmonary exercise testing (CPX), measured at ventilatory threshold (VT), are related to invasively measured peak diastolic pulmonary artery pressure (dPAP) and peak cardiac output (CO). 23 males with severe chronic heart failure underwent CPX on a bicycle ergometer (supine; steps of 25 W/5 min) during right heart catheterization. dPAP and/or CO increased significantly from rest to VT (18 ±10-9 30 ±10 mm Hg, p 〈 0.01; 4.8 ± 1.4 -9 6.4 ± 2.3 liters/min, p〈 0.05), but did not from VT to peak exercise (33 ± 10 mm Hg; 7.3 ± 2.5 liters/min). Data indicated severely deteriorated hemodynamics at rest and during exercise. Oxygen uptake (VO2) increased from rest (270 ± 45 ml/min) to VT (650 ± 135 ml/min at 27 ± 7 W) to peak exercise (829 ± 183 ml/min at 39 ± 23 W). VO2 data were normal for a given workload. From all CPX data at VT, only 02 pulse correlated with peak dPAP (r = -0.58; p 〈 0.05). Peak CO correlated with O2 pulse (r = -0.49), VO2 (r = 0.46), ventilatory equivalent for O2 (r = -0.43) and tidal volume (r = 0.43), measured at VT (p 〈 0.05 for all parameters). Variance of peak dPAP and peak CO could only be explained by O2 pulse at VT (58 and 49%, respectively). Noninvasive cardiopulmonary data at VT did not give sufficient information about peak dPAP and peak CO in patients with severe chronic heart failure using a steady-state protocol. This indicates that early ventilatory threshold should not be considered indicative of reduced CO due to skeletal muscle underperfusion in heart failure patients.
    Keywords: Original Paper ; Chronic Heart Failure ; Central Hemodynamics ; Cardiopulmonary Exercise Testing;
    ISSN: 0258-4425
    E-ISSN: 2504-2378
    Source: S. Karger AG (Via CrossRef)
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  • 2
    In: Medicine & Science in Sports & Exercise, 1996, Vol.28(9), pp.1081-1086
    Description: This study compares hemodynamic, metabolic, and gas exchange responses, catecholamine levels, and symptoms in 35 male patients with chronic heart failure (CHF) ([mean ± SD] age 53 ± 11 yr; ejection fraction 24± 11%) during three differently graded exercise test protocols. On three consecutive days patients performed cycle ergometry supine, with prolonged steps (prol BE) and right heart catheterization, ramplike cycle ergometry sitting (ramp BE), and ramplike treadmill walking (TMW). As in routine clinical practice, the prol BE was terminated when pathologic central hemodynamics and/or increased symptomology occurred, and ramp BE and TMW due to increased symptomology and/or physician's decision. During prol BE at ventilatory threshold (VT) the ˙VO2 (8.6 ± 1.8 ml·kg·min) was lower than during ramp BE (9.3± 2.1 ml·kg·min) (P 〈 0.017) and TMW (11.8 ± 2.3 ml·kg·min)(P 〈 0.0001). Prol BE, ramp BE, and TMW also differed significantly with respect to ventilation (22 ± 71·min; 26 ± 6 l·min; 29 ± 7 l·min;P 〈 0.01) and heart rate (100 ± 15 beats·min; 103 ± 18 beats·min; 110± 16 beats·min; P 〈 0.017). No differences were found in lactate levels, catecholamine levels, and ratings of leg fatigue and dyspnea. At test termination, the peak ˙VO2 during prol BE(10.8 ± 3.3 ml·kg·min) was lower than during ramp BE (13.3 ± 4.1 ml·kg·min)(P 〈 0.0001) and TMW (14.7 ± 3.4 ml·kg·min) (P 〈 0.0001). Peak norepinephrine value during ramp BE (4.531 ± 2.788 nmol·l) was higher than during prol BE (3.707 ± 2.262 nmol·l) (P 〈 0.001). Among the three tests, no significant differences were found for peak values of heart rate, lactate, and ratings of dyspnea. Although the ˙VO2·kg at VT was significantly higher during ramp BE and TMW compared to prol BE (P〈 0.001), the values expressed as a percent of peak˙VO2·kg were significantly lower (70 ± 4%; 72 ± 6%; 79 ± 3%; P 〈 0.017). A systematic effect on aerobic capacity with reduced peak values during ramp BE and TMW was demonstrated when test termination was based primarily on pathological findings of central hemodynamics from prol BE.
    Keywords: Oxygen Consumption ; Exercise -- Physiology ; Exercise Test -- Methods ; Heart Failure -- Physiopathology;
    ISSN: 0195-9131
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  • 3
    In: Medicine & Science in Sports & Exercise, 1997, Vol.29(3), pp.306-312
    Description: This study analyzes a new exercise training procedure, which includes interval exercise training on cycle ergometer (IntCT) (30-s work phases/60-s recovery phases) and on treadmill (60-s work and recovery phases each). Training was applied for 3 wk in 18 patients with severe chronic heart failure(CHF) ((mean ± SEM) age 52 ± 2 yr, ejection fraction 21 ± 1%). Peak ˙VO2 was increased from 12.2 ± 0.7 to 14.6± 0.7 ml·kg·min owing to training(P 〈 0.001). A specific steep ramp test (work rate increments 25 W·10 s) was developed to derive exercise intensity for work phases in IntCT, which was 50% of the maximum work rate achieved. Steep ramp test was performed at the start of the study to determine the initial training work rate, then weekly to readjust it. Since the maximum work rate achieved from this test increased weekly (144 ± 10 W → 172 ± 10 W→ 200 ± 11 W; P 〈 0.001), the training work rate also increased (72 ± 4 W → 86 ± 6 W → 100 ± 7 W;P 〈 0.001). Physical responses to IntCT were measured. There was no significant change in heart rate, blood pressure, and ratings of perceived exertion (RPE) using a Borg Scale between the first and the third week of training (heart rate 88 ± 3 b·min; blood pressure 115± 4/80 ± 2 mm Hg; leg fatigue 12 ± 1; dyspnea 10 ± 1). Mean lactate concentration (1.70 ± 0.09 mmol·l) indicated an overall aerobic range of training intensity. When compared with the commonly used intensity level of 75% peak ˙VO2 from an ordinary ramp test (work rate increments 12.5 W·min), the performed training work rate was more than doubled (240%; P 〈 0.0001) while cardiac stress was lower (86%; P 〈 0.01). Values of norepinephrine and epinephrine as well as of RPE corresponded to those measured at 75% peak ˙VO2. Interval exercise training is thus recommended for selected patients with CHF as it allows intense exercise stimuli on peripheral muscles with minimal cardiac strain. Using a steep ramp test, training work rate can be determined and readjusted weekly during initial training period.
    Keywords: Exercise -- Physiology ; Exercise Therapy -- Methods ; Heart Failure -- Rehabilitation;
    ISSN: 0195-9131
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  • 4
    Language: English
    In: American Heart Journal, 1997, Vol.133(4), pp.447-453
    Description: Eighteen hospitalized patients with severe chronic heart failure (ejection fraction [mean ± SEM] 21% ± 1%) underwent 3 weeks of exercise training (interval bicycle ergometer and treadmill walking training exercises) and 3 weeks of activity restriction in a random-order crossover trial. Before and after exercise training and after activity restriction, a 6-minute walking test was performed to determine the maximum distance walked, hemodynamic and cardiopulmonary responses, norepinephrine levels, and ratings of leg fatigue and dyspnea while walking. A ramp test on bicycle ergometer (increments of 12.5 W/min) was performed before and after exercise training and activity restriction to determine peak oxygen uptake. After training, the maximum distance walked was increased by 65% (from 232 ± 21 m at baseline to 382 ± 20 m; 〈 0.001), whereas after activity restriction (253 ± 19 m) there was no significant difference compared with baseline. No significant differences in hemodynamic and cardiopulmonary parameters (with the exception of the ventilatory equivalent for carbon dioxide and perceived exertion) or norepinephrine levels were observed during walking tests. Improvement in maximum distance walked correlated significantly with training-induced increase in peak oxygen uptake measured during bicycle ergometry ( = 0.47, 〈 0.05). The lower the maximum distance walked at baseline, the more pronounced the training-induced prolongation of maximum distance ( = −0.73; 〈 0.001). These data support the value of exercise training in patients with severe chronic heart failure for improving maximum distance walked, as documented by the 6-minute walking test. The impairment of walking test performance during activity restriction suggests a need for long-term exercise training programs. (Am Heart J 1997;133:447-53.)
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 5
    Language: English
    In: The American Journal of Cardiology, 1996, Vol.78(9), pp.1017-1022
    Description: Previous exercise training studies in patients with chronic congestive heart failure (CHF) were performed for periods lasting 〉 2 months, and effects of activity restriction on exercise induced-benefits were not systematically assessed. With one exception study, patients were not reported to be transplant candidates. In this random-order crossover study, effects of 3 weeks of exercise training and 3 weeks of activity restriction on functional capacity in 18 hospitalized patients with severe CHF [(mean +/- SEM) age 52 +/- 2 years; ejection fraction 21 +/- 1%; half of them on a transplant waiting list] were assessed. The training program consisted of interval exercise with bicycle ergometer (15 minutes) 5 times weekly, interval treadmill walking (10 minutes), and exercises (20 minutes), each 3 times weekly. With training, the onset of ventilatory threshold was delayed (p 〈 0.001), with increased work rate by 57% (p 〈 0.001) and oxygen uptake by 23.7% (p 〈 0.001). On average, there was a 14.6% decrease in slope of ventilation/carbon dioxide production before the onset of ventilatory threshold (p 〈 0.05), and ventilatory equivalent of carbon dioxide production by 10.3% (p 〈 0.01). At the highest comparable work rate (56 +/- 5 W) the following variables were decreased: heart rate (7.3%; p 〈 0.05), lactate (26.6%; p 〈 0.001), and ratings of perceived leg fatigue and dyspnea (14.5% and 16.5%; p 〈 0.001 each). At peak exercise, oxygen uptake was increased by 19.7% (p 〈 0.01) and oxygen pulse by 14.2% (p 〈 0.01). There was a correlation of baseline peak oxygen uptake and increase of peak oxygen uptake due to training (r = -0.75; p 〈 0.004). Independently of the random order, data after activity restriction did not differ significantly from data measured at baseline. Patients with stable, severe CHF can achieve significant improvements in aerobic and ventilatory capacity and symptomology by short-term exercise training using interval exercise methods. Impairments due to activity restriction suggest the need for long-term exercise training.
    Keywords: Medicine
    ISSN: 0002-9149
    E-ISSN: 1879-1913
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  • 6
    Language: English
    In: Clinical Cardiology, December 1996, Vol.19(12), pp.944-948
    Description: Patients with chronic heart failure (CHF) are characterized by abnormal gas exchange and ventilatory responses to exercise. This study compares variables obtained from cardiopulmonary exercise testing in 35 patients with CHF with 35 age‐ and weight‐matched healthy subjects. A second goal was to obtain cardiopulrnonary variables measured at ventilatory threshold to distinguish patient changes from those of healthy subjects. Exercise testing was carried out using bicycle ergometry with ramplike protocol (work rate increments 12.5 W/min). Gas exchange and ventilation were measured breath by breath. Compared with healthy subjects, the VO in patients was lower at identical work rates (p〈0.004) and at ventilatory threshold (p〈0.0001), and the slope of the VO curve during incremental exercise was flatter (p〈0.05). With the exception of heart rate, the variables for VO, VCO, ventilation, O pulse, ventilatory equivalents for O and CO, and V/V (physiologic deadspace to tidal volume ratio), as well as lactate differed significantly at identical work rates. With the exception of V/V all cardiopulmonary variables showed significant differences in their slopes during exercise. By means of a discriminant analysis, VCO and ventilation proved to be the most distinguishing variables at ventilatory threshold between patients with CHF and healthy subjects. These results indicate the clinical usefulness of cardiopulmonary exercise testing when assessing functional impairment due to CHF. For treatment evaluation, not only VQ but also VCO and ventilation responses to exercise should be considered.
    Keywords: Chronic Heart Failure ; Healthy Subjects ; Cardiopulmonary Exercise Testing ; Gas Exchange ; Ventilation
    ISSN: 0160-9289
    E-ISSN: 1932-8737
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  • 7
    Language: English
    In: Cardiology, 1996, Vol.87(5), pp.443-449
    Description: Classes I/II and III of the classification systems of the New York Heart Association (NYHA), Canadian Cardiovascular Society (CCS) and American Medical Association (AMA) were compared with each other and with the Weber classification (O2ptake, VO2/kg during treadmill walking) in 35 male patients with severe left ventricular dysfunction. Measured end points were ventilatory threshold (VT) and peak exercise. Also investigated was whether the CCS and AMA scales, due to their more stringent differentiation, are more precise than the NYHA system in determining a limited physical capacity and whether there are other differentiating factors useful in classification which may be derived from cardiopulmonary exercise testing. At the VT, the mean VO2/kg did not differ significantly in any classification system between classes I/II and III (12.8 ± 2.5 vs. 11.1 ± 2.3 ml/kg/min) and corresponded to Weber class B. At peak exercise, the mean VO2/kg only differed significantly within the NYHA classification; classes I/II (16.3 ± 3.1 ml/kg/min) corresponded to Weber class B, and class III (13 ± 3 ml/kg/min) to Weber class C. The individual values displayed a large scatter. Factors differing in classes I/II and III of all three systems at peak exercise were the ventilatory equivalent of O2 and CO2 as well as end-tidal partial pressure for (O2 and CO2. At VT these factors showed a separating character only in the AMA classification. It is not possible to determine objective functional impairment by use of the NYHA, CCS and AMA systems because they are not analogous to the Weber system. Nevertheless, these classification systems can be used for clinical assessment and follow-up.
    Keywords: Exercise and Cardiac Rehabilitation ; Severe Left Ventricular Dysfunction ; New York Heart Association Classification ; Canadian Cardiovascular Society Classification ; American Medical Association Classification ; Weber Classification ; Medicine
    ISSN: 0008-6312
    E-ISSN: 1421-9751
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