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Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy?
BACKGROUND: Exercise parameters are not routinely incorporated in decision making for cardiac resynchronisation therapy (CRT). Submaximal exercise parameters better reflect daily functional capacity of heart failure patients than parameters measured at maximal exertion, and may therefore better pred...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664270/ https://www.ncbi.nlm.nih.gov/pubmed/36376007 http://dx.doi.org/10.1136/openhrt-2022-002047 |
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author | Wouters, Philippe Schoots, Thijs Niemeijer, Victor Spee, Ruud F Kemps, Hareld |
author_facet | Wouters, Philippe Schoots, Thijs Niemeijer, Victor Spee, Ruud F Kemps, Hareld |
author_sort | Wouters, Philippe |
collection | PubMed |
description | BACKGROUND: Exercise parameters are not routinely incorporated in decision making for cardiac resynchronisation therapy (CRT). Submaximal exercise parameters better reflect daily functional capacity of heart failure patients than parameters measured at maximal exertion, and may therefore better predict response to CRT. We compared various exercise parameters, and sought to establish which best predict CRT response. METHODS: In 31 patients with chronic heart failure (61% male; age 68±7 years), submaximal and maximal cycling testing was performed before and 3 months after CRT. Submaximal oxygen onset (τVO(2) onset) and recovery kinetics (τVO(2) recovery), peak oxygen uptake (VO(2) peak) and oxygen uptake efficiency slope (OUES) where measured. Response was defined as ≥15% relative reduction in end-systolic volume. RESULTS: After controlling for age, New York Heart Association and VO(2) peak, fast submaximal VO(2) kinetics were significantly associated with response to CRT, measured either during onset or recovery of submaximal exercise (area under the curve, AUC=0.719 for both; p<0.05). By contrast, VO(2) peak (AUC=0.632; p=0.199) and OUES (AUC=0.577; p=0.469) were not associated with response. Among patients with fast onset and recovery kinetics, below 60 s, a significantly higher percentage of responders was observed (91% and 92% vs 43% and 40%, respectively). CONCLUSIONS: Impaired VO(2) kinetics may serve as an objective marker of submaximal exercise capacity that is age-independently associated with non-response following CRT, whereas maximal exercise parameters are not. Assessment of VO(2) kinetics is feasible and easy to perform, but larger studies should confirm their clinical utility. |
format | Online Article Text |
id | pubmed-9664270 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-96642702022-11-15 Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? Wouters, Philippe Schoots, Thijs Niemeijer, Victor Spee, Ruud F Kemps, Hareld Open Heart Heart Failure and Cardiomyopathies BACKGROUND: Exercise parameters are not routinely incorporated in decision making for cardiac resynchronisation therapy (CRT). Submaximal exercise parameters better reflect daily functional capacity of heart failure patients than parameters measured at maximal exertion, and may therefore better predict response to CRT. We compared various exercise parameters, and sought to establish which best predict CRT response. METHODS: In 31 patients with chronic heart failure (61% male; age 68±7 years), submaximal and maximal cycling testing was performed before and 3 months after CRT. Submaximal oxygen onset (τVO(2) onset) and recovery kinetics (τVO(2) recovery), peak oxygen uptake (VO(2) peak) and oxygen uptake efficiency slope (OUES) where measured. Response was defined as ≥15% relative reduction in end-systolic volume. RESULTS: After controlling for age, New York Heart Association and VO(2) peak, fast submaximal VO(2) kinetics were significantly associated with response to CRT, measured either during onset or recovery of submaximal exercise (area under the curve, AUC=0.719 for both; p<0.05). By contrast, VO(2) peak (AUC=0.632; p=0.199) and OUES (AUC=0.577; p=0.469) were not associated with response. Among patients with fast onset and recovery kinetics, below 60 s, a significantly higher percentage of responders was observed (91% and 92% vs 43% and 40%, respectively). CONCLUSIONS: Impaired VO(2) kinetics may serve as an objective marker of submaximal exercise capacity that is age-independently associated with non-response following CRT, whereas maximal exercise parameters are not. Assessment of VO(2) kinetics is feasible and easy to perform, but larger studies should confirm their clinical utility. BMJ Publishing Group 2022-11-14 /pmc/articles/PMC9664270/ /pubmed/36376007 http://dx.doi.org/10.1136/openhrt-2022-002047 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Heart Failure and Cardiomyopathies Wouters, Philippe Schoots, Thijs Niemeijer, Victor Spee, Ruud F Kemps, Hareld Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? |
title | Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? |
title_full | Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? |
title_fullStr | Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? |
title_full_unstemmed | Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? |
title_short | Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? |
title_sort | does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? |
topic | Heart Failure and Cardiomyopathies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664270/ https://www.ncbi.nlm.nih.gov/pubmed/36376007 http://dx.doi.org/10.1136/openhrt-2022-002047 |
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