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Gianfranco Parati - One of the best experts on this subject based on the ideXlab platform.

  • Risk stratification in heart failure with mild reduced ejection fraction.
    European journal of preventive cardiology, 2020
    Co-Authors: Damiano Magrì, Giovanna Gallo, Gianfranco Parati, Mariantonietta Cicoira, Michele Senni
    Abstract:

    Heart failure with mid-range ejection fraction represents a heterogeneous and relatively young heart failure category accounting for nearly 20-30% of the overall heart failure population. Due to its complex phenotype, a reliable clinical picture of heart failure with mid-range ejection fraction patients as well as a definite risk stratification are still relevant unsolved issues. In such a context, there is growing interest in a comprehensive functional assessment by means of a Cardiopulmonary Exercise Test, yet considered a cornerstone in the clinical management of patients with heart failure and reduced ejection fraction. Indeed, the Cardiopulmonary Exercise Test has also been found to be particularly useful in the heart failure with mid-range ejection fraction category, several Cardiopulmonary Exercise Test-derived parameters being associated with a poor outcome. In particular, a recent contribution by the metabolic Exercise combined with cardiac and kidney indexes research group showed an independent association between the peak oxygen uptake and pure cardiovascular mortality in a large cohort of recovered heart failure with mid-range ejection fraction patients. Contextually, the same study supplied an easy approach to identify a high-risk heart failure with mid-range ejection fraction subset by using a combination of peak oxygen uptake and ventilatory efficiency cut-off values, namely 55% of the maximum predicted and 31, respectively. Thus, looking at the above-mentioned promising results and waiting for specific trials, it is reasonable to consider Cardiopulmonary Exercise Test assessment as part of the heart failure with mid-range ejection fraction work-up in order to identify those patients with an unfavourable functional profile who probably deserve a close clinical follow-up and, probably, more aggressive therapeutic strategies.

  • improvement of functional capacity in sacubitril valsartan treated patients assessed by Cardiopulmonary Exercise Test
    Acta Cardiologica, 2020
    Co-Authors: Gabriella Malfatto, Gianfranco Parati, Silvia Ravaro, Sergio Caravita, Claudia Baratto, Antonio Sorropago, Alessia Giglio, Michele Tomaselli, Alessandra Villani
    Abstract:

    Neprilisin and angiotensin receptor inhibition (Sacubitril/Valsartan, i.e. ARNI) is recommended in heart failure guidelines for patients in NYHA class II-III with reduced left ventricular ejection ...

  • improvement of functional capacity in sacubitril valsartan treated patients assessed by Cardiopulmonary Exercise Test
    Journal of Hypertension, 2019
    Co-Authors: Gabriella Malfatto, Silvia Ravaro, Sergio Caravita, Claudia Baratto, Antonio Sorropago, Alessia Giglio, Michele Tomaselli, Alessandra Villani, Mario Facchini, Gianfranco Parati
    Abstract:

    Objective:The combination of neprilisin and angiotensin receptor inhibition (Sacubitril/Valsartan, i.e. ARNI) is recommended in heart failure guidelines for patients in NYHA class II-III with reduced left ventricular ejection fraction (LVEF).Sacubitril/Valsartan increases survival and quality of lif

Jonas Lírio Gurgel - One of the best experts on this subject based on the ideXlab platform.

  • Validity of an Interval Taekwondo-Specific Cardiopulmonary Exercise Test.
    Journal of strength and conditioning research, 2019
    Co-Authors: Marcus Paulo Araujo, Pedro Paulo Da Silva Soares, Matheus Hausen, Hilbert Julio, Flávia Porto, Jonas Lírio Gurgel
    Abstract:

    Araujo, MP, Soares, PP, Hausen, MR, Julio, HS, Porto, F, and Gurgel, JL. Validity of an interval taekwondo-specific Cardiopulmonary Exercise Test. J Strength Cond Res XX(X): 000-000, 2018-The objective of this study is to propose and validate an interval taekwondo-specific Cardiopulmonary Exercise Test (ITKDTest) and compare it with running Cardiopulmonary Exercise Test (CPET) and a continuous taekwondo-specific Cardiopulmonary Exercise Test (CTKDTest). Fifteen athletes (age 22 ± 4 years; body mass 71.1 ± 10.2 kg; height 178.14 ± 8.3 cm; and body mass index 22.4 ± 2.4 kg·m) performed CPET, CTKDTest, and ITKDTest on a counterbalanced order. Oxygen uptake (V[Combining Dot Above]O2), heart rate (HR), and ventilatory thresholds (VTs 1 and 2) were measured during the 3 Tests. ITKDTest started at 30 kicks per minute and increased 10 kicks each 2 minutes, with a period of passive recovery, lasting 1 minute. Interval protocol design simulated the temporal structure of an official taekwondo fight. Significant difference between specific Tests was found for V[Combining Dot Above]O2 VT1 (p = 0.03), V[Combining Dot Above]O2 VT1 (%V[Combining Dot Above]O2peak) (p = 0.009), V[Combining Dot Above]O2 VT2 (p = 0.005), and V[Combining Dot Above]O2 VT2 (%V[Combining Dot Above]O2peak) (p = 0.013). Reliability was considered "excellent" for V[Combining Dot Above]O2peak (α = 0.902; SEM = 0.179), "good" for V[Combining Dot Above]O2 VT1 (α = 0.708; SEM = 3.823) and HRpeak (α = 0.803; SEM = 2.987), and "fair" for V[Combining Dot Above]O2 VT2 (α = 0.659; SEM = 4.498) and HR VT2 (α = 0.580; SEM = 8.868). Bland-Altman analyses reported a mean difference of 2.9 ± 6.6 ml·kg·min (CPET-ITKDTest) and 1.4 ± 6.1 ml·kg·min (CTKDTest-ITKDTest). ITKDTest may be used for measurement of cardiorespiratory variables commonly used in Exercise prescription, whereas CTKDTest seems to be a more appropriate method to assess V[Combining Dot Above]O2 and HR at VTs.

  • proposal of a new specific Cardiopulmonary Exercise Test for taekwondo athletes
    Journal of Strength and Conditioning Research, 2017
    Co-Authors: Marcus Paulo Araujo, Pedro Paulo Da Silva Soares, Matheus Hausen, Antonio Claudio Lucas Da Nobrega, Gabriel Espinosa, Renata Rodrigues Teixeira De Castro, Jonas Lírio Gurgel
    Abstract:

    The objective of this study is to evaluate the cardiorespiratory variables of Taekwondo athletes while performing incremental Exercise Test on an ergometer using a ramp protocol and to propose a specific protocol for assessing these physiological variables during Taekwondo practice. Fourteen athletes participated in 2 incremental Exercise Tests: a treadmill Exercise Test (TREADTest) and a Taekwondo-specific Exercise Test (TKDTest). The TKDTest consists in 1-minute stages of kicks with an incremental load between then. The subjects perform kicks each time a sound signal was heard. Heart rate (HR), oxygen uptake (V[Combining Dot Above]O2), and their reserve correspondents (V[Combining Dot Above]O2R and reserve heart rate [HRR]) were divided into quartiles to verify their kinetics along the Tests. Significant difference between 2 Tests was found only for V[Combining Dot Above]O2R (p = 0.03). Regarding the quartiles, significant differences were found for HR in the first (p = 0.030) and second (p = 0.003). Analyzing the regression curves, significant differences were found for HR for intercept (p = 0.01) and slope (p = 0.05) and HRR for slope (p = 0.02). Analysis showed that significant reliability, with intraclass correlation coefficient (ICC), was found for the V[Combining Dot Above]O2peak (ICC = 0.855, p = 0.003), V[Combining Dot Above]O2 in ventilatory thresholds 1 (ICC = 0.709, p = 0.03) and 2 (ICC = 0.848, p = 0.003). Bland-Altman analyses reported a mean difference ± the 95% limits of agreement of 2.2 ± 8.4 ml·kg·min to V[Combining Dot Above]O2peak. The TKDTest is reliable for measurement of cardiorespiratory variables, and the behavior of these variables differs mainly from TREADTest, probably because of the motor task performed.

Piergiuseppe Agostoni - One of the best experts on this subject based on the ideXlab platform.

  • non invasive estimation of stroke volume during Exercise from oxygen in heart failure patients
    European Journal of Preventive Cardiology, 2020
    Co-Authors: Emanuele Accalai, Elisabetta Salvioni, Beatrice Pezzuto, Mauro Contini, Carlo Vignati, Christian Cadeddu, Luigi Meloni, Piergiuseppe Agostoni
    Abstract:

    AimsIn heart failure, oxygen uptake and cardiac output measurements at peak and during Exercise are important in defining heart failure severity and prognosis. Several Cardiopulmonary Exercise Test...

  • Prognostic Role of Cardiopulmonary Exercise Testing in Clinical Practice.
    Annals of the American Thoracic Society, 2017
    Co-Authors: Stefania Paolillo, Piergiuseppe Agostoni
    Abstract:

    Risk stratification is a mainstay in the care of cardiac and pulmonary disorders, as the identification of adverse outcomes helps provide measures to improve survival and quality of life. The Cardiopulmonary Exercise Test is a useful prognostic tool in the clinical evaluation of several pathological conditions, such as heart diseases, respiratory disorders, and pulmonary hypertension. If not contraindicated, a Cardiopulmonary Exercise Test should always be performed and integrated with clinical, laboratory, and hemodynamic parameters to better stratify patient risk. In heart failure, the Cardiopulmonary Exercise Test is important in all the stages of patient management, from diagnosis to risk assessment. Different Exercise variables have been advocated as prognostic indicators in this condition, including peak oxygen uptake, ventilatory efficiency, respiratory patterns, and identification of the anaerobic threshold. The prognostic role of the Cardiopulmonary Exercise Test in heart failure is amplified when included in multiparametric risk stratification methodology, currently considered the best method to assess patient outcome. In respiratory disorders and in pulmonary hypertension, Cardiopulmonary Exercise Test parameters, focusing on ventilatory performance during Exercise, may help evaluate the risk of adverse events. Finally, the Cardiopulmonary Exercise Test may help define the presence of coexisting cardiac and respiratory disorders, a combination that leads to increased rates of disability and mortality.

  • Cardiopulmonary Exercise Test and sudden cardiac death risk in hypertrophic cardiomyopathy
    Heart, 2016
    Co-Authors: Damiano Magrì, Piergiuseppe Agostoni, Giuseppe Limongelli, Elisabetta Zachara, Michele Correale, Vittoria Mastromarino, Caterina Santolamazza, Matteo Casenghi, Giuseppe Pacileo, Fabio Valente
    Abstract:

    Background In hypertrophic cardiomyopathy (HCM), most of the factors associated with the risk of sudden cardiac death (SCD) are also involved in the pathophysiology of Exercise limitation. The present multicentre study investigated possible ability of Cardiopulmonary Exercise Test in improving contemporary strategies for SCD risk stratification. Methods A total of 623 consecutive outpatients with HCM, from five tertiary Italian HCM centres, were recruited and prospectively followed, between September 2007 and April 2015. The study composite end point was SCD, aborted SCD and appropriate implantable cardioverter defibrillator (ICD) interventions. Results During a median follow-up of 3.7 years (25th–75th centile: 2.2–5.1 years), 25 patients reached the end point at 5 years (3 SCD, 4 aborted SCD, 18 appropriate ICD interventions). At multivariate analysis, ventilation versus carbon dioxide relation during Exercise (VE/VCO 2 slope) remains independently associated to the study end point either when challenged with the 2011 American College of Cardiology Foundation/American Heart Association guidelines-derived score (C index 0.748) or with the 2014 European Society of Cardiology guidelines-derived score (C index 0.750). A VE/VCO 2 slope cut-off value of 31 showed the best accuracy in predicting the SCD end point within the entire HCM study cohort (sensitivity 64%, specificity 72%, area under the curve 0.72). Conclusions Our data suggest that the VE/VCO 2 slope might improve SCD risk stratification, particularly in those HCM categories classified at low-intermediate SCD risk according to contemporary guidelines. There is a need for further larger studies, possibly on independent cohorts, to confirm our preliminary findings.

  • rationale for Cardiopulmonary Exercise Test in the assessment of surgical risk
    Journal of Cardiovascular Medicine, 2013
    Co-Authors: Annamaria Iorio, Elisabetta Salvioni, Damiano Magrì, Piergiuseppe Agostoni, Stefania Paolillo, Andrea Di Lenarda, Gianfranco Sinagra, Susanna Sciomer
    Abstract:

    Although in the past years a reduced mortality in peri-operative care has been observed, cardiovascular mortality and morbidity still is a major burden in patients undergoing noncardiac surgery and its evaluation is still a difficult task. An accurate risk stratification can improve quality of peri-operative care and may improve survival, while reducing healthcare costs. In clinical practice, we make our assessment of a patient's cardiac status based on history, examination and investigations, together with risks related to the surgical procedure, to generate an 'individualized cardiac risk assessment'. At the present, risk stratification with clinical risk score and cardiac Testing have been shown to be suboptimal in identifying high-risk patients. Surgery, like Exercise, increases oxygen consumption. Indeed, one of the key elements in determining risk assessment is Exercise intolerance, but future research in this field is needed to clarify this statement. Cardiopulmonary Exercise Testing (CPET) provides a global assessment of functional capacity involving and integrating the physiological measurement during incremental Exercise. The pattern of CPET's variables identifies the abnormal Exercise capacity, often providing an objective evaluation of cause and, moreover, predicting outcomes in both apparently healthy and chronic disease populations. An anaerobic threshold VO2 above 11 ml/kg per min seems to identify individuals with a very low surgical risk even if undergoing major surgery. This review is focused on tools of risk assessment in patients undergoing noncardiac surgery and on the physiological basis for CPET in detecting patients 'at risk'.

  • Cardiopulmonary Exercise Test evidence of isolated right coronary artery disease
    International journal of cardiology, 2005
    Co-Authors: Mauro Contini, Daniele Andreini, Piergiuseppe Agostoni
    Abstract:

    Isolated right coronary artery disease is usually difficult to diagnose because of frequent negativity of standard Exercise stress Test. We report a case of isolated coronary artery stenosis which was not detected by standard ECG stress Testing. The Cardiopulmonary Exercise Test showed a peculiar pattern: abrupt flattening in VO2/Work relationship, plateau in O2 pulse and 90 s afterwards a plateau in heart rate, probably related to vagal afferent stimulation by ischaemia of the postero-inferior wall of the left ventricle. Multidetector computed tomography of coronary vessels and coronary angiography confirmed isolated critical stenosis of middle right coronary artery. After revascularization by PTCA, normalization of Cardiopulmonary Exercise Test was obtained.

Marcus Paulo Araujo - One of the best experts on this subject based on the ideXlab platform.

  • Validity of an Interval Taekwondo-Specific Cardiopulmonary Exercise Test.
    Journal of strength and conditioning research, 2019
    Co-Authors: Marcus Paulo Araujo, Pedro Paulo Da Silva Soares, Matheus Hausen, Hilbert Julio, Flávia Porto, Jonas Lírio Gurgel
    Abstract:

    Araujo, MP, Soares, PP, Hausen, MR, Julio, HS, Porto, F, and Gurgel, JL. Validity of an interval taekwondo-specific Cardiopulmonary Exercise Test. J Strength Cond Res XX(X): 000-000, 2018-The objective of this study is to propose and validate an interval taekwondo-specific Cardiopulmonary Exercise Test (ITKDTest) and compare it with running Cardiopulmonary Exercise Test (CPET) and a continuous taekwondo-specific Cardiopulmonary Exercise Test (CTKDTest). Fifteen athletes (age 22 ± 4 years; body mass 71.1 ± 10.2 kg; height 178.14 ± 8.3 cm; and body mass index 22.4 ± 2.4 kg·m) performed CPET, CTKDTest, and ITKDTest on a counterbalanced order. Oxygen uptake (V[Combining Dot Above]O2), heart rate (HR), and ventilatory thresholds (VTs 1 and 2) were measured during the 3 Tests. ITKDTest started at 30 kicks per minute and increased 10 kicks each 2 minutes, with a period of passive recovery, lasting 1 minute. Interval protocol design simulated the temporal structure of an official taekwondo fight. Significant difference between specific Tests was found for V[Combining Dot Above]O2 VT1 (p = 0.03), V[Combining Dot Above]O2 VT1 (%V[Combining Dot Above]O2peak) (p = 0.009), V[Combining Dot Above]O2 VT2 (p = 0.005), and V[Combining Dot Above]O2 VT2 (%V[Combining Dot Above]O2peak) (p = 0.013). Reliability was considered "excellent" for V[Combining Dot Above]O2peak (α = 0.902; SEM = 0.179), "good" for V[Combining Dot Above]O2 VT1 (α = 0.708; SEM = 3.823) and HRpeak (α = 0.803; SEM = 2.987), and "fair" for V[Combining Dot Above]O2 VT2 (α = 0.659; SEM = 4.498) and HR VT2 (α = 0.580; SEM = 8.868). Bland-Altman analyses reported a mean difference of 2.9 ± 6.6 ml·kg·min (CPET-ITKDTest) and 1.4 ± 6.1 ml·kg·min (CTKDTest-ITKDTest). ITKDTest may be used for measurement of cardiorespiratory variables commonly used in Exercise prescription, whereas CTKDTest seems to be a more appropriate method to assess V[Combining Dot Above]O2 and HR at VTs.

  • proposal of a new specific Cardiopulmonary Exercise Test for taekwondo athletes
    Journal of Strength and Conditioning Research, 2017
    Co-Authors: Marcus Paulo Araujo, Pedro Paulo Da Silva Soares, Matheus Hausen, Antonio Claudio Lucas Da Nobrega, Gabriel Espinosa, Renata Rodrigues Teixeira De Castro, Jonas Lírio Gurgel
    Abstract:

    The objective of this study is to evaluate the cardiorespiratory variables of Taekwondo athletes while performing incremental Exercise Test on an ergometer using a ramp protocol and to propose a specific protocol for assessing these physiological variables during Taekwondo practice. Fourteen athletes participated in 2 incremental Exercise Tests: a treadmill Exercise Test (TREADTest) and a Taekwondo-specific Exercise Test (TKDTest). The TKDTest consists in 1-minute stages of kicks with an incremental load between then. The subjects perform kicks each time a sound signal was heard. Heart rate (HR), oxygen uptake (V[Combining Dot Above]O2), and their reserve correspondents (V[Combining Dot Above]O2R and reserve heart rate [HRR]) were divided into quartiles to verify their kinetics along the Tests. Significant difference between 2 Tests was found only for V[Combining Dot Above]O2R (p = 0.03). Regarding the quartiles, significant differences were found for HR in the first (p = 0.030) and second (p = 0.003). Analyzing the regression curves, significant differences were found for HR for intercept (p = 0.01) and slope (p = 0.05) and HRR for slope (p = 0.02). Analysis showed that significant reliability, with intraclass correlation coefficient (ICC), was found for the V[Combining Dot Above]O2peak (ICC = 0.855, p = 0.003), V[Combining Dot Above]O2 in ventilatory thresholds 1 (ICC = 0.709, p = 0.03) and 2 (ICC = 0.848, p = 0.003). Bland-Altman analyses reported a mean difference ± the 95% limits of agreement of 2.2 ± 8.4 ml·kg·min to V[Combining Dot Above]O2peak. The TKDTest is reliable for measurement of cardiorespiratory variables, and the behavior of these variables differs mainly from TREADTest, probably because of the motor task performed.

Gabriella Malfatto - One of the best experts on this subject based on the ideXlab platform.