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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
[Clinical study on the characteristics of exercise pathophysiological in patients with severe heart failure]
Rong Chen1,2, Xing-Guo Sun1, Ye Zhang1
1Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/ State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100037.
Insights
Cardiopulmonary exercise testing reveals significantly reduced exercise capacity in chronic heart failure (CHF) patients. Circulatory limitations are the primary driver, followed by respiratory and metabolic factors.
Area of Science:
- Cardiology
- Pulmonology
- Exercise Physiology
Background:
- Chronic heart failure (CHF) severely limits cardiopulmonary function.
- The underlying exercise pathophysiology in CHF remains incompletely understood.
Purpose of the Study:
- To investigate the holistic integrative exercise pathophysiology in patients with severe CHF.
- To compare cardiopulmonary function during exercise between CHF patients and healthy controls.
Main Methods:
- Eighty-three severe CHF patients and 12 healthy controls underwent Ramp incremental loading program Cardio-Pulmonary Exercise Testing (CPET).
- Circulatory, respiratory, and metabolic parameters were measured and analyzed according to standard protocols.
Main Results:
- CHF patients exhibited significantly lower Peak VO2, anaerobic threshold (AT), and oxygen uptake efficiency platform (OUEP) compared to controls.
- Key lung function parameters (FEV1, FVC, DLCO) and circulatory responses (systolic blood pressure, heart rate) were significantly impaired in CHF.
- Respiratory parameters (minute ventilation, tidal volume) and metabolic markers showed significant differences between groups during various CPET stages.
Conclusions:
- Reduced functional capacity in cardiogenic CHF is predominantly caused by circulatory limitations.
- Respiratory and metabolic limitations also contribute significantly to the overall exercise intolerance observed in CHF patients.
Abstract:
Objective: The cardiopulmonary function of patients with chronic heart failure (CHF) was severely limited, but the holistic integrative exercise pathophysiology is still unclear. Methods: After signed the consent form, Eighty three patients with severe CHF from October 2016 to October 2017 in Fuwai Hospital were performed Ramp incremental loading program CardioPulmonary Exercise Testing (CPET), and 12 normal subjects served as control. CPET were performed according to standard of Harbor-UCLA MC and the circulatory, respiratory and metabolic parameters during CPET were measured and analyzed. Results: Peak oxygen uptake (Peak VO2) in CHF (14.33±2.69) ml/(min·kg), (44.25±14.74)%pred was significantly lower than control ((29.42±5.46) ml/(min·kg), (83.88±6.28)%pred). Other core parameters of CPET such as anaerobic threshold (AT), peak oxygen pulse, oxygen uptake efficiency platform (OUEP), the lowest of carbon dioxide output ventilation ratio (Lowest VE/VCO2), and carbon dioxide output ventilation slope (VE/VCO2 Slope) in CHF were significantly different with the control group(P<0.01). The core parameters of lung function, such as forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, and carbon monoxide diffusion (DLCO) were significantly decreased (P<0.01). Systolic blood pressure during all stages of CPET in CHF was significantly lower than control group (P<0.05); Heart rate at AT, peak and recovery stages were significantly lower than control (P<0.01). Minute ventilation, tidal volume and respiratory frequency at rest, warm-up were significantly higher than control (P<0.05). Tidal volume at recovery was significantly higher than control (P<0.05). VO2 at AT, peak and recovery stages in CHF were significantly higher than control (P<0.01). Oxygen pulse at AT and peak were significantly higher than control (P<0.01). Pulse oxygen saturation during all stages of CPET in CHF were significantly lower than control (P<0.01). Conclusion: The decreased holistic functional capacity of cardiogenic CHF dominantly due to circulatory limitation, and secondly due to respiratory and metabolic limitation.
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