The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional...The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.展开更多
Exercise stress echocardiography(ESE)is a widely used diagnostic test in cardiology departments.ESE is mainly used to study patients with coronary artery disease;however,it has increasingly been used in other clinical...Exercise stress echocardiography(ESE)is a widely used diagnostic test in cardiology departments.ESE is mainly used to study patients with coronary artery disease;however,it has increasingly been used in other clinical scenarios including valve pathology,congenital heart disease,hypertrophic and dilated cardiomyopathies,athlete evaluations,diastolic function evaluation,and pulmonary circulation study.In our laboratories,we use an established methodology in which cardiac function is evaluated while exercising on a treadmill.After completing the exercise regimen,patients remain in a standing position or lie down on the left lateral decubitus,depending on the clinical questions to be answered for further evaluation.This method increases the quality and quantity of information obtained.Here,we present the various methods of exercise stress echocardiography and our experience in many clinical arenas in detail.We also present alternatives to ESE that may be used and their advantages and disadvantages.We review recent advances in ESE and future directions for this established method in the study of cardiac patients and underline the advantage of using a diagnostic tool that is radiation-free.展开更多
Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs ...Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs during graded EST and analyzed via a post-processing method. Autonomic function was determined by Power Spectral Analysis of the very low frequency (VLF), low frequency (LF), high frequency (HF), and the ratio of LF/HF. We correlated HRV indices with resting, exercise, and recovery data. Results: No differences were found in anthropometric measurements, peak EST HR, and METS between individuals with slow HRR (below 18 b/min) compared with controls (HRR > 18 b/min). Only the VLF component of the HRV indices was statistically different (p = 0.03) at one-minute post-exercise compared with controls. Additionally, a significant correlation between HRR and resting LF and HF indices was found in the individuals with slow HRR but not in the controls. Conclusion: In apparently healthy individuals with slow HRR post-EST, autonomic function did not demonstrate any differences at any phase of the EST, including at one minute of recovery. However, a significant correlation was found between resting LF and HF powers and HRR in individuals with slow vagal reactivation post-exercise. The clinical and prognostic implications of such observation deserve further investigation.展开更多
Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how ca...Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Conclusion:HRR during submaximal exercise is associated with future risk for delirium.Given that HRR is potentially modifiable,it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.展开更多
Objective: To examine the reproducibility of HRR in healthy individuals with slow HRR response undergoing routine annual checkups. Method: HRR data (>18 b/min;Group 1 and 18 b/min;Group 2) were analyzed using ...Objective: To examine the reproducibility of HRR in healthy individuals with slow HRR response undergoing routine annual checkups. Method: HRR data (>18 b/min;Group 1 and 18 b/min;Group 2) were analyzed using a fixed-effects regression model adjusted for age and gender, including random effects group-specific slopes on age. Results: One hundred and thirteen individuals (56.5 ± 9.2 y), underwent 573 cumulative ESTs with an average of 5.1 ± 1.6 tests per individual during a 21-year retrospective follow-up. No differences were found in anthropometric measurements and blood variables. All individuals achieved 94% ± 7.7% of age-predicted HR max at peak EST. Group 2 demonstrated 38% of inconsistent HRR. Regression analysis demonstrated a decrease of 0.5 b/min, on average across individuals, in HRR per each extra year of age. The random effects showed an inter-subject SD level of 9.91 b/min and an SD on the age slope of 0.40 b/min/year. Conclusion: HRR showed low reproducibility in nearly 40% of tests, which was not reflected by the variation of HR nor in the slope of age during a 21-year retrospective follow-up.展开更多
美国有一个每四年公布一次的dietary guidelines(食品指导),它被誉为gold standard of nutritional information。今年修正的dietary guidelines增加了新的exercise的内容,非常引人注目:The new guideliner recommend that bothadults a...美国有一个每四年公布一次的dietary guidelines(食品指导),它被誉为gold standard of nutritional information。今年修正的dietary guidelines增加了新的exercise的内容,非常引人注目:The new guideliner recommend that bothadults and children get at least 30 minutes of physical activity daily in order tolower the risk of heart disease,colon(结肠)cancer and diabetes(糖尿病;多尿症).本文最幽默的一句话是:Although you don’t eat exercise,it’s the second half ofthe energy balance equation.(虽然你不吃“运动”,可是,运动却是能量收支平衡的另一部分。)此话非常形象地道出了运动的重要性。本文强调了所谓healthyliving,每日的饮食应该是:We should choose more whole-grain foods and a varietyof fruits and vegetables every day.美国总统克林顿亲自公布了这个新的食品指导,报道还顺便透露了总统本人的一些“隐私”,读来让人颇生联想: 1/…who(指克林顿)has a well-documented(被证明了的)appetite for not-very-healthy food. 2/Clinton,a regular jogger(慢跑者)until a knee injury in 1997.本文的另一个重要信息是:少吃糖！…the final version calls for Americans to展开更多
文摘The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.
文摘Exercise stress echocardiography(ESE)is a widely used diagnostic test in cardiology departments.ESE is mainly used to study patients with coronary artery disease;however,it has increasingly been used in other clinical scenarios including valve pathology,congenital heart disease,hypertrophic and dilated cardiomyopathies,athlete evaluations,diastolic function evaluation,and pulmonary circulation study.In our laboratories,we use an established methodology in which cardiac function is evaluated while exercising on a treadmill.After completing the exercise regimen,patients remain in a standing position or lie down on the left lateral decubitus,depending on the clinical questions to be answered for further evaluation.This method increases the quality and quantity of information obtained.Here,we present the various methods of exercise stress echocardiography and our experience in many clinical arenas in detail.We also present alternatives to ESE that may be used and their advantages and disadvantages.We review recent advances in ESE and future directions for this established method in the study of cardiac patients and underline the advantage of using a diagnostic tool that is radiation-free.
文摘Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs during graded EST and analyzed via a post-processing method. Autonomic function was determined by Power Spectral Analysis of the very low frequency (VLF), low frequency (LF), high frequency (HF), and the ratio of LF/HF. We correlated HRV indices with resting, exercise, and recovery data. Results: No differences were found in anthropometric measurements, peak EST HR, and METS between individuals with slow HRR (below 18 b/min) compared with controls (HRR > 18 b/min). Only the VLF component of the HRV indices was statistically different (p = 0.03) at one-minute post-exercise compared with controls. Additionally, a significant correlation between HRR and resting LF and HF indices was found in the individuals with slow HRR but not in the controls. Conclusion: In apparently healthy individuals with slow HRR post-EST, autonomic function did not demonstrate any differences at any phase of the EST, including at one minute of recovery. However, a significant correlation was found between resting LF and HF powers and HRR in individuals with slow vagal reactivation post-exercise. The clinical and prognostic implications of such observation deserve further investigation.
基金funded by National Institutes of Health(NIH)Grant R03AG067985Foundation for Anesthesia Education and Research+1 种基金funded by the BrightFocus Foundation Alzheimer’s Disease Research Program(A2020886S)funded by NIH Grants RF1AG059867 and RF1AG064312,funded by NIH Grant R01HL140574。
文摘Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Conclusion:HRR during submaximal exercise is associated with future risk for delirium.Given that HRR is potentially modifiable,it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.
文摘Objective: To examine the reproducibility of HRR in healthy individuals with slow HRR response undergoing routine annual checkups. Method: HRR data (>18 b/min;Group 1 and 18 b/min;Group 2) were analyzed using a fixed-effects regression model adjusted for age and gender, including random effects group-specific slopes on age. Results: One hundred and thirteen individuals (56.5 ± 9.2 y), underwent 573 cumulative ESTs with an average of 5.1 ± 1.6 tests per individual during a 21-year retrospective follow-up. No differences were found in anthropometric measurements and blood variables. All individuals achieved 94% ± 7.7% of age-predicted HR max at peak EST. Group 2 demonstrated 38% of inconsistent HRR. Regression analysis demonstrated a decrease of 0.5 b/min, on average across individuals, in HRR per each extra year of age. The random effects showed an inter-subject SD level of 9.91 b/min and an SD on the age slope of 0.40 b/min/year. Conclusion: HRR showed low reproducibility in nearly 40% of tests, which was not reflected by the variation of HR nor in the slope of age during a 21-year retrospective follow-up.
文摘美国有一个每四年公布一次的dietary guidelines(食品指导),它被誉为gold standard of nutritional information。今年修正的dietary guidelines增加了新的exercise的内容,非常引人注目:The new guideliner recommend that bothadults and children get at least 30 minutes of physical activity daily in order tolower the risk of heart disease,colon(结肠)cancer and diabetes(糖尿病;多尿症).本文最幽默的一句话是:Although you don’t eat exercise,it’s the second half ofthe energy balance equation.(虽然你不吃“运动”,可是,运动却是能量收支平衡的另一部分。)此话非常形象地道出了运动的重要性。本文强调了所谓healthyliving,每日的饮食应该是:We should choose more whole-grain foods and a varietyof fruits and vegetables every day.美国总统克林顿亲自公布了这个新的食品指导,报道还顺便透露了总统本人的一些“隐私”,读来让人颇生联想: 1/…who(指克林顿)has a well-documented(被证明了的)appetite for not-very-healthy food. 2/Clinton,a regular jogger(慢跑者)until a knee injury in 1997.本文的另一个重要信息是:少吃糖！…the final version calls for Americans to
