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Exercise physiology heart failure

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https://www.readbyqxmd.com/read/29122139/role-of-exercise-testing-in-hypertrophic%C3%A2-cardiomyopathy
#1
REVIEW
Ethan J Rowin, Barry J Maron, Iacopo Olivotto, Martin S Maron
Over the last 25 years, patients with hypertrophic cardiomyopathy (HCM) have been studied with a variety of methods employing physiological exercise that have made major contributions to disease management and are performed without increased risk. Previously under-utilized in HCM, exercise (stress) echocardiography has become incorporated into the standard clinical assessment and diagnostic armamentarium of HCM using upright or supine symptom-limited treadmill or bicycle modalities. In patients without outflow gradients at rest, exercise echocardiography is the most appropriate method for provoking obstruction, with the capability of predicting future development of progressive heart failure symptoms, and differentiating patients with provocable obstruction from those without obstruction, with major implications for dictating treatment options, that is, surgical myectomy (alternatively, alcohol septal ablation) versus heart transplant...
November 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29098628/exercise-induced-mitochondrial-adaptations-in-addressing-heart-failure
#2
Jubert Marquez, Jin Han
Mitochondria are complex organelles essential for the production of energy. These dynamic, complex organelles found in every cell and tissues of the body have been well-studied in various physiological models, stressing that mitochondrial dysfunction is characteristic of pathological states, especially in cardiovascular diseases and heart failure. Since heart failure progresses due to energy deficits brought about by altered mitochondrial bioenergetics and functioning, novel ways of ameliorating mitochondrial dysfunction are being studied...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29098626/micrornas-mediate-beneficial-effects-of-exercise-in-heart
#3
Yihua Bei, Lichan Tao, Dragos Cretoiu, Sanda Maria Cretoiu, Junjie Xiao
MicroRNAs (miRNAs, miRs), a group of small non-coding RNAs, repress gene expressions at posttranscriptional level in most cases and are involved in cardiovascular physiology and disease pathogenesis. Increasing evidence has proved that miRNAs are potential regulators of exercise induced cardiac growth and mediate the benefits of exercise in a variety of cardiovascular diseases. In this chapter, we will review the regulatory effects of miRNAs in cardiac adaptations to exercise, and summarize their cardioprotective effects against myocardial infarction, ischemia/reperfusion injury, heart failure, diabetic cardiomyopathy, atherosclerosis, hypertension, and pulmonary hypertension...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29098623/the-igf1-pi3k-akt-signaling-pathway-in-mediating-exercise-induced-cardiac-hypertrophy-and-protection
#4
Kate L Weeks, Bianca C Bernardo, Jenny Y Y Ooi, Natalie L Patterson, Julie R McMullen
Regular physical activity or exercise training can lead to heart enlargement known as cardiac hypertrophy. Cardiac hypertrophy is broadly defined as an increase in heart mass. In adults, cardiac hypertrophy is often considered a poor prognostic sign because it often progresses to heart failure. Heart enlargement in a setting of cardiac disease is referred to as pathological cardiac hypertrophy and is typically characterized by cell death and depressed cardiac function. By contrast, physiological cardiac hypertrophy, as occurs in response to chronic exercise training (i...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29098615/the-benefits-of-exercise-training-on-aerobic-capacity-in-patients-with-heart-failure-and-preserved-ejection-fraction
#5
Danilo Marcelo Leite do Prado, Enéas Antônio Rocco
Heart failure with preserved ejection fraction (HFpEF) is defined as an inability of the ventricles to optimally accept blood from atria with blunted end- diastolic volume response by limiting the stroke volume and cardiac output. The HEpEF prevalence is higher in elderly and women and may be associated to hypertension, diabetes mellitus and atrial fibrillation. Severe exercise intolerance, manifested by dyspnea and fatigue during physical effort is the important chronic symptom in HFpEF patients, in which is the major determinant of their reduced quality of life...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29079391/strategies-for-supporting-intervention-fidelity-in-the-rehabilitation-therapy-in-older-acute-heart-failure-patients-rehab-hf-trial
#6
Amy M Pastva, Pamela W Duncan, Gordon R Reeves, M Benjamin Nelson, David J Whellan, Christopher M O'Connor, Joel D Eggebeen, Leigh Ann Hewston, Karen M Taylor, Robert J Mentz, Paul B Rosenberg, Dalane W Kitzman
INTRODUCTION: Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in older adults. Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial is a multi-site clinical trial to determine if physical rehabilitation intervention in older patients with ADHF improves physical function and reduces rehospitalizations. The REHAB-HF intervention aims to improve functional performance utilizing reproducible and progressive exercises that are individually tailored to the patient's physiological and physical capabilities...
October 24, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/29054325/use-of-ideal-alveolar-air-equations-and-corrected-end-tidal-pco2-to-estimate-arterial-pco2-and-physiological-dead-space-during-exercise-in-patients-with-heart-failure
#7
Erik H Van Iterson, Thomas P Olson
BACKGROUND: Arterial CO2 tension (PaCO2) and physiological dead space (VD) are not routinely measured during clinical cardiopulmonary exercise testing (CPET). Abnormal changes in PaCO2 accompanied by increased VD directly contribute to impaired exercise ventilatory function in heart failure (HF). Because arterial catheterization is not standard practice during CPET, this study tested the construct validity of PaCO2 and VD prediction models using 'ideal' alveolar air equations and basic ventilation and gas-exchangegas exchange measurements during CPET in HF...
October 7, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29050512/iron-deficiency-beyond-erythropoiesis-should-we-be-concerned
#8
Khaled M Musallam, Ali T Taher
OBJECTIVE: To consider the key implications of iron deficiency for biochemical and physiological functions beyond erythropoiesis. METHODS: PubMed was searched for relevant journal articles published up to August 2017. RESULTS: Anemia is the most well-recognized consequence of persisting iron deficiency, but various other unfavorable consequences can develop either before or concurrently with anemia. Mitochondrial function can be profoundly disturbed since iron is a cofactor for heme-containing enzymes and non-heme iron-containing enzymes in the mitochondrial electron transport chain...
October 20, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29045315/a-single-dose-of-oral-atp-supplementation-improves-performance-and-physiological-response-during-lower-body-resistance-exercise-in-recreational-resistance-trained-males
#9
Marcelo C Freitas, Jason M Cholewa, Jose Gerosa-Neto, Daniela C Gonçalves, Erico C Caperuto, Fábio S Lira, Fabrício E Rossi
The aim of this study was to investigate the acute effect of ATP supplementation on performance and physiological responses during resistance exercise in recreationally resistance trained males. Eleven men (age= 27.5±5.5 yrs, weight= 83.4±9.8 kg, height= 182±0.04 cm) completed two randomized, double-blind trials: ATP supplement condition (ATP=400mg) or a placebo condition. Thirty minutes after supplement consumption, subjects performed four sets of half-squats until momentary muscular failure at 80% of the 1RM with two minutes of recovery between sets...
October 16, 2017: Journal of Strength and Conditioning Research
https://www.readbyqxmd.com/read/29040221/thermoeffector-responses-at-a-fixed-rate-of-heat-production-in-heart-failure-patients
#10
Bryce N Balmain, Ollie Jay, Norman R Morris, Kenji Shiino, Glenn M Stewart, Rohan Jayasinghe, Jonathan Chan, Surendran Sabapathy
PURPOSE: Heart failure (HF) patients appear to exhibit altered thermoregulatory responses during exercise in the heat. However, the extent to which these responses are altered due to physiological impairments independently of biophysical factors associated with differences in metabolic heat production (Hprod), evaporative heat balance requirements (Ereq) and/or body size, is presently unclear. Therefore, we examined thermoregulatory responses in 10 HF and 10 age-matched controls (CON) similar in body size during exercise at a fixed rate of Hprod, and therefore Ereq in a 30°C environment...
October 16, 2017: Medicine and Science in Sports and Exercise
https://www.readbyqxmd.com/read/29026925/er-protein-quality-control-and-the-unfolded-protein-response-in-the-heart
#11
A Arrieta, E A Blackwood, C C Glembotski
Cardiac myocytes are the cells responsible for the robust ability of the heart to pump blood throughout the circulatory system. Cardiac myocytes grow in response to a variety of physiological and pathological conditions; this growth challenges endoplasmic reticulum-protein quality control (ER-PQC), a major feature of which includes the unfolded protein response (UPR). ER-PQC and the UPR in cardiac myocytes growing under physiological conditions, including normal development, exercise, and pregnancy, are sufficient to support hypertrophic growth of each cardiac myocyte...
October 13, 2017: Current Topics in Microbiology and Immunology
https://www.readbyqxmd.com/read/29025748/compromised-cerebrovascular-regulation-and-cerebral-oxygenation-in-pulmonary-arterial-hypertension
#12
Simon Malenfant, Patrice Brassard, Myriam Paquette, Olivier Le Blanc, Audrey Chouinard, Valérie Nadeau, Philip D Allan, Yu-Chieh Tzeng, Sébastien Simard, Sébastien Bonnet, Steeve Provencher
BACKGROUND: Functional cerebrovascular regulatory mechanisms are important for maintaining constant cerebral blood flow and oxygen supply in heathy individuals and are altered in heart failure. We aim to examine whether pulmonary arterial hypertension (PAH) is associated with abnormal cerebrovascular regulation and lower cerebral oxygenation and their physiological and clinical consequences. METHODS AND RESULTS: Resting mean flow velocity in the middle cerebral artery mean flow velocity in the middle cerebral artery (MCAvmean); transcranial Doppler), cerebral pressure-flow relationship (assessed at rest and during squat-stand maneuvers; analyzed using transfer function analysis), cerebrovascular reactivity to CO2, and central chemoreflex were assessed in 11 patients with PAH and 11 matched healthy controls...
October 12, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29022265/exercise-amaliorates-metabolic-disturbances-and-oxidative-stress-in-diabetic-cardiomyopathy-possible-underlying-mechanisms
#13
Ayman M Mahmoud
Cardiomyopathy is a serious complication of diabetes mellitus and occurs independently of coronary artery disease or hypertension. It manifests as systolic/diastolic dysfunction and hypertrophy of the left ventricle and can lead to heart failure. Hyperglycemia can trigger a series of maladaptive stimuli and result in cardiac hypertrophy, fibrosis and reduced performance and contractility. The pathogenesis of diabetic cardiomyopathy is a multifactorial process that includes metabolic derangements such as increased oxidative stress, and altered non-oxidative glucose pathways and lipid metabolism...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28990307/physiological-dead-space-and-arterial-carbon-dioxide-contributions-to-exercise-ventilatory-inefficiency-in-patients-with-reduced-or-preserved-ejection-fraction-heart-failure
#14
Erik H Van Iterson, Bruce D Johnson, Barry A Borlaug, Thomas P Olson
AIMS: Patients with heart failure (HF) with reduced (HFrEF) or preserved (HFpEF) ejection fraction demonstrate an increased ventilatory equivalent for carbon dioxide (V̇E /V̇CO2 ) slope. The physiological correlates of the V̇E /V̇CO2 slope remain unclear in the two HF phenotypes. We hypothesized that changes in the physiological dead space to tidal volume ratio (VD /VT ) and arterial CO2 tension (PaCO2 ) differentially contribute to the V̇E /V̇CO2 slope in HFrEF vs. HFpEF. METHODS AND RESULTS: Adults with HFrEF (n = 32) and HFpEF (n = 27) [mean ± standard deviation (SD) left ventricular ejection fraction: 22 ± 7% and 61 ± 9%, respectively; mean ± SD body mass index: 28 ± 4 kg/m(2) and 33 ± 6 kg/m(2) , respectively; P < 0...
October 8, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28990152/therapeutic-targets-for-the-multi-system-pathophysiology-of-heart-failure-exercise-training
#15
REVIEW
Erik H Van Iterson, Thomas P Olson
Adult chronic heart failure (HF) is a terminal syndrome. While the HF phenotype is inhomogeneous across the ejection fraction spectrum, exercise intolerance remains a cardinal feature of all HF patients. Impairment of a single organ system cannot independently account for exercise intolerance in HF. Thus, the multi-system integrative pathophysiology of HF leads to challenges in identifying an effective medical therapy aimed at targeting a single mechanism to improve exercise tolerance. This unresolved medical care approach raises a number of points for discussion in this field as it is well-recognized that exercise intolerance is accompanied by increased hospitalizations and mortality across the HF spectrum...
October 9, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28957535/exercise-and-the-right-ventricle-a-potential-achilles-heel
#16
Andre La Gerche, Dhrubo J Rakhit, Guido Claessen
Exercise is associated with unequivocal health benefits and results in many structural and functional changes of the myocardium that enhance performance and prevent heart failure. However, intense exercise also presents a significant hemodynamic challenge in which the right-sided heart chambers are exposed to a disproportionate increase in afterload and wall stress that can manifest as myocardial fatigue or even damage if intense exercise is sustained for prolonged periods. This review focuses on the physiological factors that result in a disproportionate load on the right ventricle during exercise and the long-term consequences...
October 1, 2017: Cardiovascular Research
https://www.readbyqxmd.com/read/28939710/hemodynamic-profile-of-patients-with-heart-failure-and-preserved-ejection-fraction-vary-by-age
#17
Shane Nanayakkara, Mark Haykowsky, Justin Mariani, Vanessa Van Empel, Micha T Maeder, Donna Vizi, David M Kaye
BACKGROUND: Patients with heart failure with preserved ejection fraction (HFpEF) exhibit a range of cardiovascular phenotypic profiles modified by several common comorbidities. In particular, patients with HFpEF tend to be older; however, it is unclear whether the effects of cardiovascular aging per se modify the expression of HFpEF. We therefore sought to investigate the interaction between age and physiologic profile in patients with HFpEF. METHODS AND RESULTS: We assessed the hemodynamic and metabolic profile of 40 patients with HFpEF...
September 22, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28935040/cardiopulmonary-exercise-testing-what-is-its-value
#18
REVIEW
Marco Guazzi, Francesco Bandera, Cemal Ozemek, David Systrom, Ross Arena
Compared with traditional exercise tests, cardiopulmonary exercise testing (CPET) provides a thorough assessment of exercise integrative physiology involving the pulmonary, cardiovascular, muscular, and cellular oxidative systems. Due to the prognostic ability of key variables, CPET applications in cardiology have grown impressively to include all forms of exercise intolerance, with a predominant focus on heart failure with reduced or with preserved ejection fraction. As impaired cardiac output and peripheral oxygen diffusion are the main determinants of the abnormal functional response in cardiac patients, invasive CPET has gained new popularity, especially for diagnosing early heart failure with preserved ejection fraction and exercise-induced pulmonary hypertension...
September 26, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28925073/role-of-cardiopulmonary-exercise-testing-in-clinical-stratification-in-heart-failure-a-position-paper-from-the-committee-on-exercise-physiology-and-training-of-the-heart-failure-association-of-the-european-society-of-cardiology
#19
REVIEW
Ugo Corrà, Pier Giuseppe Agostoni, Stefan D Anker, Andrew J S Coats, Maria G Crespo Leiro, Rudolph A de Boer, Veli-Pekka Hairola, Loreena Hill, Mitja Lainscak, Lars H Lund, Marco Metra, Piotr Ponikowski, Jillian Riley, Petar M Seferović, Massimo F Piepoli
Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle-aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co-morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis...
September 18, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28887766/short-term-effects-of-passive-mobilization-on-the-sublingual-microcirculation-and-on-the-systemic-circulation-in-patients-with-septic-shock
#20
Tuanny Teixeira Pinheiro, Flávio Geraldo Rezende de Freitas, Karla Tuanny Fiorese Coimbra, Vanessa Marques Ferreira Mendez, Heloísa Baccaro Rossetti, Paulo Vinicius Talma, Antônio Tonete Bafi, Flávia Ribeiro Machado
BACKGROUND: Active mobilization is not possible in patients under deep sedation and unable to follow commands. In this scenario, passive therapy is an interesting alternative. However, in patients with septic shock, passive mobilization may have risks related to increased oxygen consumption. Our objective was to evaluate the impact of passive mobilization on sublingual microcirculation and systemic hemodynamics in patients with septic shock. METHODS: We included patients who were older than 18 years, who presented with septic shock, and who were under sedation and mechanical ventilation...
September 8, 2017: Annals of Intensive Care
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