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Cardiopulmonary exercise testing and surgery

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https://www.readbyqxmd.com/read/28511024/cardiopulmonary-exercise-testing-and-surgery
#1
Paul O Older, Denny Zh Levett
The surgical patient population is increasingly elderly and comorbid and poses challenges to perioperative physicians. Accurate pre-operative risk stratification is important to direct perioperative care. Reduced aerobic fitness is associated with increased post-operative morbidity and mortality. Cardiopulmonary exercise testing is an integrated and dynamic test that gives an objective measure of aerobic fitness or functional capacity and identifies the cause of exercise intolerance. Cardiopulmonary exercise testing provides an individualized estimate of patient risk that can be used to predict post-operative morbidity and mortality...
May 16, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28510737/total-haemoglobin-mass-but-not-haemoglobin-concentration-is-associated-with-preoperative-cardiopulmonary-exercise-testing-derived-oxygen-consumption-variables
#2
J M Otto, J O M Plumb, D Wakeham, E Clissold, L Loughney, W Schmidt, H E Montgomery, M P W Grocott, T Richards
Background: Cardiopulmonary exercise testing (CPET) measures peak exertional oxygen consumption ( V˙O2peak ) and that at the anaerobic threshold ( V˙O2 at AT, i.e. the point at which anaerobic metabolism contributes substantially to overall metabolism). Lower values are associated with excess postoperative morbidity and mortality. A reduced haemoglobin concentration ([Hb]) results from a reduction in total haemoglobin mass (tHb-mass) or an increase in plasma volume. Thus, tHb-mass might be a more useful measure of oxygen-carrying capacity and might correlate better with CPET-derived fitness measures in preoperative patients than does circulating [Hb]...
May 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28500413/impaired-pulmonary-function-is-an-additional-potential-mechanism-for-the-reduction-of-functional-capacity-in-clinically-stable-fontan-patients
#3
Aída L R Turquetto, Luiz F Canêo, Daniela R Agostinho, Patrícia A Oliveira, Maria Isabel C S Lopes, Patrícia F Trevizan, Frederico L A Fernandes, Maria A Binotto, Gabriela Liberato, Glaucia M P Tavares, Rodolfo A Neirotti, Marcelo B Jatene
Central factors negatively affect the functional capacity of Fontan patients (FP), but "non-cardiac" factors, such as pulmonary function, may contribute to their exercise intolerance. We studied the pulmonary function in asymptomatic FP and its correlations with their functional capacity. Pulmonary function and cardiopulmonary exercise tests were performed in a prospective study of 27 FP and 27 healthy controls (HC). Cardiovascular magnetic resonance was used to evaluate the Fontan circulation. The mean age at tests, the mean age at surgery, and the median follow-up time of FP were 20(±6), 8(±3), and 11(8-17) years, respectively...
May 12, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28475760/evaluating-patients-walking-capacity-during-hospitalization-for-lung-cancer-resection%C3%A2
#4
Pedro A Esteban, Nieves Hernández, Nuria M Novoa, Gonzalo Varela
OBJECTIVES: The goal of this study was to describe non-supervised daily physical activity in patients during the period immediately following anatomical lung resection. METHODS: The study was an observational study on 50 consecutive patients (33 men) admitted for anatomical lung resection over a 4-month period. All cases were approached using a minimally invasive technique. Patients were instructed by nursing and physiotherapy staff and asked to wear a portable pedometer (Omron HJ-720 T-E2) from admission until hospital discharge, excluding the day of the operation and the first hours in the recovery room...
May 4, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28449487/performance-in-the-shuttle-walk-test-is-associated-with-cardiopulmonary-complications-after-lung-resections
#5
Joseph Fennelly, Lauren Potter, Cecilia Pompili, Alessandro Brunelli
BACKGROUND: The current functional guidelines recommend the shuttle walk test (SWT) as an initial screening tool to identify candidates for lung resection without requiring cardiopulmonary exercise testing. This study aims to: (I) assess the use of the SWT in predicting postoperative cardiopulmonary complications; and (II) determine whether the recommended 400 m cut-off is an appropriate distance. METHODS: We retrospectively analysed 101 patients that had performed a SWT prior to surgery...
March 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28419206/short-term-preoperative-exercise-therapy-does-not-improve-long-term-outcome-after-lung-cancer-surgery-a-randomized-controlled-study%C3%A2
#6
Wolfram Karenovics, Marc Licker, Christoph Ellenberger, Michel Christodoulou, John Diaper, Chetna Bhatia, John Robert, Pierre-Olivier Bridevaux, Frédéric Triponez
OBJECTIVES: Poor aerobic fitness is a potential modifiable risk factor for long-term survival and quality of life in patients with lung cancer. This randomized trial evaluates the impact of adding rehabilitation (Rehab) with high-intensity interval training (HIIT) before lung cancer surgery to enhance cardiorespiratory fitness and improve long-term postoperative outcome. METHODS: Patients with operable lung cancer were randomly assigned to usual care (UC, n  = 77) or to intervention group (Rehab, n  = 74) that entailed HIIT that was implemented only preoperatively...
April 17, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28409004/effect-of-%C3%AE-blockade-on-lung-function-exercise-performance-and-dynamic-hyperinflation-in-people-with-arterial-vascular-disease-with-and-without-copd
#7
Angela Key, Matthew Parry, Malcolm A West, Rebecca Asher, Sandy Jack, Nick Duffy, Francesco Torella, Paul P Walker
INTRODUCTION: β Blockers are important treatment for ischaemic heart disease and heart failure; however, there has long been concern about their use in people with chronic obstructive pulmonary disease (COPD) due to fear of symptomatic worsening of breathlessness. Despite growing evidence of safety and efficacy, they remain underused. We examined the effect of β-blockade on lung function, exercise performance and dynamic hyperinflation in a group of vascular surgical patients, a high proportion of who were expected to have COPD...
2017: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/28386756/effects-of-a-physical-activity-program-on-cardiorespiratory-fitness-and-pulmonary-function-in-obese-women-after-bariatric-surgery-a-pilot-study
#8
Tatiana Onofre, Renata Carlos, Nicole Oliver, Amanda Felismino, Davi Fialho, Renata Corte, Eliane Pereira da Silva, Eudes Godoy, Selma Bruno
BACKGROUND: In severely obese individuals, reducing body weight induced by bariatric surgery is able to promote a reduction in comorbidities and improve respiratory symptoms. However, cardiorespiratory fitness (CRF) reflected by peak oxygen uptake (VO2peak) may not improve in individuals who remain sedentary post-surgery. The objective of this study was to evaluate the effects of a physical training program on CRF and pulmonary function in obese women after bariatric surgery, and to compare them to a control group...
April 7, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28284501/cardiopulmonary-exercise-test-in-adults-with-prior-fontan-operation-the-prognostic-value-of-serial-testing
#9
Alexander C Egbe, David J Driscoll, Arooj R Khan, Sameh S Said, Emmanuel Akintoye, Fernando M Berganza, Heidi M Connolly
BACKGROUND: The purpose of the study was to determine the role of cardiopulmonary exercise test (CPET) indices in predicting cardiovascular adverse events (CAEs) in patients with Fontan palliation. CAE was defined as death or cardiac surgery. METHODS: Retrospective review of adult Fontan patients who had treadmill CPET at Mayo Clinic, 1994-2013. Patients with loss of follow-up defined as ≥2years without clinical follow-up were excluded. The results of serial CPETs were reviewed, and patients with CPETs meeting the following criteria were selected for analysis: maximum effort on serial CPETs, minimum of 3-year interval between CPETs, and absence of CAE between CPETs...
May 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28275174/physiological-and-clinical-relevance-of-exercise-ventilatory-efficiency-in-copd
#10
REVIEW
J Alberto Neder, Danilo C Berton, Flavio F Arbex, Maria Clara Alencar, Alcides Rocha, Priscila A Sperandio, Paolo Palange, Denis E O'Donnell
Exercise ventilation (V'E) relative to carbon dioxide output (V'CO2 ) is particularly relevant to patients limited by the respiratory system, e.g. those with chronic obstructive pulmonary disease (COPD). High V'E-V'CO2 (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV1). Establishing an association between high V'E-V'CO2 and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining...
March 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28274955/physical-activity-in-adults-with-congenital-heart-disease-and-associations-with-functional-outcomes
#11
Jan Müller, Tamara Amberger, Anika Berg, Daniel Goeder, Julia Remmele, Renate Oberhoffer, Peter Ewert, Alfred Hager
OBJECTIVE: Improved survival has yielded to growing importance of functional outcome measures in patients with congenital heart disease (CHD). This study applied the International Physical Activity Questionnaire (IPAQ) to assess self-reported physical activity (PA) in patients with CHD and their association with exercise capacity and health-related quality of life (HrQoL). PATIENTS AND METHODS: Prior to cardiopulmonary exercise testing (CPET), 786 consecutive patients (335 female, 31...
March 8, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28126509/-cardiac-rehabilitation-for-children-and-adults-with-congenital-heart-disease
#12
Pascal Amedro, Arthur Gavotto, Charlène Bredy, Sophie Guillaumont
Advances in heart surgery over the past 30 years have significantly improved the prognosis of congenital heart diseases (CHD). Therefore, the epidemiology of CHD has changed dramatically with a shift of mortality from pediatrics to adulthood and an increased prevalence of complex CHD. Today, caregivers and patients focus their interests to new perspectives: improving the quality of life, practicing sports, improving psychosocial care. Cardiac rehabilitation is completely integrated in these new therapeutic strategies...
January 23, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28075500/very-short-short-term-benefit-of-inpatient-outpatient-cardiac-rehabilitation-programs-after-coronary-artery-bypass-grafting-surgery
#13
Dejan Spiroski, Mojsije Andjić, Olivera Ilić Stojanović, Milica Lazović, Ana Djordjević Dikić, Miodrag Ostojić, Branko Beleslin, Snežana Kostić, Marija Zdravković, Dragan Lović
BACKGROUND: Exercise-based rehabilitation is an important part of treatment patients following coronary artery bypass graft (CABG) surgery. HYPOTHESIS: To evaluate effect of very short/short-term exercise training on cardiopulmonary exercise testing (CPET) parameters. METHODS: We studied 54 consecutive patients with myocardial infarction (MI) treated with CABG surgery referred for rehabilitation. The study population consisted of 50 men and 4 women (age 57...
January 11, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28071950/reporting-individual-surgeon-outcomes-does-not-lead-to-risk-aversion-in-abdominal-aortic-aneurysm-surgery
#14
A Saratzis, A Thatcher, M F Bath, D A Sidloff, M J Bown, J Shakespeare, R D Sayers, C Imray
INTRODUCTION Reporting surgeons' outcomes has recently been introduced in the UK. This has the potential to result in surgeons becoming risk averse. The aim of this study was to investigate whether reporting outcomes for abdominal aortic aneurysm (AAA) surgery impacts on the number and risk profile (level of fitness) of patients offered elective treatment. METHODS Publically available National Vascular Registry data were used to compare the number of AAAs treated in those centres across the UK that reported outcomes for the periods 2008-2012, 2009-2013 and 2010-2014...
February 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/27916346/cardiopulmonary-exercise-testing-is-a-better-outcome-predictor-than-exercise-echocardiography-in-asymptomatic-aortic-stenosis
#15
Olivia Domanski, Marjorie Richardson, Augustin Coisne, Anne-Sophie Polge, Stephanie Mouton, François Godart, Jean Louis Edmé, Regis Matran, Patrizio Lancellotti, David Montaigne
BACKGROUND: Objective assessment of maximal aerobic capacity using peak oxygen consumption (peak VO2) can be helpful in the management of patients with asymptomatic aortic stenosis (AS). The relationship between peak VO2 and AS severity criteria derived from rest and supine exercise echocardiography (SEE) has never been explored. OBJECTIVES: We aimed to determine whether low peak VO2 (<85% of predicted value) is associated with severity parameters in SEE, and poor clinical outcome...
January 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/27875636/evaluation-of-coronary-artery-disease-in-potential-liver-transplant-recipients
#16
REVIEW
Brian J Hogan, Enoka Gonsalkorala, Michael A Heneghan
Improvements in the management of patients undergoing liver transplantation (LT) have resulted in a significant increase in survival in recent years. Cardiac disease is now the leading cause of early mortality, and the stress of major surgery, hemodynamic shifts, and the possibilities of hemorrhage or reperfusion syndrome require the recipient to have good baseline cardiac function. The prevalence of coronary artery disease (CAD) is increasing in LT candidates, especially in those with nonalcoholic fatty liver disease...
March 2017: Liver Transplantation
https://www.readbyqxmd.com/read/27872897/physiotherapy-practice-patterns-for-management-of-patients-undergoing-thoracic-surgeries-in-india-a-survey
#17
Sagarika Sultanpuram, Gopala Krishna Alaparthi, Shyam Krishnan Krishnakumar, Zulfeequer C P Ottayil
Aim. The aim of the current study is to determine the practice patterns of physiotherapists for patients undergoing thoracic surgeries in India. Materials and Methodology. A cross-sectional survey was conducted across India in which 600 questionnaires were sent in emails to physiotherapists. The questionnaire addressed assessment and treatment techniques of thoracic surgery. Results. A total of 234 completed questionnaires were returned with a response rate of 39%, with the majority of responses received from Telangana, Karnataka, and Andhra Pradesh...
2016: Surgery Research and Practice
https://www.readbyqxmd.com/read/27865641/canadian-cardiovascular-society-guidelines-on-perioperative-cardiac-risk-assessment-and-management-for-patients-who-undergo-noncardiac-surgery
#18
Emmanuelle Duceppe, Joel Parlow, Paul MacDonald, Kristin Lyons, Michael McMullen, Sadeesh Srinathan, Michelle Graham, Vikas Tandon, Kim Styles, Amal Bessissow, Daniel I Sessler, Gregory Bryson, P J Devereaux
The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27771425/short-term-preoperative-high-intensity-interval-training-in-patients-awaiting-lung-cancer-surgery-a%C3%A2-randomized-controlled-trial
#19
Marc Licker, Wolfram Karenovics, John Diaper, Isabelle Frésard, Frédéric Triponez, Christoph Ellenberger, Raoul Schorer, Bengt Kayser, Pierre-Olivier Bridevaux
INTRODUCTION: Impairment in aerobic fitness is a potential modifiable risk factor for postoperative complications. In this randomized controlled trial, we hypothesized that a high-intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications. METHODS: Patients with operable lung cancer were randomly assigned to usual care (UC) (n = 77) or preoperative rehabilitation based on HIIT (Rehab) (n = 74)...
October 19, 2016: Journal of Thoracic Oncology
https://www.readbyqxmd.com/read/27730011/risk-stratification-in-lung-resection
#20
REVIEW
Michele Salati, Alessandro Brunelli
PURPOSE OF REVIEW: Surgery is considered the best treatment option for patients with early stage lung cancer. Nevertheless, lung resection may cause a variable functional impairment that could influence the whole cardio-respiratory system with potential life-threatening complications. The aim of the present study is to review the most relevant evidences about the evaluation of surgical risk before lung resection, in order to define a practical approach for the preoperative functional assessment in lung cancer patients...
2016: Current Surgery Reports
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